Bow Legs (Genu Varum): Symptoms, Causes, and Treatment Explained
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick answer
Bow legs (genu varum) is a condition in which one or both legs curve outward at the knees, so the knees don't touch when standing with feet together. It usually comes from a cramped position in the womb [1] [6], and legs typically straighten between 11 and 18 months [1]. See a provider if bowing doesn't improve by age 2 [1].
What the research says
According to PubMed:
Most bowing within normal measurements resolves on its own. A review in American Family Physician reports that most children who present with leg problems have normal angular findings, that findings within normal measurements resolve spontaneously as the child grows, and that X-rays are not routinely required except to exclude pathologic conditions. It also states orthotics are not beneficial and that surgery is rarely needed, in patients older than 8 years with severe deformities that cause dysfunction. (Rerucha et al., Am Fam Physician, 2017) [2].
Bracing for infantile Blount disease is still debated. An update on treating infantile Blount disease, one cause of persistent bowing, found no consensus on how well bracing works, and recommended that all affected children be followed at regular intervals until skeletal maturity. (Sabharwal & Sabharwal, J Pediatr Orthop, 2017) [3].
Guided-growth plates corrected most deformities in infantile Blount disease. In a systematic review of 7 retrospective studies covering 92 limbs, tension-band plating corrected the deformity by an average of about 79%, with an average reoperation rate of about 30% (range 0% to 47%). Infection and hardware failure were the most common complications. (Raftis et al., Cureus, 2024) [4].
Study details are from PubMed abstracts.
What are bow legs?
Being bow legged is when one or both of your child's legs curve out, away from the center of their body at the knees. "Genu varum" is the medical term for bow legs [1].
Being bow legged creates extra space between your child's knees and lower legs. Their knees will be noticeably farther apart than usual when they stand straight with their ankles together. It's the opposite of being knock kneed — a similar issue that creates a gap between your child's knees instead of their ankles.
Bow legs are common in infants and toddlers, and it's rarely serious. Babies born with genu varum usually grow out of it naturally within two years [1]. Untreated bow legs that don't go away on their own can last into adulthood [1]. A healthcare provider will tell you if your child will need any treatments and what to look out for.
What are the symptoms?
The physical shape of your child's legs is the main symptom of being bow legged. You'll be able to see that their knees don't touch when they stand with their feet and ankles together.
The bowing is usually more noticeable when they're walking. Some children with bow legs might walk with their toes pointed in. This is known as having pigeon toes (intoeing) [1].
Being bow legged usually isn't painful. And it won't affect your child's ability to crawl, walk, or run [1].
What causes bow legs?
Lots of issues can cause bow legs. The most common cause is a condition called physiologic genu varum [1]. This happens if a fetus develops in a cramped position in the uterus. The pressure from the unusual position makes bones develop more rotated than usual. Then, after your baby is born, that extra rotation leads to bow legs [1].
Physiologic genu varum will likely correct itself as your child's bones grow and develop. If their legs haven't straightened by the time they turn 2, there may be another reason:
Possible cause | What it is |
Blount's disease | A growth disorder of the shinbone that causes the lower leg to angle inward |
Rickets | A condition caused by vitamin D deficiency that softens bones |
Skeletal dysplasia | A group of bone growth disorders, including dwarfism |
Broken bones | Fractures that don't heal correctly |
Fluoride or lead poisoning | Poisoning that can affect bone development |
What are the complications?
Being born bow legged rarely causes complications — most children grow out of it naturally. But untreated bowed legs that don't get better on their own may increase your child's risk of bone and joint issues. The unusual shape of their legs can put extra pressure on their hips, knees, and ankles [1].
If a health condition causes persistent bow legs, your child may be at risk for other complications. These are usually more from the condition that causes bow legs than the change to their bones themselves. Your healthcare provider will help you understand what you should expect.
How are bow legs diagnosed?
Your child's healthcare provider will do a physical exam and ask about your child's medical history. If your child is under 2 years old, they might not need any other tests. Your provider will check your child's legs regularly to make sure they're growing out of bow legs.
