Bowed Leg (Varus) and Knock-Knee (Valgus) Malalignment

Leg malalignment, often called “bowed legs” or “knock-knees”, can cause knee pain and limitations. The medical terms for these conditions are varus (bowed legs) and valgus (knock-knees). Leg malalignment is frequently seen in very young children and is usually corrected naturally with growth and physical maturation. In adults, malalignment may occur to one or both legs and be either a congenital disorder or happen as a result of a knee injury.

Varus (bowed leg), the more common condition, may cause pain in the inner (medial) area of the knee. Knee symptoms may be worsened with obesity or overuse of the knee joint, and may become serious if the medial meniscus (cartilage) tears and is removed. Valgus malalignment (knock-knee) may cause pain in the outer (lateral) area of the knee and can worsen upon removal of the lateral meniscus. Arthritis may occur because there is an abnormal amount of stress and pressure placed on just the inner (varus) or outer (valgus) part of the knee joint. A good analogy to this problem is the wearing of part of a car’s tire that is out of alignment. If the alignment is not fixed, the tire will wear out on one side, shortening its lifespan.

Fortunately, operations exist for younger active patients who have painful arthritis in one portion of the knee due to malalignment. An operation called an osteotomy may be performed in which bone in either the femur (thigh bone) or tibia (shin bone) is cut and the leg is properly aligned by the surgeon. The operation commonly done for varus malalignment is called a high tibial osteotomy. Valgus malalignment is corrected with an operation called a distal femoral osteotomy. Osteotomy may be performed in patients who have some arthritic damage to one area of the knee joint, but is not indicated in individuals who have severe damage, widespread arthritis, or when a “bone-on-bone” situation exists in which little or no joint space is left between the femur and tibia. In these patients, either a partial knee replacement or total knee replacement is the better option. Osteotomy is frequently required to restore proper alignment to the lower limb before other operations may be done, such as a meniscus transplant or cartilage restoration procedure.

Currently, no eBooks exist that provide detailed information on osteotomy for varus or valgus malalignment. After treating patients for nearly 4 decades with knee problems, we decided to write this eBook to try to help individuals understand treatment options and what to realistically expect if they decide to undergo surgery. This eBook provides information on basic knee anatomy, what causes lower limb malalignment, the process of arthritis in the knee, the factors that go into deciding whether or not to have an osteotomy, how the operations are performed, success rates in terms of pain relief and increased function, how to prepare for surgery, and physical therapy required after surgery. In addition, exercises to do at home and in a fitness club are described in detail.

About Sue Barber-Westin

Sue Barber-Westin has been a member of the Cincinnati Sportsmedicine Research and Education Foundation staff since its establishment in 1985 and serves as Director of Clinical and Applied Studies. She has co-authored over 120 articles in peer-reviewed medical journals and textbooks, focusingon the clinical outcome of various knee operative procedures and on neuromuscular indices in young athletes. Sue is the associate editor, along with editor Dr. Frank Noyes of the orthopaedic textbook, “Noyes Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes” published in 2009. In 2004, Sue and Dr. Noyes were members of the research team that won the Clinical Research Award from the Orthopaedic Research and Education Foundation, the highest clinical research honor bestowed annually in orthopaedics.