Knock Knees and Bow Legs in Children — When to Worry

It’s common for parents to worry when they notice that their child’s legs aren’t perfectly straight. Some children appear bow-legged (genu varum), while others seem knock-kneed (genu valgum). The good news is that in most cases, this is a normal part of growth and development — not a cause for concern.However, in certain situations, these deformities can be signs of an underlying orthopaedic problem that needs medical attention.

Understanding Normal Leg Development

Children’s bones and joints change shape as they grow:

• At birth: Babies are naturally bow-legged due to their curled-up position in the womb.

• By age 2 to 3 years: The legs usually straighten.

• Between 3 to 6 years: Many children develop a knock-kneed appearance, which typically corrects itself as they grow taller.

• By 7 to 8 years: Most children have straight legs or a very mild, normal knock-knee alignment.

This natural pattern of alignment change is called physiological genu varum/valgum — and it does not need any treatment.

When to Worry — Red Flags for Parents

You should consult a paediatric orthopaedic surgeon if you notice any of the following:

✅ Severe deformity — knees or ankles significantly apart even when the other is touching✅ Asymmetry — one leg looks different from the other✅ Persistent deformity beyond 7–8 years of age✅ Pain, limp, or difficulty walking✅ History of trauma or infection around the knee✅ Short stature, delayed growth, or family history of bone disorders

Such cases may indicate pathological causes like:

• Rickets (vitamin D deficiency)

• Blount’s disease (growth plate disorder of the tibia)

• Bone dysplasias or metabolic bone diseases

Diagnosis

A clinical examination and simple standing leg X-rays are usually enough to measure the mechanical axis and identify the cause.In certain cases, your doctor may also advise:

• Vitamin D and calcium tests

• Bone length studies

• Growth monitoring over time

Treatment Options

Treatment depends on the cause, age, and severity of deformity:

1. Observation and Monitoring

   • Most children outgrow mild deformities with time and normal activity.

   • Regular follow-ups every 6–12 months may be suggested.

2. Medical Management

   • If caused by rickets, correction of vitamin D and calcium deficiency is vital.

3. Bracing

   • Sometimes used in young children with early Blount’s disease to guide proper bone growth.

4. Surgical Correction (Osteotomy / Guided Growth)

   • Reserved for severe or persistent deformities after growth has ended.

   • Modern guided growth surgery uses small plates to correct alignment gradually — a minimally invasive approach with quick recovery.

Prognosis

With timely diagnosis and treatment, most children regain normal leg alignment and function. The key is early recognition and regular orthopaedic evaluation, especially if deformity seems to be progressing instead of improving.

Takeaway

Mild knock knees or bow legs are often a normal phase of growth — so there’s no need to panic. But if your child’s legs appear uneven, painful, or worsening, don’t wait.An early visit to a paediatric orthopaedic specialist ensures proper guidance and treatment, preventing long-term joint problems in adulthood.

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About Dr. Kashyap Prabhu Solanki & Dr. Prabhu Solanki

Orthopaedic Surgeon – Andheri, Mumbai

Dr. Kashyap Solanki specializes in hip and knee replacement, robotic-assisted knee surgery, and joint preservation procedures like HTO, arthroscopy, and ligament reconstruction. He is also known for performing complex revision joint replacements and managing challenging upper and lower limb fractures. With a focus on precision and patient-centered care, Dr. Solanki helps restore mobility and improve quality of life through advanced orthopaedic solutions.

With over four decades of distinguished orthopaedic practice, Dr. Prabhu Solanki stands as one of Mumbai’s most experienced and respected orthopaedic surgeons. Having treated more than 40,000 patients and performed over 10,000 surgeries, his clinical outcomes and dedication have earned him widespread recognition — not just in Mumbai, but across India and abroad.

Dr. Solanki’s reputation for precision, ethical care, and long-term results has brought him patients from all over India, as well as international patients seeking high-quality orthopaedic

treatment and surgical expertise in Mumbai.

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