When Should I Be Concerned About Bowlegs?

“Do I need A PT referral if my baby is bowlegged?””

ANSWER- Bowlegs, aka genuvarum, are when knees are further away from each other when ankles are touching.

The appearance of legs being bowed is generally normal in babies up until about 2 years of age. Some sources say 3, but most orthopedists I’ve worked with would rather see a child closer to 2 if it’s not resolving or improving. Other times it would be a concern would be if it’s one sided, or if it’s impacting function (ie: tripping & falling, appearing to walk on the outsides of the feet, any appearance of pain).

Bowleg appearance is thought to be from in utero positioning, when the legs are bent up while in the womb. As a child moves around during crawling, pull to stand, cruising, & eventually walking, the forces of gravity combined with weight bearing causes bones to change & mature – which improves alignment & ultimately moves from the bow leg appearance to legs looking straight.

An anecdotal piece of info – the earlier a child walks, the more bow legged they often appear. One theory I’ve seen is that this is because they are closer to that in utero positioning & haven’t had quite as much weight bearing yet, BUT regardless, it should improve as they walk!

For reference – check out the video for a better idea of what I mean!

• In the first clip, the child is a very new walker. Her legs are really far apart & steps are more side to side than forward.

• Next, you can see her legs are coming closer together, but see how that also makes it look a little more bowed (remember – as feet come closer together, the leg alignment is still working it’s way towards straight, so the bowing appearance is more noticeable.).

• In the third video, you can see after about 4 months of walking, even though this video isn’t a straight shot of her walking, her legs are straighter.

• In the last clip, she’s been walking for around a year, and they’re completely straight.

So – the takeaway is, bowed appearance of the legs *can* be normal! Keep an eye on it, & you should see improvements as your little one practices being uprights against gravity. Again, as always, if you have *ANY* concerns, talk to your ped and/or request a further assessment, but hopefully this helps to set your mind at ease!

Hope this helps!

Want More?

For developmental questions, tips and guidance related to milestones about tummy time, rolling & sitting, crawling and walking, check out KC’s developmental Masterclasses linked here.

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KC is a pediatric doctor of physical therapy, wife and mom of three! She has spent her career working with children and young adults of all ability levels, and currently specializes in birth to three years.