Bowlegs in Children: Causes and Treatments

• Bowlegs are common in infants and toddlers learning to walk. In most cases, the condition improves naturally as the child grows. However, it can also be caused by conditions such as rickets, Blount’s disease, injury, or genetic disorders.
• Treatment depends on the cause and severity. Parents should closely observe their child, consult a doctor, and follow up regularly as this will ensure effective treatment and help prevent long-term complications.

Parents who notice that their child’s legs appear bowed may worry that something is wrong. In fact, bowlegs in young children are very common and usually improve naturally with age. However, in some cases, bowlegs can be a sign of an underlying health problem, so parents should pay close attention and consult a specialist for proper diagnosis and treatment if needed.

Bowlegs are a condition where the child’s legs and knees curve slightly outward. It may occur in both legs or only one and may also be accompanied by the feet turning inward. When standing straight with the heels together, the knees remain apart and do not touch. This condition is commonly seen in infants and toddlers. In most cases, it is normal and corrects itself naturally.

Bowlegs can be divided into two main types:

1. Normal bowlegs in children
   They may be caused by thigh bones bending and adjusting to the limited space in the womb during pregnancy.
   In young children who develop too quickly, such as standing or walking earlier than usual, or in children who are overweight, temporary bowlegs may occur before gradually straightening.
   In some cases, children may show signs of “duck legs” or “violin legs” at the age of 3-4 years before returning to normal alignment as they grow, usually around 7-8 years old.
2. Abnormal bowlegs in children can result from several causes, such as:
   • Blount’s disease, a growth disorder of the bone on the inner side of the knee, leading to progressively severe bowlegs, especially in older children or adolescents.
   • Rickets, which is caused by a severe deficiency of vitamin D and calcium, making the bones soft and easily deformed.
   • Infections or injuries to the bone, which may affect bone growth and cause bowlegs.
   • Certain genetic disorders, such as brittle bone disease, some metabolic disorders, or other conditions that affect bone growth.

If your child shows any of the following signs, you should take them to see a doctor for diagnosis:

• Bowlegs in only one leg, or cases where the bowing is uneven.
• Severe bowlegs, or cases where the bowing is getting worse.
• Pain in the legs, knee pain, or abnormal walking.
• Smaller than normal size or delayed development, which may be a sign of rickets or other diseases.
• A family history of diseases that cause bowlegs, such as Blount’s disease.

In most cases, bowlegs in children improve naturally as they grow. The leg bones gradually straighten, usually showing improvement at around ages 2-3. A slight bowing may appear again at ages 3-4, but the legs typically return to normal alignment by around ages 7-8, meaning parents do not need to do anything.

• Children with bowlegs from rickets
  Treatment approach: The doctor will recommend taking vitamin D and calcium supplements. This treatment is usually effective if started early.
• Children with bowlegs from Blount’s disease
  Treatment approach: In the early stage of Blount’s disease, or when the bowlegs are not very severe, the doctor may recommend wearing leg braces to help correct alignment.

In cases of severe bowlegs that do not respond to other treatments or show signs of worsening, the doctor may recommend corrective surgery. There are several surgical methods, such as:

1. Guided growth (hemiepiphysiodesis) is a minor surgical procedure where small pins or plates are inserted into the growth plate on the inner side of the knee to slow bone growth in that area. As the outer side continues to grow faster, the legs are gradually pulled into a straighter alignment. This method is usually performed in school-age children who still have growth potential.
2. Osteotomy is a more complex form of surgery where the doctor cuts part of the leg bone and realigns it to a straight position, then fixes it in place with plates or screws. This surgery is usually done in cases of very severe bowlegs, when other treatments have not worked, or in older children.

Whether it is a case of normal bowlegs that just require observation or bowlegs that are already being treated, it is important to follow the doctor’s advice strictly, especially after surgery or in cases where leg braces are needed. This allows the doctor to assess treatment progress,

adjust the treatment plan, and prevent complications. Although bowlegs in children is usually a normal condition that corrects itself with growth, parents should regularly observe changes in the legs, walking, and other symptoms. If there are any concerns or signs of abnormality, parents should consult a doctor for proper diagnosis and care, so that the child can grow up healthy and with good physical development.

The pediatric surgery team at Samitivej International Children’s Hospital is capable of performing minimally invasive surgery. Newborn and pediatric minimally invasive surgery utilizes small instruments, with incisions as small as 2mm, reducing injury and enabling faster recovery.

The hospital is also equipped with a hybrid operating room that uses bi-plane technology with X-ray imaging in multiple planes, supporting immediate emergency diagnosis and surgical decision-making. This enhances the hospital’s surgical capacity and capability to care for patients requiring complex surgery.