What should you know about extreme bow leg?

Bow legs, also called genu varum, describe knees that remain apart when the feet and ankles are together. In young children, alignment can change as the legs develop. Concern rises when the bowing is pronounced, present on one side, increasing with age, or associated with pain, a limp, short stature, or difficulty keeping up with activities. In older children and adults, the shape may alter how force passes through the knee and ankle. An examination considers age, growth pattern, walking mechanics, and the angle of the legs; imaging may be selected when the alignment needs closer measurement.

Book an orthopaedic review if the appearance is worsening or function is changing. Bring observations about when the bowing began, whether both legs are similar, and whether shoes wear unevenly. Do not use braces, supplements, or exercises without advice tailored to the person’s age and cause. Paediatric Physiotherapy can help assess movement, balance, and strength when a child has functional difficulties. For established alignment that overloads a joint, an orthopaedic surgeon may discuss options such as Osteotomy; this is a specialist decision based on examination and imaging.

Arrange prompt assessment for new severe pain, sudden change in leg shape, inability to walk normally, repeated falls, or a limp that does not settle. Seek urgent care after a significant injury if there is deformity, loss of sensation, a cold foot, or inability to bear weight. A child with progressive one-sided bowing should be reviewed rather than monitored without a plan.

Is the alignment appropriate for this age? Is one leg more affected? Could it be changing knee or ankle loading? Do we need an X-ray or growth review? Would physiotherapy help function, and when would surgery be considered?