e Knie - Fehlstellungen - ECOM - Praxis für Orthopädie, Sportmedizin & Unfallchirurgie

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Fehlstellungen der Beine

EXPERTS FOR MISALIGNMENT OF THE LEGS

For those affected, knock knees and bow legs are not just a visual flaw – the joints are also extremely painful and increasingly prone to osteoarthritis.

The experts at ECOM® Excellent Center of Medicine specialise in the treatment of axial misalignments of the legs (knock knees and bow legs).

WHAT IS AN AXIAL MISALIGNMENT OF THE LEGS?

Bowlegs and knock-knees are both characterised by knee malalignment. If a knock-knee (genu valgum or valgus position) is present, the angle of the lower leg to the centre of the body is more than 185°. This appearance is also known as angulation.

With bow legs (genu varum), on the other hand, the legs are wide apart at knee height – this means that the knees do not touch even when the legs are closed.

HOW DO THESE MALFORMATIONS DEVELOP?

Both knock knees and bow legs are congenital in rare cases. The deformities usually appear during childhood, often as a result of a vitamin D deficiency in infancy. Vitamin D, which is produced by the body itself, is essential for healthy bone growth. If there is a deficiency of the vitamin – for example due to a hereditary disorder or as a result of insufficient sunlight – the bones do not become sufficiently hard. They are therefore unable to support the growing weight of the person affected, so that bow legs or knock-knees develop over the years. The deformities usually become apparent between the ages of one and five.

In addition, knock knees and bow legs can be the result of bowed or fallen arches. In such a case, the feet are at an angle to the knees – the misalignment of the feet thus causes an additional misalignment of the knee joints in the long term.

In adulthood, knock knees and bow legs occur almost without exception as a result of accidents or after years of sitting in a certain position. A classic example is the rider who develops significant bow legs as a result of regularly sitting on a horse.

Other, but rather rare, causes of malalignment of the knee joints include

– Metabolic disorders of the bone (hypophosphatemia)

– Ulcers

– Hormonal disorders

– Inflammation

– Overweight (obesity)

WHAT ARE THE SYMPTOMS OF X-LEGS AND O-LEGS?

Bowlegs and knock-knees are generally regarded as a cosmetic defect. However, those affected also suffer from joint pain, which can worsen in the cold and rain or when the weather changes. They also suffer from poor posture, which has a detrimental effect on other joints (e.g. the hip joint). The uneven strain on the joint structures causes disproportionate wear and tear on the cartilage, bones and menisci. This increases the risk of osteoarthritis of the knee joint (so-called gonarthrosis) or meniscus damage. In children, growth is also often impaired.

HOW ARE X-LEGS AND BOWLEGS DIAGNOSED?

Bowlegs and knock-knees cannot always be recognised at first glance. Especially when the deformity is not yet particularly pronounced, the gait pattern is often completely unremarkable. This makes it all the more important to have children regularly examined by a doctor so that measures can be taken at an early stage. The doctor can carry out various measurements and confirm the diagnosis with the help of an X-ray.

HOW ARE X-LEGS AND O-LEGS TREATED?

It is advisable to pay attention to any malpositions in children and to take advantage of the regular preliminary examinations by the paediatrician. The malpositions are usually only observed, as spontaneous deformities can occur. In the majority of cases, shoe inserts, night splints or physiotherapy treatment also help. If these measures are not sufficient, surgery (osteotomy) can be considered – but only at the end of the growth phase. Correcting the misalignment is crucial in order to avoid long-term damage to the joints, which can be accompanied by lifelong knee pain. Without treatment, this leads to permanent incorrect loading of the joints and those affected develop severe osteoarthritis from the age of 30.

ACTIVE AGAINST X-LEGS AND BOWLEGS: TRAINING AND ORTHOSES

Special gymnastic exercises – known as leg axis training – can help to ensure that existing deformities at least do not worsen. They can also help to reduce discomfort and other impairments. Exercises must be supervised by a trained physiotherapist – however, patients are usually also instructed in gymnastic exercises that can be performed at home.

Common exercises for leg axis training are, for example, special squats, which pay particular attention to the position of the legs and serve to strengthen the thigh muscles in particular. The one-legged stand is also a simple method of training strength, coordination and balance. The one-legged stand can be varied in many ways – for example by using a soft surface. For self-monitoring, it is best to perform the exercises in front of a mirror.

Orthoses are another option for treating knock knees and bow legs. These are used in particular for adults in whom the deformity has not been corrected at an early stage. The deformity is not corrected by an orthosis – but the targeted support and parallel strengthening of the leg can lead to a significant reduction in pain. Without an orthosis, however, the risk of the deformity worsening further increases.

For this reason, it is important to have deformities treated as early as possible! The earlier knock knees and bow legs are treated, the better the chances of success that those affected will be able to enjoy a largely pain- and discomfort-free everyday life. Parents in particular should therefore have their children medically examined at regular intervals. But there is also hope for adults, as the negative effects of knee malalignment can be significantly reduced thanks to modern aids.

SUMMARY

Definition
Malalignment of the knees which results in the legs not being parallel but bent outwards or inwards.

Causes
The most common cause of impaired bone growth is a vitamin D deficiency in childhood. However, a twisted or fallen foot, accidents or other pre-existing conditions can also trigger the condition.

Symptoms
In addition to the obvious deformity, secondary conditions can develop, such as joint pain and sensitivity to the weather, postural problems, knee osteoarthritis, meniscus damage and growth disorders in children.

Diagnosis
The doctor will carry out various measurements and an X-ray will show the corresponding deformity.

Treatment
Insoles, night splints and physiotherapy can already contribute to improvement. In severe cases, surgery in the form of an osteotomy is recommended. Osteotomy is the surgical cutting of bones or the removal of bone fragments to correct joint misalignments.

Active participation
Physiotherapy prevents aggravation and relieves pain. Typical exercises include special squats and the one-legged stance.

YOUR SPECIALISTS

“Minimally invasive surgical procedures and regenerative treatment methods get patients back to sport and everyday life quickly.”

“The patient is often in a state of emergency. Targeted diagnosis and individualised therapy are the key to successful treatment”.

FOR QUESTIONS ABOUT MISALIGNMENT OF THE LEGS

Do you have questions about treatment and therapy for knock knees and bow legs? Our specialists Dr Erich Rembeck and Dr Alexander Rauch will be happy to provide you with detailed information and advice in a personal consultation.
Simply make an appointment. We look forward to seeing you.

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