Proper leg alignment is necessary for distributing weight evenly across the joints, which minimizes stress and ensures efficient movement. This alignment is defined by the mechanical axis, an imaginary straight line running from the hip joint down to the ankle joint. When the bones are misaligned, the body’s weight-bearing line shifts, increasing the load on specific joint compartments and potentially leading to pain or premature wear. Alignment issues are common, often developmental, and can be successfully managed or corrected.
Common Types of Leg Misalignment
The most frequently encountered structural issues involve angular deformities at the knee joint. Genu varum, commonly known as bow legs, describes a condition where the knees angle outward, creating a noticeable gap between the knees when the feet are together. This misalignment places excess compressive force on the inner (medial) compartment of the knee joint. While often a normal physiological phase in toddlers, genu varum can persist due to underlying conditions like Rickets or Blount’s disease.
The opposite condition, genu valgum or knock knees, is characterized by the knees touching while the ankles remain separated. This inward angle shifts the mechanical axis, overloading the outer (lateral) compartment of the knee joint. Genu valgum is also common during childhood, usually peaking around age three and correcting itself by age seven to nine.
Beyond angular deviations, rotational issues also affect the orientation of the foot during gait. In-toeing, or “pigeon-toed” walking, can be caused by an inward twist in the thigh bone (femoral anteversion) or the shin bone (internal tibial torsion). Conversely, out-toeing involves the feet pointing outward, often due to external tibial torsion or hip rotation. Most rotational issues are developmental and correct naturally, but persistent cases require evaluation.
Corrective Measures Without Surgery
Non-surgical interventions aim to improve biomechanical function, particularly in children with open growth plates or in adults with mild to moderate alignment issues. Physical therapy (PT) is a primary treatment modality, focusing on strengthening muscles that control the pelvis and hip, which form the foundation for the rest of the leg. Weak hip abductors, such as the gluteus medius, often contribute to genu valgum by allowing the knees to collapse inward. Therapy programs include specific exercises like side-lying hip abduction, clam shells, and squats with resistance bands to stabilize the hip and pelvis. Core stability training supports optimal lower extremity mechanics.
Orthotic devices, particularly custom-made insoles, address alignment from the ground up by supporting the foot’s arch and controlling excessive pronation or supination. Overpronation, where the foot rolls excessively inward, can contribute to a functional knock-kneed posture. Insoles designed for this condition feature firm arch support and a deep heel cup to guide the foot into a more neutral position.
For children with significant developmental angular deformities, specialized bracing or casting may be utilized to help guide bone growth. These devices, sometimes worn at night or during rest, apply external pressure to the long bones, such as the femur or tibia, to modulate their shape over time. While bracing is sometimes used for conditions like Blount’s disease (a progressive genu varum), its effectiveness for common physiological alignment variations is not universally supported by controlled studies.
Simple lifestyle adjustments can reinforce proper alignment in daily life. Maintaining a “soft” knee position by avoiding hyperextension (locking the knees) helps distribute forces more evenly across the knee joint. Appropriate footwear, featuring a supportive arch, adequate cushioning, and a slight heel (about one centimeter), supports the foot’s natural function. Practicing good postural habits, such as avoiding crossing the legs while sitting, also helps maintain proper hip and pelvic alignment.
Surgical Options for Advanced Correction
When severe leg misalignment causes significant pain, functional limitation, or is unlikely to resolve conservatively, surgical intervention is necessary. Osteotomy is a procedure used primarily for skeletally mature adolescents and adults to correct mechanical axis deviation. The surgeon precisely cuts and realigns a long bone, typically the tibia or femur, to relieve pressure on the damaged compartment of the knee joint.
The corrected alignment is fixed using metal plates and screws while the bone heals. For example, a high tibial osteotomy (HTO) corrects genu varum by shifting the weight-bearing line from the worn inner knee compartment to the healthier outer compartment. Full bone healing typically takes around 12 weeks, and a full return to activities takes six to 12 months.
For children and adolescents whose growth plates are still open, guided growth is often the preferred, less invasive method. This technique, also known as temporary hemiepiphysiodesis, uses a small tension-band plate or screws to temporarily slow growth on the convex side of the growth plate (physis). This allows the concave side to continue growing normally, gradually straightening the bone.
This differential growth occurs over 10 to 28 months, depending on the deformity and the child’s growth rate. Guided growth is minimally invasive; patients are usually discharged quickly and can return to most activities within two to four weeks. Once correction is achieved, a second minor surgery removes the plate, allowing normal growth to resume.