If your child is older than 2, your provider may measure their legs and watch them walk. Your child may need X-rays to take pictures of their leg bones. Your provider might order blood tests to check for conditions like rickets [1].
Your child might need to visit an orthopaedist — a healthcare provider who specializes in caring for bones, joints, and muscles.
How are bow legs treated?
If your child is under 2, they probably won't need any special treatment. Children usually grow out of being bow legged on their own [1]. Your healthcare provider will monitor changes in your child's legs as they develop and make sure it's getting better on its own as your child grows.
If your child is older than 2, or if their bow legs are severe, your provider can recommend treatments. They'll suggest ways to support and straighten your child's leg bones.
Treatment | How it works |
Braces, splints, or casts | Gently hold your child's bones in the correct position so they grow straighter — like braces on your teeth realigning your smile |
Special shoes | Rarely used; special shoes and shoe inserts have not been shown to straighten bow legs, so ask your provider before buying them |
Treatments for specific causes | Your child might need treatment for the condition causing bow legs — for example, vitamin D and calcium supplements to treat rickets |
Surgery | Rare; suggested if bowing affects your child's ability to move and other treatments haven't worked; the surgeon reshapes the bones or implants metal plates to act like a brace on the inside of the body |
How are bow legs corrected in adults?
Untreated bow legs that don't naturally straighten on their own can last into adulthood. Most of the time, this won't cause pain or other issues. But if it does, surgery is the only treatment for adults with bow legs [1].
That's because your bones won't respond to treatments like braces or splints once you're an adult. Children's bones are much softer and more flexible than adult bone tissue. Once you finish developing, your bones harden and won't change shape without surgery.
Talk to a healthcare provider if you have bow legs that cause any pain or discomfort. They'll let you know if surgery is a good option for you.
When should you see a healthcare provider?
Visit a healthcare provider if your child has bow legs and they don't improve by age 2 [1]. Your provider will keep an eye on your child's legs and let you know if or when your baby will need treatment.
Ask your provider how often your child will need follow-up exams. Most of the time, you can follow the typical schedule for check-ups and well-child visits [1].
What is the outlook?
Your child's legs should straighten out as they start walking. Every baby is different, but this is usually between 11 and 18 months [1]. In most cases, being bow legged won't cause any long-term issues. Even if your child needs surgery, they should have no lasting effects once they heal [1].
It's natural to feel worried when you find out something is affecting your baby's bones. But being bow legged shouldn't have an effect on your child's growth or development. In fact, getting bigger and older is usually all kids need to grow out of bow legs. Your healthcare provider can suggest treatments to help your child's body correct bow legs if needed. Even though bow legs aren't usually a serious issue, ask your provider any questions you may have — there's no such thing as a silly question when it comes to your child's health.
Conclusion
Bow legs are one of the most common — and least worrisome — things parents notice about their baby's legs. Genu varum simply means the legs curve outward at the knees, and in most cases it's simply a leftover from cramped quarters in the womb. The vast majority of children straighten out on their own as they start walking, usually between 11 and 18 months [1], without any treatment at all. If the bowing persists past age 2 or is severe, braces, special shoes, supplements, or rarely surgery can help guide the bones straight [1]. And while untreated bow legs can last into adulthood, they usually cause no pain or problems — though surgery is the only option for adults [1]. If you're ever unsure about your child's legs, a healthcare provider can check them at a regular well-child visit and tell you exactly what to watch for.
Wondering about your child's development? Get clear, plain-language answers. Explore more trusted health guides at Rinnit.com — your everyday companion for understanding conditions, treatments, and staying healthy.
Frequently asked questions
What does it mean to be bow legged?
Being bow legged means one or both legs curve outward at the knees, away from the center of the body. The medical term is genu varum, and it creates a wide gap between the knees when a child stands with ankles together.
Is bow legs the same as knock knees?
