How are X- legs corrected?
There are several ways to correct knock knees. In addition to conservative therapy with shoe insoles on the inside of the shoe or physiotherapy, there are several invasive and non-invasive procedures: Firstly, the growth plate of the knee side is stiffened for a short period of time, as it grows too quickly. The growth plate is the part of the bone where bone growth occurs.
While it is already closed in adults, it is in a continuous process of growth and decay in children. A short-term stiffening has the consequence that the bone does not continue to grow at this point for a certain period of time. In the meantime, the outer side of the knee has time to grow back – because logically it is not stiffened.
In the best case, the result is a horizontal straightening of the knee joint. The disadvantage of this method is certainly that it impairs longitudinal growth. On the other hand, this procedure is not particularly large and can be performed quickly.
A stiffening of the growth plate can also be done permanently. Another surgical method is the removal of a piece of bone (usually from the iliac crest) and subsequent implantation in the “too short” side (in the case of the knock-knees, the outer side). This compensates for the “kink to the inside”.
It is not absolutely necessary, however, to remove a piece of bone; the extension can also be carried out using metal plates or screws. The great advantage of this operation is that patients are usually able to walk again one day after the operation (on crutches) and can do physiotherapy. In this way, the muscular apparatus can also adjust to the unaccustomed strain early on.
After such an “adjustment operation”, full weight-bearing of the knee is possible again after 2 months. The removal of the plates and screws is usually carried out 1.5 years after the operation, when the bone has grown back sufficiently. If performed in time, this type of surgery can achieve a great relief of pain and allow normal sports activity even in the long term (10 years and more).
In addition to the surgical procedures, there is the so-called leg axis training, which aims to correct the x-leg position by strengthening the surrounding muscles. Exercises such as knee bends to strengthen the thigh muscles, or self-control through exercises in front of the mirror, can also achieve a correction of the malposition under professional guidance. This is particularly suitable for adult patients in whom the process is already more advanced.
If the X-legs occur during the growth phase, no therapy is usually necessary. However, the affected children should be observed and the legs checked. If no spontaneous improvement of the X-legs has occurred after longer observation shortly before the end of growth or if the axial deviation is more than 20 degrees, surgical therapy may be necessary.
Several procedures can be used here: Even in the case of a rickets (vitamin D deficiency) caused deformation of the legs can regress spontaneously – provided the deformities are not too pronounced. If the legs are bent too much, the deformation can be further aggravated by the muscle tension. In children and adults, edge inserts in the shoes can somewhat compensate for the deformity.
In the case of the X-legs, the insides of the soles are reinforced so that the kinked foot can be compensated. The load in the knee joint is shifted laterally (outwards).
- (Wedge) Osteotomy (here a usually wedge-shaped piece of bone is removed to compensate for the oblique position)
- Temporary epiphysiodesis (here the growth plate (pineal gland) is temporarily stiffened so that the leg cannot grow any further)
- Definitive epiphysiodesis (in contrast to temporary epiphysiodesis, the growth plate is permanently stiffened)
Since knock-knees are a congenital malposition of the feet, other joints may also be affected over time.
Especially the knee joints, the hip and the spine can be affected by pronounced knock-knees in the long run. There are basically different procedures for the treatment of the knock-knees. Due to the foot malposition, there is increased stress in the area of the inner edge of the feet, while at the same time the stress on the outer edges of the foot decreases significantly.
Special insoles with raised inner edges can lift the foot and thus compensate for the malposition.However, these insoles cannot always prevent the impairment of other joints despite special inner rim elevation. The chances of success of this form of treatment depend on various factors. Above all, the severity of the knock-knees and the age at which the insoles are first worn play a decisive role in this context.
In general, it can be assumed that starting treatment as early as possible and wearing the insoles with an elevated inner rim can significantly increase the chances of success. Especially for older patients, the possibilities of insole therapy are quite limited. If wearing the insoles with elevated inner edges does not lead to a compensation of the knock-knees, an alternative treatment should be considered.
Depending on the severity of the foot malposition, the surgical removal of a part of the bone or the stiffening of the growth plate may be considered. Particularly in children who suffer from pronounced knock-knees, special exercises can also help to compensate for the causal foot malposition. Above all, a construction of the so-called abductors should help to stabilize the leg axis and thus counteract the long-term effects of bow legs.
The group of abductors includes those muscles that are located on the outside of the legs. The abductors of the foot itself can be stabilized by specific exercises and help to strengthen the ankle joint in general. In this way, the congenital foot malposition should be slightly compensated.
In addition, affected patients should perform special exercises at regular intervals to strengthen the vastus lateralis muscle. This muscle is also known as the external broad thigh muscle. From an anatomical point of view, however, the vastus lateralis muscle is not an independent muscle, but only one of the four heads of the large thigh muscle (Musculus quadrizeps femoris).
People who suffer from pronounced knock-knees can correct the malposition of the leg axis by specific exercises of this muscle. When performing the special exercises for correcting knock-knees, however, it must be remembered that abductors and vastus lateralis muscle must never be trained in isolation. In addition to these muscles, other muscle groups, such as the adductors of the inner side of the thigh, must always be developed.
Otherwise, there is a risk that the malposition of the leg axis will be shifted towards the bow legs. A shift of the leg axis in the direction of the bow legs can also lead in the long term to the impairment of various joints, for example the ankle joints, knee joints, hip and spine. Early surgery to straighten the axial malposition can prevent knee joint arthrosis.
The axial malposition on can be prevented depending on the cause. Corrections during growth can only be performed by epiphysiodesis. This is the sclerotherapy of a growth joint.
However, the prerequisite is that growth still exists. Through targeted unilateral sclerotherapy of a growth plate, the bowleg grows straight until the end of growth. In order to achieve the right time for the sclerotherapy and correct growth, the so-called bone age must be determined. From the bone age, the body size can be determined and the exact time of the epiphyseodes can be determined.
