Bow-Legs & Knock-Knees: Information For Parents

McKenzie Pediatrics

What Parents Think iAs Abnormal, When It's Really Normal:

Toddlers walk with a wide-based gait, especially if diapered, and little arm swing, with little ground clearance, and a mild foot drop. All of these are normal in the first 3 to 6 months of walking.
When toddlers hurry, they don't take longer steps, but instead walk faster, leading to increased trips and falls.
Toddlers knees are closer to their ankles than in older kids and adults, make milk torsional (or twisting) irregularities more obvious
Toddlers seldom walk in a straight line...they're are always twisting, turning, leaning, & over-balancing
Toddlers appear bowlegged until 18 to 24 months. Children's legs then straighten out temporarily, then become knock-kneed to some degree by age 3, until as old as age 7!

To summarize, an adult-like gait is not reached until around age 3!

Should I Worry That My Child Is Bow-Legged?

Many children in diapers have bowlers. For every 100 small children brought to the doctor for concerns about bowleggedness, only 1 or 2 will have a disease requiring treatment. In many cases, the bowing is more apparent than real. When you light the child down to extend their knees, they bowing usually goes away. Most children stop being or appearing bowlegged by age 3. There is no point in treating something that will correct itself. Special shoes and splints have been used for hundreds of years, and are now realized as antiquated and useless.

The few children who have bowlegs due to a bone disease generally have impaired bone growth throughout their bodies, and the bone disease often runs in families. Blount's disease (Tibia Vara) is another bone disease occurring in 1 in 150 children, more often in African-Americans. Your doctor will check the distance between knees when your child's ankles are pressed together in order to rule out this disease. X-rays are only needed if the bowing is on one side, if a parent remained bowlegged into school age, if a bone disease is suspected, or if the bowleggedness persists after age 3.

Should I Worry That My Child Is Knock-Kneed?

Between the ages of 2 and 5, 75% of children standing with their knees gently pressed together will have 1 to 3 inches of space between their ankles. Knock-knees are very common, and generally goes away without treatment. Grandparents may remember the days when knock-knees were regarded as a sign of rickets due to bad nutrition. Today, rickets is rare and occurs usually in children whose parents are food faddists. The special shoes and splints used in grandparents' day are also now realized as antiquated and useless.

Others may worry because so many older Americans with arthritis have knock-knees, but it is the arthritis that causes this, no the other way around. In general, taking an X-ray is unnecessary in children who are otherwise healthy and growing normally. Knock-knees that begin in adolescence should be taken more seriously, and evaluated by an orthopedist.