What should you know about physiologic bowing of legs?

With bow legs, the knees stay apart when the feet and ankles are together. In a young child, this can reflect normal growth rather than a disease. A clinician considers the child’s age, whether both legs look similar, the direction of change, walking pattern and overall health. Examination may include checking leg length, joints and gait; imaging is considered when the pattern is unusual or does not follow expected development.

Arrange routine assessment if you are unsure whether the shape is within the child’s developmental pattern. Keep track of whether the bowing is changing, and mention pain, frequent falls or difficulty walking. Do not use braces, supplements or exercises to straighten the legs without clinical advice. A paediatric physiotherapy assessment can help when walking skills, balance or strength also need support.

Seek assessment sooner when bowing is clearly greater on one side, is worsening rather than changing with growth, causes pain, affects walking, follows an injury, or appears with poor growth or other health concerns. Urgent care is appropriate after major trauma or when the child cannot stand or bear weight.

Does the alignment fit my child’s stage of growth? Should we measure or photograph changes over time? What findings would lead to imaging, paediatric physiotherapy or discussion of an osteotomy?