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?
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.
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.
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.
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.
For More Information
- MedlinePlus Medical Encyclopedia: Bowlegs
Has a complete list of medical names, causes, symptoms and treatments for bow legs.
- Knock knees - WrongDiagnosis.com
Knock knees information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis.
- Flat Feet in Children -- familydoctor.org
Information for parents about flat feet in children from the American Academy of Family Physicians.