Bowed Legs? Why Rickets Softens Bones and What to Do Next

If you've noticed bowed legs in a child—or leg pain, weakness, or delayed growth—you may be wondering about rickets. While bowed legs can have several causes, rickets is one of the most well-known and medically significant.

The good news: rickets is treatable, especially when caught early. The key is understanding what it is, why it happens, and what steps to take next.

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What Is Rickets?

Rickets is a condition that affects bone development in children. It happens when bones do not get enough of certain nutrients—most often vitamin D, calcium, or phosphate. Without these nutrients, bones cannot properly mineralize (harden). As a result, they become soft and weak.

Because children's bones are still growing, soft bones can bend under normal body weight. This is why bowed legs are a classic sign of rickets.

In adults, a similar condition is called osteomalacia.

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Why Does Rickets Soften Bones?

Healthy bones depend on a steady balance of:

• Vitamin D
• Calcium
• Phosphate

Vitamin D helps the body absorb calcium from food. Without enough vitamin D, calcium levels drop. When calcium or phosphate levels are too low, bones cannot properly harden.

Instead of being strong and rigid, bones become:

• Soft
• Flexible
• Structurally weaker

Over time, normal activities like standing and walking can cause bones to bend.

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What Causes Rickets?

Several factors can lead to rickets. The most common include:

1. Vitamin D Deficiency

This is the leading cause worldwide. Vitamin D comes from:

• Sunlight exposure
• Certain foods (fatty fish, fortified milk)
• Supplements

Children at higher risk include:

• Those with limited sun exposure
• Infants exclusively breastfed without vitamin D supplementation
• Children with darker skin (which reduces vitamin D production from sunlight)

2. Poor Dietary Intake

Low intake of:

• Calcium
• Vitamin D
• Phosphate

can contribute to rickets.

3. Medical Conditions

Certain health problems interfere with nutrient absorption or balance, such as:

• Celiac disease
• Inflammatory bowel disease
• Kidney disorders
• Genetic disorders affecting phosphate metabolism

These forms are less common but may require specialized treatment.

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Signs and Symptoms of Rickets

Bowed legs are often the most noticeable sign, but rickets can affect the whole body.

Bone Changes

• Bowed legs
• Knock knees
• Thickened wrists or ankles
• Soft skull bones in infants
• Delayed closure of fontanelles (soft spots)

Growth and Development Issues

• Delayed growth
• Delayed walking
• Short stature

Pain and Weakness

• Bone pain (especially in legs, pelvis, spine)
• Muscle weakness
• Fatigue

Dental Problems

• Delayed tooth eruption
• Weak enamel

Symptoms often develop gradually. Some children may only show mild signs at first.

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When Bowed Legs Are Not Rickets

It's important to know that not all bowed legs mean rickets.

Many toddlers naturally have some bowing as part of normal development. In most cases, this corrects on its own by age 3–4.

However, bowing is more concerning when:

• It worsens over time
• One leg is more bowed than the other
• The child has pain
• Growth is delayed
• There are other signs of nutrient deficiency

If you are unsure, a medical evaluation is important.

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How Is Rickets Diagnosed?

A doctor may evaluate:

Medical History

• Diet
• Sun exposure
• Growth pattern
• Family history

Physical Exam

Looking for:

• Bone deformities
• Growth delays
• Muscle weakness

Blood Tests

To measure:

• Vitamin D levels
• Calcium
• Phosphate
• Alkaline phosphatase (often elevated in rickets)

X-rays

X-rays can show classic signs of soft bone near growth plates.

Early diagnosis helps prevent permanent bone deformity.

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Treatment for Rickets

The treatment depends on the cause, but most cases are highly treatable.

Vitamin D and Calcium Supplementation

For deficiency-related rickets, treatment often includes:

• High-dose vitamin D (under medical supervision)
• Calcium supplements if needed

Improvement can begin within weeks.

Dietary Changes

Encouraging:

• Fortified dairy or alternatives
• Fatty fish
• Eggs
• Vitamin D–fortified cereals

Sunlight Exposure

Safe sun exposure (as recommended by a doctor) can help boost vitamin D levels.

Treating Underlying Conditions

If rickets is due to a medical disorder:

• Kidney disease may require specialized therapy
• Genetic forms may need phosphate supplements or other medications

Severe Deformities

In advanced cases, braces or surgery may be needed to correct bone alignment—but this is less common when treated early.

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Can Rickets Be Prevented?

Yes, in most cases.

Prevention Tips

• Ensure adequate vitamin D intake
• Follow pediatric guidance for infant supplementation
• Provide a balanced diet with sufficient calcium
• Encourage safe outdoor activity

Breastfed infants often need vitamin D drops, since breast milk may not provide enough on its own.

Prevention is especially important in regions with limited sunlight.

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What Happens If Rickets Is Not Treated?

Untreated rickets can lead to:

• Permanent bone deformities
• Chronic pain
• Growth problems
• Increased fracture risk
• Dental complications

In rare severe cases, dangerously low calcium levels can cause:

• Seizures
• Heart rhythm problems

This is uncommon but serious. Prompt medical care prevents these outcomes.

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Should You Be Concerned?

If you notice bowed legs or symptoms suggestive of rickets, try not to panic. Many cases are mild and reversible.

However, you should not ignore persistent bone changes or pain.

Consider your next steps:

• Monitor symptoms
• Review diet and vitamin D intake
• Schedule a medical evaluation

You might also find it helpful to use a free Osteomalacia / Rickets symptom checker to see if your child's symptoms match this condition and get personalized guidance before your doctor's appointment.

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When to Speak to a Doctor Urgently

Seek medical care promptly if there is:

• Severe bone pain
• Difficulty walking
• Muscle weakness interfering with daily activities
• Seizures
• Signs of very low calcium (muscle cramps, tingling, irregular heartbeat)

These situations require immediate medical evaluation.

Even if symptoms seem mild, it's wise to speak to a doctor about persistent bowed legs, growth delays, or nutritional concerns. Early treatment can prevent long-term complications.

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The Bottom Line

Rickets is a condition that softens bones in children, most often due to vitamin D deficiency. Bowed legs are a common sign, but rickets can also cause bone pain, delayed growth, and muscle weakness.

The condition is:

• Common in certain risk groups
• Usually treatable
• Often preventable

The most important step is recognizing the signs and taking action early. With proper medical care, most children recover well and go on to develop strong, healthy bones.

If you are concerned about bowed legs or symptoms related to rickets, don't guess. Use reliable tools, review your child's diet and sun exposure, and most importantly, speak to a doctor to ensure proper diagnosis and treatment.