Bowlegs & Knock Knees

Bowlegs and knock knees are common alignment issues in young children that affect how the legs look and how weight is distributed when standing or walking.

• Bowlegs cause the knees to stay apart when the feet are together.
• Knock knees cause the knees to touch while the ankles stay apart.

In most children, these changes are a normal part of growth and development and improve on their own over time. In some cases, however, they may need evaluation and treatment. With proper monitoring, most children develop normal leg alignment and stay active and healthy.

What Causes Bowlegs and Knock Knees?

Many children go through natural stages of leg alignment as they grow:

• Bowlegs are common in infants and toddlers
• Knock knees are common between ages 2 and 5

Most children develop straight legs by ages 7-8 years.

Other factors include:

• Family history of alignment differences
• Growth plate problems
• Vitamin D deficiency (rickets)
• Conditions like Blount’s disease
• Previous injury or infection affecting bone growth

Your child’s doctor can help determine whether the alignment is normal or needs treatment.

What Are the Symptoms?

Most children with bowlegs or knock knees do not have pain. Signs may include:

• Visible bowing or inward angling of the legs
• Uneven walking pattern
• Tripping or clumsiness
• Knee or leg discomfort in older children
• One leg appears more affected than the other

If the alignment is severe or worsening, further evaluation is important.

When Should My Child See a Specialist?

• You should consider seeing a pediatric orthopedic specialist if:
• Bowing persists beyond age 2 years
• Knock knees persist beyond age 7 years
• The condition appears to be getting worse
• Only one leg is affected
• Your child has pain or difficulty walking
• Your pediatrician has concerns about leg alignment

Early evaluation helps rule out underlying conditions and guide care.

How Are Bowlegs and Knock Knees Diagnosed?

Diagnosis begins with a physical exam and review of your child’s growth pattern. Imaging studies may include:

• X-rays to evaluate bone structure and growth plates
• Measurements to assess leg alignment

These help determine whether the condition is part of normal development or requires treatment.

How Are Bowlegs and Knock Knees Treated?

Treatment depends on your child’s age and the severity of the alignment. Most young children only need observation combined with regular follow-up to track changes. More aggressive treatment is only needed if alignment does not improve or worsens.

Treatment goals focus on:

• Supporting normal growth
• Preventing joint stress
• Improving walking comfort and balance

Nonsurgical Options

When treatment is needed, nonsurgical options may include:

• Observation with regular checkups
• Bracing in select cases
• Treating underlying causes such as vitamin deficiencies

Most children do not need braces or therapy.

Surgical Options

Surgery is rarely needed, but may be recommended if:

• Alignment is severe
• The condition does not improve with growth
• It causes pain or difficulty walking

Surgical options may include:

• Growth modulation to guide bone growth
• Osteotomy to realign the bone

Your child’s surgeon will explain the best option if surgery is necessary.

What Are the Risks of Surgery?

If surgery is needed, risks may include:

• Infection
• Problems with bone healing
• Need for additional procedures
• Nerve or blood vessel injury (rare)

All risks will be carefully reviewed with you.

What Does Recovery From Treatment Involve?

Most children monitored without treatment continue normal activities. After surgery, recovery may involve:

• Temporary limited weight-bearing
• Physical therapy
• Follow-up visits to monitor healing and growth

How Long Does Recovery Take?

• For observation, no recovery time is needed.
• After surgery, initial recovery usually takes 6–8 weeks, with continued improvement over several months.

What Is the Outlook for My Child?

The outlook for children with bowlegs or knock knees is excellent. Most grow out of the condition naturally. When treatment is necessary, outcomes are overwhelmingly positive, and children typically return to normal activity without long-term complications.