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Bow legs & knock knees

It’s a one of the most common concern of parents and results in their anxiety. Normally, each child’s legs appear bowed inside till he is two years old known as Physiological Genu Varum. On the contrary child’s knees appear knocked till he is six years of age. But during this growth period due to calcium and vitamin deficiency it results in Rickets (Pathological bowing of legs). If the child’s legs remain bowed after two years of age, the parents must start treatment for bowlegs or Genu Varum. The parents also need to start treatment for knock-knees or Genu Valgum if the child’s legs remained knocked after four years of age.


Both bow legs and knock knees are normal in early age of life. But the parents must start treatment for bowlegs or knock knees if the symptoms are severe and persist. Most common cause of bowing and knock knee is low calcium load in the body known as Rickets. There is many other bone diseases are linked with these types of deformities.


Symptoms are obvious and one can easily detect unequal angle of legs around knee. Sometimes children may cause pain in leg and difficulty in walking and abnormal gait pattern.


Clinical examinations along with x-rays and scanograme helps in diagnosing the exact cause of deformity. One should always look for sign of active rickets and its possible implications. Other cause of deformity should also be kept in mild while treating the patient.


In early age of life both knock knee and bow leg get corrected by self as the child grows. Hence, orthopaedic surgeon often tries to treat the bone diseases non-surgically. If deformity persist and severe then we need to correct them surgically. In younger age group it can be corrected by growth modulation (Hemi-epiphyseodesis). If child presents late with deformity then we need to correct it with more invasive procedure like osteotomy. Role of braces to correct the deformity is limited and doubtful.


In early age one should wait and watch to correct the deformity spontaneously and focus should be on to correct the basic pathology like low calcium level. We need to examine the child’s knees and legs at regular intervals to assess the severity of symptoms and its progression. On the other hand, the surgery helps the child to straighten his bowed leg or knocked knees with good results.


Q: – Why it happens to my child? What is rickets?

A: – Most common cause for bow leg/ knock knee is calcium deficiency during the growth period known as rickets. Rickets is a state of calcium deficiency in which bone start bending.

Q: – What type of surgery you will do? For how long is rest required?

A: – If diagnosed early then growth modulation/Hemiepiphyseodesis can correct the deformity with time. In this hospital stay is less and recovery is fast. If diagnosed late then corrective osteotomy may require in which hospital stay is comparatively more.

Q: – Is it correctable?

A: – Yes

Dr. Nargesh Agrawal

Child Ortho Care
Child Orthopedic Surgeon & Consultant, Delhi

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