Bow legs and knock knees

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Overview

Babies are born with bowlegs, meaning the knees appear to "bow" out from the body, but the knees tend to straighten out between 18 and 24 months of age. This means that when most children begin to walk, at around 12 months of age, they appear to be bow-legged.

In children with knock-knees, on the other hand, the knees appear to bend toward each other. Knock-knees are most noticeable around age 3, and then gradually become less pronounced. By age 7, these children will have the normal adult amount of slight knock-knee – 5 to 9 degrees – which they will maintain throughout their lives.

Although you may be concerned about the shape of your child's legs, a slight degree of bowing or knocking is normal. That said, if your child has severe knock-knees or bowlegs, it's a good idea for a pediatric orthopedist to take a look.

Signs & symptoms

Again, a slight degree of bowing or knocking is normal, but if your child exhibits any of the following, it's probably a good idea to visit a pediatric orthopedist:

  • Excessive knee angle either inward or outward.
  • Unequal knee angles. While slight variation from one side of the body to the other is normal, a large difference between one leg and the other should be investigated.
  • Pain or other complaint connected to the knee angle.
  • Bowlegs after age 3. This is when children have the greatest amount of knock-knee alignment, so bowlegs would be abnormal.
  • Knock-knees at an angle greater than 15 degrees.

Diagnosis

The main way doctors diagnosis bowlegs or knock-knees is through a physical exam. In addition, X-rays may be taken when needed to get more information about the knee joint.

Treatment

Surgery is the only way to change the angle of the knee  — braces, shoe inserts and physical therapy are ineffective. Since normal leg development goes from bowlegs to knock-knees, surgery should be postponed until kids are at least 10 years old.

Two bones meet at the knee joint: the femur (thighbone) and the tibia (shinbone). Surgical treatment depends on the maturity of the child. In younger kids, whose growth plates are open and still growing, knee alignment can be changed by tethering the growth plates of the femur or tibia using staples. As the growth plate grows on the untethered side, the knee will grow out of its excessive angle.

In older children, who no longer have open growth plates, treatment consists of cutting, straightening and then holding the bones of the knee in place while they heal with metal implants, including pins, plates and screws.

Although both treatments have high success rates, they should be done only if clearly necessary and at the appropriate age.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

Where to get care

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Pediatric Orthopedic Clinic

Pediatric Orthopedic Clinic

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