Malalignment of the Lower Extremity

Knock-knees and bow legs are common conditions that develop during a child’s normal growth and development. In most cases, children will outgrow either condition. Proper alignment of the knee is important for normal function and balance of the joint. In a properly balanced knee, the body’s weight is transferred evenly through the middle of the joint. When the knee is not balanced and perfectly straight, a knee injury can occur from a weight overload on one side. When our legs are not aligned straight at the hips, knees, and ankles, there can be an abnormal force across the knee. The pediatric orthopedic surgeon in Kenya, Col (Dr) Adari, offers the most comprehensive diagnosis and treatment options for children with bowlegs and knocked knees. Our orthopedic clinic in Nairobi, Kenya offers convenient and friendly services to allow natural, safe, and gradual correction of limb alignment.

Types of malalignment of the lower extremity

There are two types of malalignment of the lower extremity that can cause a knee injury. They are described below: Bow-legged is medically known as Genu Varum: Bow legs are a condition in which a person’s knees stay wide apart when they stand with their feet and ankles together. The majority of the body’s weight passes through the inside (medial) portion of the knee.

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Knock-kneed medically known as Genu Valgum: Knock knees are angular deformities at the knee, in which the head of the deformity points inward. The majority of the body’s weight passes through the outside (lateral) portion of the knee.

Symptoms of knock knees and bow legs

These knee conditions are often visually noticeable in patients standing or walking.

A slight degree of bowing or knocking is normal. But if your child exhibits any of the following, it is probably a good idea to visit pediatric orthopedics :

Excessive knee angle either inward or outward.
Unequal knee angles. While slight variation from one side of the body to the other is normal, a large difference between one leg and the other should be investigated.

More signs and symptoms include:

Pain or other complaint connected to the knee angle.
Bowlegs after 3 years of age. This is when children have the greatest amount of knock-knee alignment and, therefore, bowlegs would be abnormal at this time
Abnormal walking gait
Knees are constantly touching/rubbing against each other, but ankles don’t.
The distance between the ankles when standing straight up is more than 3 inches (8 cm)
Knock knees at an angle more than 15 degrees
Inwardly / outwardly curved legs

What are the causes of knock knees and bow legs?

BOW LEGS (Genu Varum)

Because of their folded position in the uterus, normal children are born bowlegged. This actually increases until the age of 18 months, and then the legs straighten as the child grows.

Bowleg can be caused by Rickets (a metabolic disorder), Blount’s Disease, trauma, a fracture healing incorrectly, and genetic bone growth abnormalities.

When it is not a part of normal development or due to trauma, is a symptom of a disease and not a disease itself.

KNOCK KNEES (Genu Valgum)

By the time a child reaches age three or four, they develop a knock-kneed configuration, in which their legs angle inwards.

The knock-kneed pattern straightens by about age six.

There are several potential causes of knock knees, including metabolic bone disorders and genetic disorders.

Medical causes of knock knees and bow legs

Obesity: It can lead to ligaments in the knee becoming loose due to the excessive amount of pressure on the knees.
Injury or illness affecting the leg or knee
Knee arthritis: Osteoarthritis is the most commonly seen arthritis that will lead to changes in the curvature of your legs.
Rickets: This is caused by a deficiency in vitamin D, phosphate, and calcium. This nutritional condition makes your bones become soft and weak.
Blount’s Disease: This is a condition that causes abnormal growth in the lower leg bone called the tibia or shin bone.
Scurvy: this condition is a result of vitamin deficiency. In rare cases, these conditions may continue into adolescence. In other cases, older children may develop it as a result of an underlying disease or condition.

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Diagnosis of knock knees and bow legs

These conditions are not typically diagnosed in young children, as the condition is common in early development. In older children and adults, an orthopedic surgeon will diagnose the cause of the knock knee and bow legs. The cause will determine if any treatment is needed to correct the condition. To formally diagnose these conditions, a doctor would need to look at a person’s medical history by asking questions in order to get information about family history and any other known pre-existing conditions that might cause the conditions

The main way orthopedic surgeons diagnose bow legs or knock knees is through a physical exam. In addition, X-rays and blood tests may be taken when needed to get more information about the knee joint and identify all underlying problems accurately.

If the doctor feels that your child’s bowed legs or knock-knees are a normal variation, no treatment is usually needed.

Depending on your child’s age, the orthopedic surgeon may recommend follow-up to make sure his or her leg alignment improves over time.

Knock Knees & Bow Legs Treatment

If the bow-leggedness is caused due to vitamin deficiency, the pediatric orthopedics will prescribe the required supplement. The skilled pediatric orthopedists may treat bow-leggedness with physical therapy, braces, or corrective shoes also known as orthotics. When a brace is used, it is attached to the individual’s shoes; the braces are used in order to attempt to straighten their knees so that they are able to touch their ankles and have their legs completely straight. Knock knees get cured as the child grows. But often the child is recommended to take adequate calcium and vitamin D supplements to eliminate symptoms of knock knees fully.

Exercises for knock knees and bowlegs

Exercises aim to strengthen the legs so that the knees become more stabilized and realign themselves. The doctor will put together an exercise program that should be performed routinely each day.

Since these conditions are usually linked to lower body posterior chain muscles (gluteus medius) the exercises will focus on strengthening these muscles.

Some exercises include hamstring exercises, lateral walks with ankle weights, side lunges, side step-ups, and knee presses.

Surgical Treatment with Col (Dr) Adari

In cases where knock knee follows someone into adulthood, surgery might be an option to repair their legs.

Surgery is only performed when the conditions of the bone disease are severe and persistent. There are two types of surgeries that are commonly used to treat knock knee.

One of the types is called “guided-growth” which involves stopping the growth on the bent part bone on the inside of their knee from showing. This can be done by placing a small metal device inside the knee, and it usually takes 12 months for correction to fully occur.

The second surgery option is called an osteotomy which involves the cutting and straightening of the bone in the leg in order to correct the angle of the knee.

When this is completed, the knee has a different amount of weight on it which can help the condition.

Surgical correction can help treat the deformity. With this minimally invasive treatment, your leg can be realigned. As a result, you’ll feel less pain, look better, and have healthier knees. At Orthobridge Orthopedic Centre in Nairobi, Kenya, we would like to see you spend more time walking, running, and doing more of the physical activities you enjoy.

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