Leg bowing in children

Leg bowing in children is common and often developmental.

Differential diagnosis

The differential includes:

  • developmental bowing
    • exaggeration of normal age-related angulation changes at the knee
    • neonates and infants normally have varus angulation that gradually corrects within 6 months of walking or by 2 years of age
    • changes to valgus angulation at age 2-3 years and reverts to the adult pattern by age 6-7 years
    • more common if begin walking at an early age, heavier children, and African-American children
    • does not require treatment, but should follow-up to ensure resolution of bowing and ensure that tibia vara does not develop
  • congenital bowing
    • secondary to abnormal intrauterine position
      • localized skeletal dysplasia or fetal vascular insufficiency may play a role in some cases
    • usually bowing of tibia/fibula convex posteriorly and medially, less commonly convex laterally
    • good prognosis for remodeling during growth, but bracing may be necessary in some cases
    • associated leg-length discrepancy is usually seen
  • rickets
  • scurvy
  • Blount disease
    • tibia vara
    • metaphyseal-diaphyseal angle >11° (in contrast to <8° in developmental bowing)
    • usually unilateral or asymmetric (in contrast to symmetry of developmental bowing)
  • focal fibrocartilaginous dysplasia
  • neurofibromatosis type 1
    • usually anterolateral bowing of the tibia with or without a hypoplastic fibula
  • skeletal dysplasias 
  • osteomyelitis
  • syphilis: saber shin
  • yaws: boomerang tibia

See also

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Article information

rID: 8232
Section: Gamuts
Tag: tibia
Synonyms or Alternate Spellings:
  • Tibial bowing in children
  • Causes of lower limb bowing
  • Causes of lower limb bowing in children

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Cases and figures

  • Case 1: Blount disease
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  • Case 2: rickets
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  • Fibular hemimelia
    Case 3: fibular hemimelia
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  • Case 4: rickets
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