Bow and Knocked knees

Lateral bowing [bowleg – genu varum]

  • Normal in < 2y old: resolves by 3y
  • Often with out-toeing [maximum @ 1y]
  • Check – intercondyal distance [<6cm], vegetarian [rickets], knees should be symmetrical, stature [short is red flag], pain
  • Consider – Rickets, scurvey, paget’s, Blount’s disease [severe bowing in black children]

Anterior bowing

  • Always significant – absence of fibula, NF-T1, oesteogenesis imperfecta

Knock-knee [genu valgum]

  • Normal @ 2-4y: resolves around 7y
  • Often with in-toeing [maximum @ 4y]
  • Check – inter-malleolar gap [ <10cm @ 4 is normal], vegetarian [rickets], knees should be symmetrical, stature [short is red flag], pain
  • If severe – exclude rickets

Information: http://www.tsrhc.org/downloads/pdf/bowedlegs.pdf