Bowlegs in children

Try this with your child: make him/her stand straight with toes pointing forward and the ankles touching each other. Check if their knees are joined or apart. If the knees don’t touch each other, your child may have bowlegs. “Bowlegs in children [or genu varum] is a condition where a child’s legs curve outwards at the knees,” says Dr Kavitha Bhat, senior consultant, pediatric endocrinology, Aster CMI Hospital, Bengaluru. “Bowed legs are common in babies and toddlers. It is a normal part of their growth process.”

Four-year-old Insiyah had this condition, but her family was not aware of it at first. She would refuse to run around like the other toddlers. She would cry and resist moving when forced to walk or run. That’s when her parents finally sensed that something wasn’t right.

“We tried everything from bribing her with chocolates to running around with her favourite toy, but it was evident that she wasn’t very comfortable moving around,” recalls her father, Nooruddin Challawala, a businessman from Vadodara, Gujarat.

The pediatrician they consulted pointed out that Insiyah’s legs were bowed and her resistance to the movement was probably due to the pain she experienced because of bone misalignment.

Dr Siddarth Shah, consultant orthopedic surgeon at SL Raheja Hospital, Mumbai, says that in most children, the legs get realigned at two to three years of age. If the condition persists beyond that age, the problem may need to be addressed.

The reason for bowlegs in children?

Doctors say there are many reasons for bowlegs in children. Only an in-depth physical examination with a detailed history can ascertain the cause.

According to Dr Bhat, all babies show a slight difference in the shape of their legs at birth due to their position in the womb.

“This physiological bowing remains till three years of age,” she says. “It doesn’t hinder the child’s ability to walk, run, climb and play. If a kid doesn’t outgrow this condition, it may be a sign of a growth or a bone disorder.”

In the case of Insiyah, investigation revealed that she had vitamin D deficiency. She was then prescribed supplements. Within two months, she showed significant improvement in her movement and the bowing in her legs reduced.

Dr Shah says that rickets, a deficiency of vitamin D, is the most common cause of bowlegs in children. “It affects the absorption of calcium and phosphorous that are essential for bone health and hinders the development of the bones,” he says.

According to Dr Bhat. “Apart from the age of the child, the difference between physiological bowing and rickets is that the latter is accompanied by other symptoms like deformities in teeth, reduced muscle tone, delayed milestones and bone deformities in other parts of the body.”

She says the other reasons for bowlegs in children are:

• Blount’s disease: occurs in obese children and causes the growth plates around the knees to be affected by too much weight
• Ligament laxity: a person born with loose ligaments has legs which appear to bend outwards while walking
• Skeletal dysplasia: a condition that affects bone and cartilage development and manifests as bowed legs in short people.

Football and bowlegs

According to a 2018 meta-analysis of three studies conducted on 1,344 football players and 1,277 control individuals in North America, intensive soccer playing during the growing years can also lead to bowlegs and, in turn, increase the risk of knee arthritis.

Bowing of legs, however, was only seen in people who played intensive soccer, not in those who play football as a leisure activity.

How important is the correction of bowlegs in children?

According to Dr Shah, it is important for the problem to be identified and resolved at a younger age to avoid complications. “There are chances that the bowing [of legs] may be overlooked sometimes if it doesn’t hinder the daily activities of the child,” he says.

Insiyah’s father agrees. He says if his daughter hadn’t shown resistance to movement, they probably wouldn’t have noticed the bending of her legs. Now, Insiyah no longer resists moving, and is able to walk and run well.

Dr Shah says that if the condition is not addressed in childhood, it can roll over to adulthood, where the biomechanics of the body can be affected during strenuous activities like sports. “Due to the bowing, the weight is not equally distributed throughout the knee joints and the strain is more on the inner part of the knee,” he says. “This can lead to early knee arthritis, back and foot pain, and difficulty walking.”

Treating bowlegs in children

The first step to treating bowlegs in children, according to Dr Bhat, is the evaluation of the condition by a pediatrician or a pediatric orthopedic surgeon. “Once the exact cause is identified, correction becomes easier in children as their bones can be remodelled,” she says. “There is not much in terms of treatment for skeletal dysplasia, but rickets can be reversed with vitamin D supplements.” She adds that if the condition is severe and persistent, corrective surgery can help.

Dr Shah says that braces, which are like splints or a belt worn on the leg, help correct bowed legs in Blount’s disease in the early stages.

Explaining the procedure of corrective surgery, Dr Shah says that the bent bone is broken and straightened. Once the bone is put into a new alignment, it is held in place with plates and screws till it heals.

Takeaways: A note for parents

Dr Shah urges parents to be aware and observant. If their child is limping, feels uncomfortable walking, appears to have bowed legs or complains of pain in the knees or hips, then a doctor must be consulted.

But he also advises parents not to panic and rush to the doctor if their child is yet to turn three, and let nature take its course first.