Bow Legs in Children: What Parents Need to Know
As a parent, it’s natural to worry when you notice something unusual about your child’s posture or gait. One of the most common concerns we see at Neurohealth Wellness on the Northern Beaches is bow legs and in-toeing gait in young children.
While it can look alarming, the good news is that most cases are part of normal growth and development — not a cause for concern. Understanding how children’s legs develop can help you feel confident about when to seek care and when simply monitoring is the best approach.
Understanding Bow Legs and In-Toeing
“Bow legs” (or genu varum) describe when a child’s legs curve outward at the knees while the feet and ankles touch. “In-toeing” or “pigeon-toed” walking happens when the toes point inward while walking or running.
These gait patterns are common in children under the age of two and often improve naturally as they grow and their bones and joints mature.
However, it’s still important to have your child assessed — not because every case needs treatment, but to ensure that what you’re seeing falls within normal developmental ranges.
Normal Developmental Patterns
Children’s lower limbs change shape several times through normal development:
- Birth to 18 months: It’s common for babies and toddlers to have bow legs. Their legs were folded in a confined space in the womb, and this curvature usually straightens as they begin standing and walking.
- Ages 18 months to 4 years: The legs often straighten and may even become slightly “knock-kneed” (genu valgum) before settling into a more neutral alignment around age 6–7.
- By age 10: Most children’s legs have developed a normal alignment without any intervention.
(Staheli, 1987)
Common Causes of In-Toeing by Age
Under 18 months – Metatarsus Adductus
The most common reason for in-toeing in infants is Metatarsus Adductus, where the forefoot curves inward but the heel remains aligned. This typically happens due to the baby’s position in the womb and resolves naturally in about 85% of cases (Staheli, 1987).
Gentle stretching and time are often all that’s required.
18 months to 4 years – Internal Tibial Torsion
At this stage, in-toeing often comes from the shin bone (tibia) rotating slightly inward — known as internal tibial torsion. This is also linked to in-utero positioning and usually resolves as the child grows and becomes more active.
A simple home technique can help: gently rotating the lower leg outward with the knee bent to 90 degrees during nappy changes. This encourages normal alignment and mobility.
Over 3 years – Femoral Anteversion
Older children who in-toe often have femoral anteversion, where the upper thigh bone (femur) rotates inward more than usual. This is a normal anatomical variation that gradually corrects itself in most children by age 10 (Renshaw, 1986).
These children might prefer W-sitting — sitting on their knees with their feet out to the sides — which can be a sign of inward femoral rotation or, in some cases, lower muscle tone.
When to Seek Further Assessment
While most cases of bow legs and in-toeing are harmless, you should seek professional advice if:
- The bowing or in-toeing worsens after age 2–3
- The condition only affects one leg
- Your child experiences pain, limping, or difficulty walking
- You notice other developmental delays or symptoms (such as muscle weakness or tone issues)
At Neurohealth Wellness, our chiropractors can assess your child’s posture, pelvic alignment, and lower limb biomechanics to ensure healthy development.
The Chiropractic Approach
When children present with in-toeing or bow legs, our chiropractors carefully assess the pelvis, spine, hips, knees, and feet. Sometimes, small misalignments (called subluxations) in these areas can influence how the legs and feet move.
We commonly check for:
- Pelvic misalignment, such as an EX ilium or anterior sacrum
- Internal tibial rotation
- A base-posterior sacrum, which can influence femoral rotation and gait patterns
In many cases, gentle adjustments and mobility work can help improve pelvic and lower limb function, supporting the child’s natural developmental progression.
What About W-Sitting?
If your child regularly sits in a “W” position, it’s worth mentioning during their assessment. While it can be a sign of inward femoral torsion, it’s also a position often chosen by children with low muscle tone because it requires less effort to maintain balance.
Our team will assess your child’s overall muscle tone, joint function, and developmental milestones to ensure nothing is being missed.
A Case Example
Recently, a mother brought her young son into our clinic with concerns about his bow legs and in-toeing.
After assessment, we found mild pelvic and lower limb imbalances — likely caused by his gait, rather than the cause of it. With a few weeks of gentle chiropractic adjustments and home advice, his movement patterns began to normalise.
Just as importantly, we reassured his mum that this condition was part of a normal developmental process, and his progress has continued as expected.
Takeaway Message
Bow legs and in-toeing are extremely common in young children and are usually nothing to worry about. However, every child develops differently, and a professional assessment can help you rule out anything more serious — giving you peace of mind.
At Neurohealth Wellness in Allambie Heights, we take a gentle, evidence-based approach to children’s care, focusing on supporting natural growth, healthy movement, and long-term development.
If You’re Concerned About Your Child’s Gait
Book an appointment with one of our experienced chiropractors. We’ll perform a thorough assessment, explain what’s happening, and guide you on the best next steps — whether that’s gentle care, home support, or simple reassurance.
📍 Neurohealth Wellness – 33–35 Kentwell Rd, Allambie Heights
📞 (02) 9905 9099
💻 Book Online
References
- Staheli LT. “Rotational problems in children.” J Bone Joint Surg Am. 1987;69(5):736–749.
- Renshaw TS. “Femoral anteversion in children.” J Bone Joint Surg Am. 1986;68(4):700–703.
- Drennan JC, ed. The Child’s Foot and Ankle. Raven Press, 1992.
- Wenger DR, Rang M. The Art and Practice of Children’s Orthopaedics. Raven Press, 1993.
- Cheng JC, et al. “Normal development of lower limb alignment in children.” J Orthop Sports Phys Ther.1991;14(1):22–28.
