Concerns about gait and leg alignment in children are common. It's hard to tell when to worry and when to just be reassured. We asked pediatric orthopedic surgeon David Roberts, MD, of NorthShore Orthopaedic & Spine Institute, to break down four of the most common gait and leg alignment concerns in children and when you need to do something.

In this third of a four-part series, we look at bowed legs.

Bowed legs are common in infants and toddlers. When a child with bowed legs stands, the feet are together but a large space is noted between the knees. One or both legs may be affected.

Most cases of bowed legs in infants and toddlers will naturally straighten with time and growth. If bowed legs are not resolved by age 3, there may be an underlying pathologic cause, such as Blount’s disease or rickets. Adolescents may also present with bowed legs, usually in a child who is significantly overweight. 

Whether to worry depends on your child’s age and the severity of the bowing. Mild bowing in an infant or toddler under age 3 is typically normal and will get better over time. However, bowed legs that are severe, worsening or persisting beyond age 3 should be referred to a specialist.

A timely referral is important. Correction of vitamin D deficiency in rickets leads to resolution of bowed legs if started before severe deformity has developed. Blount’s disease may respond to brace treatment and avoid surgery if started before age 3-4. For older children with bowed legs, surgery will be needed, but this is better done earlier than later after the deformity has gotten worse.

Surgery for bowed legs falls into two main types: 

• Guided growth – This is a simple outpatient procedure in which a small metal plate/screws or single screw are placed at the growth plate to tether its growth.  Over time, the leg will grow straighter in the opposite direction.
• Osteotomy – This is a more complex procedure in which the bone is divided and repositioned to correct a bowed leg. The bone is then fixed in place using a plate and screws internally, or externally using a frame. This is needed for severe cases, or those without growth remaining to allow guided growth to be successful.

We suggest seeing a doctor about your child’s bowed legs, if it is:

• Present beyond age 3
• Severe or getting worse over time
• Associated with a family history of bowed legs or abnormal diet (e.g. not drinking milk or dairy)