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What are bowlegs?

Bowlegs are legs that curve outward at the knee even when the ankles are together. In order to understand bowlegs, also called genu varum, it is important to first understand “normal” alignment of the legs. In the normal situation, when standing, the hips, knees and ankles all fall on a straight line. In other words, when you draw a line from the hip to the ankle, that line passes directly through the center of the knee. If that line passes to the inside of the knee (internally), this is called bowlegs (genu varum). If that line passes to the outside of the knee (externally), this is called knock knees (genu valgum).

Three color illustrations showing alignment from the hip to the ankle in an AP view. Images show normal alignment, knock knee alignment and bow leg alignment.

The International Center for Limb Lengthening has successfully treated children and adults with bowlegs. A large number of the children we see have “physiological” bowlegs, which are completely benign and does not need treatment. These bowed legs correct on their own gradually and usually are totally resolved by the age of 5 years. These children usually have mild and symmetrical bowlegs.

When will a doctor suspect a pathological cause of bowlegs?

The doctor however may suspect a pathological cause in case of bowlegs if one or more of the following is present:

  • Severe bowing
  • Unilateral bowing
  • Short stature
  • Obesity
  • Age above the age of 2

What causes pathological bowing?

Pathological bowing is caused by:

How is bowlegs diagnosed?

In case of suspecting a pathological cause, the doctor may run some investigations including lab work and X-rays to reach a diagnosis.

How is bowlegs treated?

The aim of treatment will be to correct limb alignment, stop disease progression and prevent expected post treatment recurrence.

I. Orthotics

Custom molded braces may be effective in mild cases of Blount disease or rickets, but they are not tolerated by all children. Treatment may last up to 18 months.

II. Surgical Correction

  • A) Hemiepiphysiodesis temporary arrest (guided growth)
  • There are growth plates in the end of long bones that are responsible for adding bone length as the child grows. Slowing the growth process on one side of this growth plate can give a gradual correction of the bowing as the child grows. The procedure is done by a small plate and two screws that straddle the growth plate. The procedure is simple, with minimal blood loss, and it is reversible. Correction occurs gradually and may take 6-12 months. The child will be able to walk right after the procedure. No casts or braces are needed.

  • B) Gradual correction using an external fixators
  • The bowed legs can be corrected gradually using an adjustable frame. The surgeon cuts the bone, and put an adjustable external frame on connected to the bone with wires and pins. The parents receive a regimen outlining the daily adjustments that should be done to the frame. The child walks, sleeps, bathes and does all his daily activities with the frame on without feeling pain. The bone gradually heals in the corrected position, and the family visits the doctor every few weeks to make sure that everything is going as planned. Based on the follow up X-rays, the doctor may revise the schedule in order to achieve better results. After correction, the patient will have to be admitted to the hospital to remove the frame.

  • C) Acute osteotomy
  • The bone is cut and full correction is done in the operating room. The patient will typically have a plate with screws inserted internally to stabilize the cut bones and will be put in cast for a period of 6 to 8 weeks until the bone unites. During that period, the patient will not be allowed to walk in order not to lose correction.

Which treatment plan is best for my child?

The treatment plan is decided based on many factors:

  • The nature of the disease and its tendency to progression
  • The severity of that disease
  • The age of the child
  • The presence of shortening requiring lengthening
  • An abnormality or depression in the knee joint line

All of these factors will dictate the surgeon’s recommendation.

Why come to the International Center for Limb Lengthening for bowlegs treatment?

Your doctor at the International Center for Limb Lengthening will take the time to make sure you understand all of your options and then will customize your treatment to meet your specific needs. Our patients benefit from our team-centered approach with world-renowned pediatric and adult orthopedic surgeons and specialized physician assistants, nurses and physical therapists. We help patients with bowlegs achieve their best possible result.

Video: Leg-Straightening: A Patient’s Story

Karie shares her leg-straightening story

Chat with a Doctor About Bowlegs

Our doctors hold free monthly chats on various subjects, including bowlegs. Click here for more information.

Doctors Who Treat Bowlegs