If bowleggedness persists beyond ages 2 to 3 years, what is recommended?

• A. Further evaluation is needed, especially in African-American children
• B. Reassurance only
• C. Vitamin D supplementation only
• D. Immediate orthopedic surgery

Answer: (A)

Persistent bowing of the legs after age 2 to 3 years can signal a problem beyond normal variation. While mild bowing is common in early toddlers, if it persists as children grow, it suggests a pathologic condition such as Blount disease or other bone/metabolic issues that require assessment. The reason this is especially important to consider in African-American children is that Blount disease occurs more frequently in this group, so clinicians are particularly vigilant for it when bowing remains beyond the early years. The appropriate next step is to pursue further evaluation—careful physical exam, growth assessment, and imaging of the knees and legs—to determine the cause and guide management. Vitamin D supplementation or reassurance alone wouldn’t address a possible underlying orthopedic problem, and immediate surgery isn’t the first step without a clear diagnosis.