On Bowlegs, Knock Knees and Flat Feet

Although current fashion trends might suggest otherwise, children are not scaled-down adults. Their body proportions, shape and alignment change as they grow, sometimes with ungainly - though usually temporary - results. One area in which this is particularly noticeable is their legs. Children do not develop "straight" legs until they are about seven years old. So there is no need to panic if your child is bow-legged, knock-kneed or flat-footed. Depending on their age, this is most likely just a normal stage of their development. So what is "normal" and when should you seek medical advice?

Child with bow legs.
Child with bow legs.

Bow Legs

There are a number of reasons why the legs of an infant bow outwards and twist inwards between the knee and the foot. It may be caused by certain medical conditions, however these are rare, and in all probability, it is a consequence of the folded position in which the foetus lays in the womb. Bowed legs become apparent when infants first stand - invariably with their feet wide apart to keep their balance. It is most obvious in the first few months of walking but the lower part of the legs should start to straighten by about two years of age.

About Arches

The foot has two sets of arches, or curves. One extends from the front of the feet (when placed together) to the back, and is a longitudinal arch. The other is from one side of the outer part of the foot to the outer part of the opposite foot, from side to side. In later life, these two arches are fairly obvious.

With flat feet, the arches are not obvious and the child, when standing on both feet, is flat on the soles.

As the child develops, the various ligaments of the bones of the feet start to develop and strengthen, and the arches become apparent. Occasionally this may be late in occurring or they may be weak, and body weight may keep the soles against the floor.

If, in play, you can bring the child's foot past a right angle onto their leg when they are lying down, it is not likely to be a problem and will correct itself in time.

Flat Feet

For infants who are not yet using their feet, the flat-footed look caused by wads of fat under their soles is normal. Often too, older children who are labelled flat-footed are actually hyper-mobile -- that is, they have more movement between the joints so the foot flattens out when bearing weight.

If your infant stands on tiptoes when they first start pulling themselves upright or your child develops an arch when they stand on tiptoes, they are not flat-footed.

Are My Baby's Feet Normal?

Most newborns have feet that curve in along the inside border. This often disappears by 18 months of age and keeps improving through childhood. Overlapping and curly toes also disappear with growth. However, if they are still noticeable at three years of age, it is worth getting them checked.

Babies feet come in all shapes and sizes.
Babies feet come in all shapes and sizes.
Child with knock knees.
Child with knock knees.
Child in "W" position.
Child in "W" position.

Knock Knees

The end of the long leg bone (the femur) grows faster on the inside than the outside. This disproportionate rate of growth angles the knee joint so that from two years to about three-and-a-half years of age, an infants' legs become increasingly knock-kneed. Fortunately, the outside end catches up and by about six or seven years old the child will have developed his/her adult leg alignment.

Any intoeing caused by these patterns of development is usually resolved by the time the child is two-and-a-half years of age. It can persist longer in some children because of "inset hips" - which simply means that the child is better at turning his/her hips inwards than outwards. Most adults can rotate their hips inwards and outwards equally, and when they walk their feet do not turn inwards or outwards but face straight ahead. Children with inset hips, however, can sit in the "W position" - flat on the floor with their heels by their buttocks and the inside of their knees touching the ground. Their knees and feet turn inwards when they walk, and they throw their feet out sideways when they run. This problem usually corrects itself with growth and most children will have normal alignment by the time they reach maturity. Even if the feet are not absolutely straight by puberty, it is unlikely to cause any functional problems.

If your child's leg and foot development fits these age and growth patterns, they are unlikely to have a problem. Overall, leg and foot deformities in infants and children are not common, and most are not serious.

Rate of Growth in Children's Feet

At one, the average child's foot is 12 centimeters long. By 16, they grow to an average of 24 centimeters in girls and 26 centimeters in boys.

Seek Medical Advice

If the difference that concerns you persists beyond the normal age, is extreme or causes pain, affects a single side, causes problems with fitting shoes or is associated with stiffness or weakness, then you should consult your doctor. He or she may advise the use of footwear inserts or refer you to a children's orthopaedic surgeon.

While on the subject of feet I might add that some parents go to almost foolish limits with shoes for their infants. In the early stages only soft booties and shoes are necessary. There is no need for "good" strong leather shoes, for the rate of growth in these areas makes them rapidly obsolete, and it is expensive and wasteful to keep repurchasing shoes that are unnecessary. For older children, we should applaud the adolescent fashion for, and encourage them to wear, shoes with flat heels and broad rounded toes.

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Comments 19 comments

Choke Frantic profile image

Choke Frantic 7 years ago from Newcastle, Australia

A very informative hub - sure to put a lot of parent's minds at ease.

