Bow legs (medically called genu varum) are a condition in which a child’s legs curve outward at the knees. When a child with bow legs stands, their ankles may touch but their knees remain apart.
Bow legs are normal in newborn babies and children up to the age of two years. In their desire to have their child look like those really abnormal babies in magazines, some parents have difficulty accepting this. In the past, an entire industry developed to treat bow legs, i.e. to treat something normal. These are vested interests that prey on the entirely normal and healthy desire of parents to have “perfect” children. In doing so, they and parents run the risk of permanently damaging a child’s legs.
The way it works is this. At birth, all babies have bow legs. They have been curled up inside their mother’s womb for a good six months, waiting for a chance to come out and stretch. The legs cannot be expected to be straight. Over the next year or so, the legs start to straighten, but before they can do so, the baby insists on standing up. This is good and should be encouraged. It makes the baby’s legs stronger. It is not true that putting a child to stand up causes the legs to become bowed. (Neither is it true that putting a child to sit down before it is ready will make the child ‘bossy-back’.) Putting pressure on bones only makes them stronger. That’s why old people are now encouraged to lift weights three times a week. Lack of exercise makes bones lose calcium and become weak.
When the baby stands up, since the muscles and ligaments that attach the muscles to the bones are weak, the legs appear to sag and the baby looks even more bow-legged (Diagram 1). This shows a perfectly normal one-year-old child with quite severely bowed legs. In fact, there is even a little normal in-turning of the left foot. All perfectly well. By age two, this child’s legs looked quite straight, even though they did not look like an adult’s legs.
By age three, the normal child has developed knock-knees (genu valgum), the opposite of bow legs. This has to do with the weight distribution of the upper body onto the weaker lower extremities and is also normal. As the child’s legs strengthen, they slowly begin to straighten, so that by six years they are beginning to look like an adult’s legs (Diagram 2).
Bow legs do make first-time parents anxious. They make children walk awkwardly and point their toes in (intoeing). At this age, they are often clumsy, and very active children may trip and fall frequently. This is all normal and frightens some parents who may not have an older person to guide them. Check with your doctor then.
The major disturbing signs of a child with bow legs are if the bow legs continue to get worse after the age of two, if one leg is more bowed than the other, or if the child limps when walking. Limps are almost always a bad sign.
However, children with bow legs do not need X-rays, lab tests or treatment of any sort. What they need is monitoring over time to be sure that the legs straighten out on their own.
If you try to straighten a one-year-old’s bow legs by forcing them into a straight line with a cast, special braces or physical therapy, as they go through the normal physiological process of becoming knock-kneed and then straightening, they may overcompensate, and the child may end up with permanent knock-knees.
I think the problem with bow legs, and with children in general, is that people, including many doctors and nurses, do not know what a normal, healthy baby and toddler should look like. Children are not little adults and do not look like little adult people.
If you look at pictures of children and adults painted up to the Middle Ages, all the children look like smaller editions of adults. They are dressed the same way, and their heads, bodies, legs and arms have adult proportions. That came to an end during the Renaissance, the enlightened era. Since then, artists have painted children to the correct proportions.
That was over 500 years ago. Surely that’s enough time for us to change our ideas of what a child’s legs should look like?
