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Knock Knees and Bow Legs in Children

Genu varum (bow legs) and genu valgum (knock knees) are angular knee deformities in children that follow a normal developmental pattern - bow legs are normal from birth to age 2 years, knees straighten by age 2-3, then knock knees peak at age 3-4 years before gradually correcting by age 7-8 - most cases are physiological (normal development) resolving without treatment, but pathological deformities from Blount disease (abnormal growth plate causing progressive bowing), rickets (vitamin D deficiency), or skeletal disorders require treatment with observation, vitamin D supplementation, bracing, or surgery (guided growth with temporary plates or corrective osteotomy) depending on severity and underlying cause.

📅Last reviewed: January 2026đŸĨBones & Joints

📖What is Knock Knees and Bow Legs in Children?

Genu varum (bow legs) and genu valgum (knock knees) are angular knee deformities in children that follow a normal developmental pattern - bow legs are normal from birth to age 2 years, knees straighten by age 2-3, then knock knees peak at age 3-4 years before gradually correcting by age 7-8 - most cases are physiological (normal development) resolving without treatment, but pathological deformities from Blount disease (abnormal growth plate causing progressive bowing), rickets (vitamin D deficiency), or skeletal disorders require treatment with observation, vitamin D supplementation, bracing, or surgery (guided growth with temporary plates or corrective osteotomy) depending on severity and underlying cause.

đŸ”ŦWhat Causes It?

  • Physiological (normal development): bow legs birth to 2 years, knock knees 3-4 years resolving by 7-8 years
  • Blount disease (tibia vara): abnormal growth plate development on inner tibia causing progressive bowing
  • Rickets (vitamin D deficiency): poor bone mineralization causing soft bones and angular deformities
  • Skeletal dysplasias (achondroplasia, hypochondroplasia): genetic bone disorders
  • Metabolic bone disease (renal rickets, hypophosphatemic rickets): kidney or metabolic disorders

âš ī¸Risk Factors

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You may be at higher risk if:

  • Obesity in early walking age (increases Blount disease risk)
  • African or Hispanic ethnicity (higher Blount disease incidence)
  • Early walking (before 10-12 months increases mechanical stress on growth plates)
  • Vitamin D deficiency (nutritional rickets - exclusive breastfeeding without supplementation)
  • Family history of angular deformities or skeletal dysplasias

đŸ›Ąī¸Prevention

  • ✓Vitamin D supplementation for exclusively breastfed infants (400 IU daily prevents rickets)
  • ✓Maintain healthy weight in toddlers (reduces Blount disease risk)
  • ✓Don't encourage very early walking (before 10-12 months increases stress on growth plates)
  • ✓Regular pediatric checkups monitoring developmental milestones and leg alignment
  • ✓Adequate dietary calcium and vitamin D throughout childhood