Whats Normal Leg Alignment for Kids?: Bow Legs, Knock Knees, Feet Turned Inwards and Outwards.

Whats Normal Leg Alignment for Kids?: Bow Legs, Knock Knees, Feet Turned Inwards and Outwards

A Growing miniSTRIDE Series: Helping your child Grow and Develop

Do you sit and marvel at your kids ability to acquire skills, learn new movements, talk, sing, catch balls or balance on one leg? It is an exciting time seeing your childs skills and abilities ever improving.

Some times, while they are growing, we notice things with their posture or alignment that just doesn’t seem right but we aren’t quite sure what to make of it.

As Podiatrists, we love to help parents to learn more about their kids development. We will explore how the legs change as kids develop, explain what is normal and when it might be worth getting some advice or attend for an assessment.

Lets talk about kids bones and leg alignment!

First thing you need to know is that kids bones are continuously remodelling (as do adults). Most parents understand that when kids have growth spurts that their bones are growing longer. But thats not the only thing they do! Their bones also ‘twist’. This is called the Torsional or Rotational alignment of the bone.

When a baby is developing in the womb their little leg bones are twisted inwards (femoral anteversion) while their legs are in a bent outwards position. When babies use their muscles and start to crawl and stand, this twisting reduces.

Bones also respond to compression and will build more bone in areas that get high compression. A great example of this is the knee joint. When an infant stands you might notice they have a bow leg and the inner side of the knee will tend to take more compression that the outside of the knee.

What is normal leg alignment in growing kids?

As kids grow, and more bone is built on one side, over time, it will change the alignment of the leg. If you look at the image showing kids leg alignment. At around 12 months old kids legs will be bow legged (Genu Varum) when first walking but will straighten at around 2 years of age.

By 3.5 years old, it will over correct and the knees will look more like Knock Knees (Genu Valgum) and again will correct by 7 years of age to a straighter alignment.

Some parents might see these changes and be concerned, however it is a normal process for your kids legs to develop.

Image Courtesy of Boston Childrens Hospital

Let’s dive into what we see and treat in Podiatry

As mentioned above, often these can be a normal variant of alignment. However, some kids do have conditions which do require assessment and possibly treatment.

Bow Legs would be assessed for Blounts Disease (growth disorder), Rickets (descreased bone mineralization) or growth plate injury which may have caused disruption to the growth of the bone.

Knock Knees are assessed for neurological conditions like Cerebral Palsy and Spina Bifida, bone disorders like Skeletal Dysplasia and Metabolic Bone Disorder. Joint Hypermobility and Obesity are often a common cause as well.

In Toeing are assessed for hip and thigh bone (femur) rotational alignment. The childs bone may not have ‘untwisted’ enough since birth which may cause the knee and the foot to stay inwards.

Often this can improve on it’s own however it is best to be assessed for tight hip muscles which could be contributing to the position.

Out Toeing is often seen in new walkers which is normal however it can often also be seen in children with Knock Knees and Flat Feet.

When should see a Podiatrist?

First of all, if you are ever concerned about your childs leg alignment or posture, it is always best to have it assessed.

Some clue’s that something may need to be assessed further are:

1) Alignment that limits the childs function or ability to participate in activities

2) Asymmetry of the legs and feet

3) Alignment that is quite different to what we would expect for that age group

4) Pain or discomfort


Most alignment of the lower leg will resolve with time and are consider a physiologically normal occurrence. Whilst this is true, we believe that some children could be better diagnosed earlier and simple strategies such as Footwear advice, Orthotic Therapy or dedicated Exercise program can be used to aid those children who do require a little support.

If you would like your child assessed, we would love to help you!

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