Bow legs in children – What is it, how to prevent and diagnose?

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Bow legs in children – What is it?

Bow legs in children, also known as genu varum, is a condition in which the legs curve outward at the knees while the ankles and feet touch each other, resembling the appearance of a bow. The condition is commonly seen in infants and toddlers. It is also seen sometimes in older children.

Children are often born with bow legs due to the cramped environment they are in while in the mother’s womb or uterus. 

The condition of bow legs in children is usually not serious and disappears and normally disappears without treatment by the time the child is two years of age. 

If the condition continues beyond this age, treatment methods like casts, braces, splints, and surgery may be required.

In this article, we will be discussing in detail about bow legs in children.

• What are the causes of bow legs ?
• What are the risk factors of bow legs in children?
• What are the symptoms of bow legs ?
• How to diagnose bow legs ?
• What is the treatment for bow legs ?
• What are the complications of bow legs ?
• How to prevent bow legs in children?

What are the causes of bow legs ?

Bow legs in children can develop due to many reasons, like:

• • Physiologic genu varum: This is the most common cause of bow legs in children. It develops as when the fetus was developing in the mother’s uterus, it was in a cramped position. Some fetal bones needed to rotate while in the uterus able to be able to fit in the small space. Physiologic genu varum refers to a normal developmental process in a child. But if the child’s legs do not straighten once they are two years of age, the condition could be due to another underlying cause. 
  • Blount’s disease: Also known as tibia vara, it is a growth disorder caused due to a problem in the growth plate of the child’s shin bone.
  • Rickets: This condition develops due to calcium or vitamin D deficiency. A deficiency in these nutrients makes the child’s bones weaker and softer, leading to bow legs. ( Know more about- What is Calcium Deficiency? )
  • Dwarfism: A bone growth disorder known as achondroplasia is the most common type of dwarfism. This disorder can result in bow legs.

• Fluoride poisoning

• Lead poisoning 

• Paget’s disease: It is a metabolic disease that is commonly seen in older people. It affects the breakdown and rebuilding of bones in a way that the rebuilt bones become weaker than normal, resulting in bow legs.
• Other bone problems: Fractures that do not heal correctly and result in abnormally developed bones, known as bone dysplasia, can result in bow legs in children. Injury or infection can also affect the bone growth around the child’s knees to cause bow legs.

What are the risk factors of bow legs in kids?

Some amount of physiologic bow legs in children are common in most infants and toddlers. 

In older children, the condition usually develops due to Blount disease or another type of medical condition. 

The condition is most commonly seen in children who:

• Are overweight 

• African American race of children

• Have learned to walk at an early age

• Family history of bow legs

What are the symptoms of bow legs in kids?

Bow legs usually do not cause any pain or discomfort in young children. The knees of the child fail to touch when they stand with their feet and ankles together. The appearance of bow legs is most obvious when the child walks. Sometimes, the children could walk with their toes pointing inward, known as pigeon toes or in toeing.

If the condition does not correct itself by the time the child is two years old, it could lead to the following symptoms:

• Knees fail to touch while standing with feet together (ankles are touching one another)

• A gap between the knees that worsens or persists after three years of age

• Symmetrical bowing of legs (same degree of bowing on both sides of the body)

• Knee pain or hip pain that is not related to any injury

• Knee instability 

• Difficulty in walking and running

• Decrease in the range of motion in the hips

How to diagnose bow legs ?

Bow legs can be diagnosed by the doctor with the help of the following  tests:

•  Physical examination: The doctor will check how the child walks and also if the bowing of legs is symmetrical or if one leg shows more bowing compared to the other leg. For children less than two years of age, symmetrical bowing of legs will not require any further testing.
• X-rays: If one leg shows more severe bowing compared to the other leg, or if the child is more than two years of age, an X-ray is recommended. It helps the doctor to check if the bowed legs are a result of rickets or other bone deformities.
• Blood tests: These tests help in checking calcium or vitamin D deficiencies, or if the bow legs are a result of Paget’s disease.
• EOS imaging: This is an alternative to the conventional X-rays. It is a technology using low doses of radiation to simultaneously take two and three-dimensional full-body images of the skeleton from the front as well as a side view.

What is the treatment for bow legs ?

The treatment of bow legs will depend on the underlying cause of the condition. The different treatment options are:

Non-surgical treatment: Depending on the severity of the bowed legs and the age of the child, bow legs can be treated in the following ways:

• Medications and supplements: These can help in the treatment of conditions like rickets.
• Bracing, splints, or other orthopedic devices: These can help in the treatment of bow legs in young children. However, this treatment is not effective for teenagers.
• Guided growth: This technique involves the placement of a metal plate or staple in the child’s leg to temporarily stop the growth on the healthy side of the child’s shin bone so that the unhealthy side of the shin bone can catch up. The child’s leg will straighten with natural growth, and the plate or staple will be removed after the alignment improves.

Surgical treatment: If non-surgical methods fail to treat bow legs or if the patient is not growing any longer (reached adulthood), the following surgical treatment options are recommended:

Osteotomy: This is a type of bone surgery performed to straighten or realign the leg by cutting the shin bone just below the knee level and then reshaped to correct the alignment. In moderate cases, the leg can be stabilized by the insertion of a plate or rod. In severe cases, an external fixator is needed, which involves the use of pins to connect the bone to an external device or frame.

Limb-lengthening surgery: This surgery is recommended when the bow legs have led to the shortening of one leg compared to another leg.

What are the complications of bow legs ?

Untreated bow legs in children above two years of age could lead to the following complications:

• Difficulty in walking and running 
• Knee instability 
• Deformities, like a difference in the leg lengths if only one side of the body is bow-legged
• Increased risk of arthritis in later life
• Knee damage  ( Know more about- Cost of Total Knee Replacement in Bangalore )

The complications that could occur after surgery to correct bow legs may include the following:

• Infection 

• Disturbance in growth

• Recurrence of bow leg deformity

• Compartment syndrome (increase in pressure in the muscle compartment)

How to prevent bow legs in kids ?

There is no exact method to prevent bow legs in children. However, the risk of developing bow legs in children can be reduced in the following ways:

• Safe exposure to natural sunlight for optimal vitamin D levels
• Maintenance of a healthy body weight 
• Strengthening of muscles to stabilize the knees
• Use of proper technique while lifting to prevent knee joint injury

We hope that we were able to answer all your questions regarding bow legs in children through this article.

If you want more information about bow legs in children, you can contact a good pediatrician.

We only aim to give you information through the article and do not recommend any medication or treatment in any way. Only a qualified doctor can give you the best advice.