No — it's the opposite. Knock knees create a gap between the ankles when the knees are together; bow legs create a gap between the knees when the ankles are together.
Why are babies born with bow legs?
The most common cause is physiologic genu varum, which happens when a fetus develops in a cramped position in the uterus. The pressure makes the bones develop more rotated than usual, leading to bow legs after birth.
Is it painful for my child?
Being bow legged usually isn't painful, and it won't affect your child's ability to crawl, walk, or run.
When do bow legs straighten out?
Legs usually straighten as the child starts walking, typically between 11 and 18 months. Most children grow out of bow legs naturally by age 2.
Does my child need treatment?
If your child is under 2, probably not — they usually grow out of it on their own while a provider monitors their legs. Treatment is considered for children over 2 or those with severe bowing.
What if bow legs don't improve by age 2?
See a healthcare provider. Persistent bow legs may have another cause, such as Blount's disease, rickets, skeletal dysplasia (including dwarfism), broken bones that don't heal correctly, or fluoride or lead poisoning.
How are bow legs diagnosed?
With a physical exam and medical history. Children over 2 may also need leg measurements, observation of walking, X-rays of the leg bones, and blood tests for conditions like rickets. An orthopaedist may be involved.
What treatments are available?
Braces, splints, or casts to hold the bones straighter; special shoes; treatments for the underlying cause (like vitamin D and calcium for rickets); and, rarely, surgery.
When is surgery needed?
Rarely — only if the bowing affects the child's ability to move and other treatments haven't worked. A surgeon reshapes the bones or implants metal plates to act like an internal brace.
Can bow legs last into adulthood?
Yes. Untreated bow legs that don't straighten naturally can last into adulthood, though they usually cause no pain or other issues.
How are bow legs treated in adults?
Surgery is the only treatment for adults, because adult bones have hardened and won't respond to braces or splints the way children's softer, more flexible bones do.
Can bow legs cause long-term problems?
Usually not. In most cases there are no long-term issues. However, untreated bowed legs that don't improve may increase the risk of bone and joint issues by putting extra pressure on the hips, knees, and ankles.
When should I take my child to a healthcare provider?
If your child has bow legs and they don't improve by age 2. Most of the time, you can follow the typical schedule for well-child check-ups.
Even if surgery is needed, will my child be OK?
Yes. Even if your child needs surgery, they should have no lasting effects once they heal, and bow legs shouldn't affect growth or development.
Related reading
Pigeon Toes (Intoeing): Symptoms, Causes, and Pediatric Care — what causes inward-toeing in children
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about any medical concern, and see a provider promptly if your child's legs don't straighten by age 2.
References
Cleveland Clinic. Bow Legged: What Is It, Causes, Symptoms & Treatment. Cleveland Clinic. Updated March 30, 2026. https://my.clevelandclinic.org/health/diseases/22049-bow-legged
Rerucha CM, et al. Lower Extremity Abnormalities in Children. American Family Physician. 2017;96(4):226-233. PMID 28925669. https://pubmed.ncbi.nlm.nih.gov/28925669/
Sabharwal S, et al. Treatment of Infantile Blount Disease: An Update. Journal of Pediatric Orthopedics. 2017;37 Suppl 2:S26-S31. PMID 28799991. https://doi.org/10.1097/BPO.0000000000001027
Raftis D, et al. Tension-Band Plating for Infantile Blount Disease: Efficacy and Outcomes Comprehensive Review. Cureus. 2024;16(6):e62514. PMID 38887744. https://doi.org/10.7759/cureus.62514
American Academy of Orthopaedic Surgeons. Bowed Legs (Genu Varum, Blount's Disease). OrthoInfo. Accessed October 14, 2026. https://www.orthoinfo.org/diseases--conditions/bowed-legs-blounts-disease
Pellegrino J. Bowlegs and Knock-Knees. Merck Manual Consumer Version. Updated November 2024. https://www.merckmanuals.com/home/children-s-health-issues/birth-defects-of-the-bones-joints-and-muscles/bowlegs-and-knock-knees
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