Bowed Legs in Children and Adults

Bowed legs is a condition that can occur in all age groups and has several distinct causes. In some people bow legs are a problem that requires treatment, in others, it may be a normal part of development. 

Causes of Bowed Legs

There are a number of different causes of bowed legs. 

• Normal Development: As a child develops, different parts of the body grow at a different rate. As a result, skeletal alignment can change causing some unusual appearance of the extremities at specific ages. The most common cause of bowed legs in the toddler age range is simply normal development. Generally, under the age of 2 years, bowed legs are considered a normal process of the developing skeleton. The angle of the bow tends to peak around the age of 18 months, and then gradually resolve within the following year. Most often, children this age are simply observed to ensure their skeletal alignment returns to normal as they continue to grow.
• Blount's Disease: Blount's disease is a condition that can occur in childhood and adolescence. The problem in these children is an abnormal growth plate at the top of the shin bone (tibia). In very young children, it can be difficult to differentiate Blount's disease from normal developmental bowing, however kids with Blount's disease will not gradually improve, and the x-ray appearance of their growth plate will show characteristic abnormalities. 
• Rickets: Ricket's has become a very rare condition in the developed world, although it is still common in developing parts of the world. The most common cause of Ricket's is a nutritional deficiency of some of the important nutrients for good bone health. Ricket's can be caused by insufficient calcium, phosphorus, or Vitamin D intake. Fortunately, with the advent of fortified foods, nutritional Ricket's has become very uncommon in the developed world.
• Osteoarthritis: In adults, the most common cause of bowing of the legs is the result of osteoarthritis or wear-and-tear arthritis of the knees. This condition can wear away the cartilage and surrounding bone of the knee joint. If the wear is evenly distributed, no deformity is expected, but when the wear is more on the inner side of the knee joint, a bow-legged deformity will often progress. Typically the degree of bowing of the legs corresponds to the severity of the arthritis wearing away the inner side of the knee joint. 

Treatment Options

Treatment of bow legs depends entirely on the cause of the condition. In order to determine the cause of a bow-legged problem, you should be evaluated by a doctor. After being examined, your doctor may order tests such as x-rays which can provide more information about bone alignment and possible abnormalities.

In young children under the age of 2 years old, bow legs are almost always observed to see if, with continued growth and development, the condition will spontaneously resolve. Kids with Blount's disease may require surgical treatment to alter the growth of the tibia bone or to realign the bones, depending on the severity of the condition and the growth remaining.

Adults with severe arthritis most often consider knee replacement surgery. However, if the adult is younger, for example in their 20s, 30s, or 40s, they may consider a surgical procedure to realign the bone. By performing this procedure, called an osteotomy, the forces acting on the knee joint can often be shifted from the unhealthy part of the joint to the healthy part of the joint.