Knock Knees and Bow Legs

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Drag Sam's knees left or right to see how leg alignment changes from bow legs through neutral to knock knees. A small amount of bowing or knocking is completely normal at different ages — the severity panel notes which age range each alignment is typical for.

What Are Knock Knees and Bow Legs?

Knock knees (genu valgum) and bow legs (genu varum) describe the alignment of the legs when viewed from the front. With knock knees, the knees angle inward and touch while the ankles are apart. With bow legs, the knees curve outward with a gap between them even when the ankles are together.

During the first 7 years of life, there is a lot of change in alignment that is normal part of childhood development. This is connected to the development of the hip socket and rotation. As children grow, their leg alignment naturally changes in a predictable pattern:

• Birth to 18 months - Most babies and toddlers have bow legs. This is from their position in the womb and is entirely normal. Some babies rotate outward during this phase before they begin to walk.
• Age 2 to 3 - The hips begin to rotate more inwards as the hip socket deepens as the child grows and walks more.
• Age 3 to 5 - A knock-knee phase is very common as sometimes the hip can inwardly rotate past neutral. The knees angle inward as the leg alignment continues to shift. This occurs as the child's gross motor skills expand.
• Age 6 to 7 - The legs gradually return to a stable, neutral adult alignment. A mature walking pattern becomes more fully established at this age.

When Should I Be Concerned?

Most children grow out of bow legs and knock knees on their own without any treatment. However, it's worth having a professional assessment if:

• Bow legs persist or worsen after age 2
• Knock knees are severe or affect only one side
• Knock knees persist beyond age 7 to 8
• Your child has pain, limping, or difficulty walking
• The alignment seems to be getting worse rather than improving
• One leg looks noticeably different from the other
• Your child is not independently walking by 18 months

A paediatric physiotherapist can assess your child's alignment, check their walking pattern, and determine whether any further investigation or treatment is needed.

How Physiotherapy Helps

If your child's leg alignment needs support, a paediatric physiotherapist can help in several ways:

• Assessment and monitoring - tracking alignment changes over time to make sure development is on track
• Strengthening exercises - building up the muscles around the hips, knees, and ankles to support healthy alignment
• Balance and coordination - improving overall movement patterns and confidence
• Gait training - helping your child develop an efficient, comfortable walking pattern
• Positioning and posturing advice - To help promote the development of good lower limb alignment.
• Advice on footwear and activity - practical guidance for everyday life
• Referral when needed - connecting you with an orthopaedic specialist if further investigation is required

Every Child Develops Differently

It's easy to compare your child's legs to other children and worry. Remember that the natural timeline of leg alignment varies from child to child. Some children spend longer in the bow-leg or knock-knee phase than others, and that's perfectly okay.

If you have any concerns about your child's leg alignment or walking pattern, we're here to help. An assessment can give you peace of mind and a clear plan if any support is needed.