Malalignment of the Lower Extremity
The knee is a crucial component of the leg. When a knee is not aligned properly in the leg axis (the line extending from the center of the hip joint to the middle of the ankle joint), it is referred to as malalignment of the lower extremity.
In order for your leg to function normally and for the balance of the knee joint, it is important that the knee is properly aligned. When the knee is properly balanced, the body’s weight is distributed evenly through the middle of the joint. When the knee is not straight and balanced, it could result in a knee injury due to one side of the body being overloaded with weight.
There are two types of malalignment in the knee, which are called varus and valgus. To most people, however, they are more commonly known as bow-legged and knock-kneed.
- Bow-legged (varus): This is a condition where a person's legs appear bowed out, meaning their knees stay wide apart even when their ankles are together. It occurs when the majority of the body’s weight passes through the inside (medial) portion of the knee. Overuse and obesity can worsen this condition.
- Knock-kneed (valgus): This is a condition where the knees are abnormally close together and the ankles are spread widely apart. It occurs when the majority of the body’s weight passes through the outside (lateral) portion of the knee.
Common problems that can occur due to either of these two malalignments may include osteoarthritis, meniscal tears (the back of the knee), ligament tears, and cartilage injury.
Malalignment of Lower Extremity Symptoms
Malalignment tends to be more visually noticeable in patients when they are standing or walking. Not all people with malalignments experience symptoms and therefore do not require treatment.
When symptoms are present, the most common one is pain, especially if the condition is left untreated and injury occurs. Other symptoms associated with malalignment may include swelling, inflammation, and stiffness.
Malalignment of Lower Extremity Diagnosis
In order to diagnose malalignment of lower extremity, your SROSM orthopedic specialist will perform a physical exam to evaluate the knee’s balance and any knee injuries that may have occurred. This includes looking at how weight is distributed and how balanced the knee appears when you are standing. Often times, full-length standing X-rays will also be needed in order to determine the extent of the condition as well as the best method of treatment.
Treatment for Malalignment of Lower Extremity
Some patients who are diagnosed with a malalignment can be treated without surgery. Common nonsurgical treatment may include:
- Modifying activities
- Losing weight
- Working with a physical therapist
- Taking nonsteroidal anti-inflammatory medications (NSAIDs)
- Wearing a knee brace
If non-surgical methods do not work or if a knee injury is associated with the malalignment, your SROSM specialist may recommend surgery. There are various surgical options, which include:
In osteotomy, a wedge is taken out of the bone on the healthy side to allow the alignment of the bone to be corrected. Once the malalignment of the lower extremity is corrected, the bone is fixed with a plate and screws. A bone graft is also used to facilitate healing.
Your SROSM surgeon will review these surgical options with you and decide on the best course of action that will suit your desires and lifestyle.
After surgery, you may be required to keep your knee immobilized for a period of time by wearing a brace. Crutches may also be needed to help minimize weight on the knee. After a few weeks of immobilization, your SROSM surgeon will start you on a physical therapy program so you can regain motion and strength in your knee and surrounding muscles.