• Rebecca 'Bec' Bacusmo

Paediatric Lower Limbs: Bow vs. Knocked Knees

Are you worried because your child has knocked knees or bowing legs?


These are common questions we are asked at Splash Physiotherapy.

The Royal Children's Hospital reports that bow legs and knock knees are often considered "normal" and are part of development in a growing child!


Image Description: Illustration of a growing child through 5 stages of development, demonstrating the change of leg positioning over time. From left to right: toddler standing with bow legs (dotted line illustrating rounded shapes of lower limbs), infant standing with reduced bow to legs, child standing with knocked knees (dotted line illustrating curve inwards of knees), child standing with reduced knocked knees, child standing with straight lower limbs (dotted line illustrating straightened position of knees).


BOW LEGS "Genu Varum"


What does bow legs look like?

When standing feet together, there is a larger gap between the knees.


When are bow legs expected?

This is seen from babies to around 2.5 years of age, and is more obvious in toddlers learning to walk.

Sometimes intoeing is also seen.

Bow legs gradually transitions to knocked knees as children grow.


How do we know if there's 'too much' gap between the knees?

Your physiotherapist or paediatrician can measure the distances between the knees at a specific point using bony landmarks (inter-condylar distance).

We compare this against expected values, just like the height and weight charts you may be familiar with.


KNOCKED KNEES "Genu Valgum"

What does knocked knees look like?

When standing, a child's knees are together, and the feet are apart.


When are knocked knees expected?

Knocked knees is seen from around 2 to 8 years of age.

This reduces with growth and an adult position is usually reached by 8 years of age.


How do we know if there's 'too much' gap between the ankles?

Your physiotherapist or paediatrician can measure the distances between the knees at a specific point using bony landmarks (inter-malleolar distance).

Again, we compare this against expected values, just like the height and weight charts you may be familiar with.

Image Description: Illustration of 3 sets of lower limbs of child. From left to right illustration shows bow knees with arrows pointing at knees illustrating increased distance between knees. Middle illustration shoes knocked knees with arrow pointing at ankles illustrating increased distance between ankles/feet. Right illustrations demonstrated straightened knees






When should we ask for help?

Ask your physiotherapist or paediatrician to have a look at your child's legs if:

  • You are concerned, and would like the distance measured

  • Only one leg is affected

  • Your child is shorter for their age

  • Your child is complaining of pain

  • Your child is limping

  • The leg position is not improving over time, especially if: Bow legs continue after 3 years of age; knocked knees are not straightening with growth, and especially if you feel the angle is increasing.

At Splash: We regularly assess and monitor the lower limbs of all the children we work with, educate and discuss findings with our families.


We observe how you child walks, runs and moves, assess their position in standing and laying and measure range of movement of each joint of the lower limbs. These measurements are then compared against "normative" values and checked if they fall within expected age range. We prrovide referrals to GP's and other health care professionals if required and work as a team to support you and your child's wellbeing.


References:

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/BOWLEGS.pdf

Jones, Stanley & Knadehar, Sumukh. (2013). Normal Variants of the Lower Limbs in Paediatric Orthopaedics. International Journal of Clinical Medicine

Graham HK. In Broughton Ed's. Paediatric Orthopaedics 1997 Chapter 14 Normal Variants


Images references:

https://www.childrenshospital.org/conditions-and-treatments/conditions/b/bowlegs

https://www.bkkkids.com/blog/symptoms-bowlegs/


This advice is general in nature. Please consider if it is right for you, and speak to your physiotherapist or paediatrician if you have any concerns.


Rebecca Bacusmo is a Splash physiotherapist working with children and young adults in aquatic, land and telehealth physiotherapy. She is passionate about helping children learn and develop functional skills to assist them in participating in meaningful activities in everyday daily life at home, school and their communities. Rebecca has daily aquatic sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne, combined with daily home, school and Telehealth sessions and sports and recreation intensives over the school holidays.


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