Lisa HW profile image

Lisa HW 7 years ago from Massachusetts

My son was 4 (or close to it) when the pediatrician noted he appeared to have flat feet. At the time she didn't seem quite ready to "officially diagnose" flat feet. The next time he went for a routine check-up she said his feet did not appear flat. He must have been a "late-arch-bloomer", I guess.

OTmommy profile image

OTmommy 7 years ago from Southern USA

Great explanations on the various orthopedic differences in young children's hips, knees, and feet. As an occupational therapist who works for an early intervention program (birth to three years of age), I am asked quite frequently about this topic. Because I work with kids with developmental disabilities, I see many orthopedic differences that do not resolve and require orthotics. Yet, I know that orthotics aren't usually necessary for kids with typical development.

Nemingha profile image

Nemingha 7 years ago Author

Thank you OTmommy, whether I had explained the situation clearly has been niggling away at me for some time.

ciidoctor profile image

ciidoctor 7 years ago

nice hub

Moneylady profile image

Moneylady 6 years ago from Texas

Very good info! Thanks!

Jeniferr profile image

Jeniferr 6 years ago from United States

Since I've yet to have a child, I didn't know any of this information about children's orthopedics. Thanks for writing this.

doctorveklich 6 years ago

In cases of Blount's Disease and Renal Osteodystrophy it is needed to be done orthopedic surgery to make child legs straight. It is better to start from age 4-5 years old.

The knock knees (genu valgum) in children sometimes is the symptom of hip dysplasia.

Saleem 6 years ago

Hi my name is Saleem and my son is 3 years of age with knock knees, whenever he tries to keep both feet together, his knees overlaps, is there any exercise to correct this problem and how much time it will take to get it corrected.

thank you

eve50 5 years ago

My 2 year old son's legs are knock-kneed, and I was worried they stay like that, but now that I know it is common, I will relax, and just let him grow.

The Insole Store profile image

The Insole Store 5 years ago

Nice Article... It's not uncommon for infants & toddlers to have flat feet till ages 6 to 8. For proper support, consider a good childrens insole.

Muplang 4 years ago

Nice writeup, and clear. I can now rest while my son bowed leg correct itself. Thank and God bless you.

Alice 4 years ago

My son is 3 and he was bow legged when little now we noticed he has knock knees and flat feet. We were so desperate when the pediatrician said it will correct since the line from his knee to his feet is straight anyway. But now that I read this God my mind is so at rest and ihave hope that he might grow out of it

Thank you so so much

sunita banik 4 years ago

my son while walking doesn't put left feet down . he uses the toes for walking what is the reason

minu 4 years ago

Hi my nefew c is 8mnts old c cnt able to sit or standand.she is habin problem in her leg...legs r nt stright. Dnt know through wat problem c is facin.....m worried...plz kindly help.

Carri102 4 years ago

I took my 2 1/2 year old daughter into her pediatrician today immediately after noticing her (inward bulging) knees. She does not display any difficulties walking/running. My doctor wasn't overly worried although my daughter is 20th percentile for height and less than 5th percentile for weight which does concern doctor. (husband and I are very slender and average height). This was very comforting to read that its generally of no concern, but I'm stressing out and very emotional over this! Anyone else experiencing anxiety and losing sleep over their little ones diagnosis?

TeachableMoments profile image

TeachableMoments 4 years ago from California

Thank you for this informative hub. Last weekend my father was so concerned because my five year old daughter walks with her feet pointing inwards. I tried to reassure him that her pediatrician said it will correct itself, but he still worried. It made me worry a little bit too. Your hub answered a lot of questions and now I'm not as worried anymore. Thanks!

Kim Rumer Armstrong 3 years ago

My Granson is now 6, we noticed his legs and feet being pigeon toed and legs bowed when he was younger. Basically told the same thing. Nothing really wrong, we needed to wait till he got a little older and see how things were then. Well he is so bow legged and he walk on the outsides of both shoes. Both sides are completely wore down and right sides are normal tread on shoes. My daughter recently took him to a very well established Orthopaedic group in our area. The doctor said it was his hips and he would grow out of it. So my Daughter goes back to the Pediatrician and says I don't agree with this man. The pediatrician finally takes notice and says yes it's his feet and legs. But he could have had surgery to fix this when he was younger, if someone would have caught it then. But he is too old now. I guess the way your bones grow. All they can do is make a mold for his shoes to help him try to walk better. Bottom line: don't believe what you read on here, half these people don't know your story and aren't doctors. Keep asking questions. If the feet are not better before age 2, you waited to long to get them fixed. Don't be afraid to go to 10 doctors, if you have to. It's your child. Go with your gut. Don't feel better, just because somebody on here told you it would be ok.

milika singh 19 months ago

My 2year 6 month old son's legs are knock-kneed, what should i do, and which kind of shoes he should wear? i m so worried about him. he feel comfortable while playing cycling and running. he have 5 cm gap between his ankles/feet. please guide

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