GP FAQ: Limb variants in young children

‘A 2 year old child was brought in by her parents because the she was tripping and falling when walking.  On examination of her legs, there was obvious bow-leggedness.’

In this case, internal tibial torsion should be considered.

This is seen in 1-3 year-old children and is characterised by internal rotation of the tibia.  The child’s foot and knee may not be in alignment and this usually comes to attention when the child learns to walk and is noticed to trip and fall frequently.

If internal tibial torsion is found, parents can be reassured that this is a normal variant and should resolve by four years of age.

Other, more serious diagnoses should be excluded such as hip abnormalities, hyper-mobile joints and rickets.

The article Normal lower limb variants in children by Andrea Yeo, Kyle James and Manoj Ramachandran gives an overview of normal lower limb variants in children:


Yeo, A et al. Normal lower limb variants in children. BMJ.

Toolbox- The Beighton Score, Dr Alan Hakim.

Image: Gabby Orcutt on Unsplash