By H. Robert Tuten, MD
Most toddlers who experience bowlegs are completely normal. It is often just a condition that comes from the fetus’s position in utero. Between the ages of two to two-and-a-half, children are likely to see the condition correct itself.
If a child has been walking for a few months and his bow legged walk fades, this is considered relatively normal. If not, the condition should be investigated further, as this may indicate a greater issue such as Blount’s disease, rickets, or congenital abnormalities of the knees.
Let’s take a closer look at Blount’s disease and rickets and investigate how each is diagnosed for a child presenting symptoms of bowlegs.
Bow Legs and Blount’s Disease
Blount’s disease is a growth disorder of the shin bone (tibia) in which the lower leg turns inward, resembling a bowleg. The exact cause of Blount’s disease is unknown but is thought to be due to the effects of weight on the growth plate. Toddlers who are large for their age and/or who walk early are most often affected by Blount’s disease. There is also a genetic component to the disease, so it’s important to keep track of your family history.
If a child with Blount’s disease has his legs braced early on and the bracing is successful, surgery will not be necessary. To treat Blount’s disease with bracing, a child is braced with a hip-knee-ankle-foot orthosis (HKAFO) or knee-ankle-foot orthosis (KAFO).
If bracing isn’t successfully completed by the age of four, or if the child has a particularly advanced case of bowlegs, surgical correction may be needed.
Bow Legs and Rickets
Rickets occurs when the body is either not getting enough vitamin D or it is not handling the vitamin D it does get properly. In such instances, bones become soft and can cause a child to look more bow-legged.
Because much of the food in the United States is now fortified with vitamin D, this is not a common issue here, but is more prevalent in other countries. In a small number of young children, vitamin D deficiency is traced to a genetic abnormality, meaning they cannot absorb or metabolize vitamin D.
Therefore, it’s important to ensure a sufficient amount of vitamin D is being consumed. With sufficient vitamin D and by using braces, much like those used for Blount’s disease, rickets can be corrected without surgery. Thus, it’s important not to neglect its early warning signs.
Diagnosing The Cause of Bowlegs
Being bow-legged at birth is a normal occurrence and is not cause for great concern. Pay attention to its progression, however, and be cognizant of whether or not things are getting worse – or if they are not improving.
If a pediatrician believes there is cause for concern, an x-ray can provide an indication of whether the problem is Blount’s disease or rickets (or another issue). After the appropriate diagnosis is made, a plan can be put in place.
In cases of rickets, more blood tests are ordered and/or a referral to an endocrinologist may be made. Those afflicted with Blount’s disease will proceed directly with a bracing program in an effort to get the legs straightened out.