X-legs are a result of a congenital deformity of the feet that can be corrected in moderation. If left untreated, knock knees can lead to discomfort.
What are knock knees?
The term X-legs refers to a specific type of angulation of the legs compared to a normal straight position. There are two forms of angulation, namely the vagus position, meaning bowlegs, and the valgus position, also known as knock-knees. In the latter position, the upper and lower legs are at an angle greater than 186 ° when viewed from the knee joint.
Causes
The causes of knock-knees are not considered to be congenital, but are thought to arise indirectly from a malalignment of the feet, which is, however, congenital. In children, knock knees are common and “grow back together”. However, there are also forms of knock-knees that result from a congenital weakness of the connective tissue. However, a deformation of the bones can also – in contrast to the above-mentioned opinion – definitely be congenital. Such deformities are the so-called bent-lower foot, in which, as the name suggests, the foot is in a position that is slightly bent outward laterally. In addition, the foot is lowered in such a deformity, which means that it lies flat on the ground, since the natural cushioning of the foot is not effective in the deformity. As a result, the legs are in an awkward position relative to the knee. Due to the “lever-like” effect of the lower leg on the knee, the growth of the leg is impaired, and later on, knee problems and hip problems may occur. One cause may be untreated rickets in childhood. In rickets, the bones do not harden properly and become deformed because they cannot fully support the body weight. The cause of rickets, in turn, may be a deficiency of the fat-soluble vitamin D. In the past, children were therefore given the unpopular cod liver oil. Rickets can also be caused by a lack of phosphatase. This is called hypophosphatasia. The whole thing can lead to arthrosis of the knee joint, a so-called gonarthrosis. In addition, with knock-knees, the femur joint is subjected to greater stress and thus also the outer meniscus. This can then also lead to lateral arthrosis. Other causes of knock knees include bone fractures, hormonal changes during menopause and also obesity.
Diagnosis and course
The diagnosis is made on the basis of the appearance and with the help of a so-called treadmill. In the case of osteoarthritis, X-ray technology is also used. The latter also applies to the mild forms of knock knees, which are difficult to detect from the outside. But a diagnosis can also be made on the basis of various complaints that are common with knock-knees. Here, discomfort at the knee joint is most likely to show up. This process can develop insidiously and will produce complaints of the arthritic variety. In addition, hip joint problems may indicate an X-position of the legs. The orthopedist can also tell if there is a tendency to have knock-knees by looking at a deformity of the feet. If the diagnosis is made at a young age, the course can still be best influenced.
Complications
As a rule, knock knees have a very negative effect on the quality of life of the affected person. In this case, the patients suffer from very severe movement restrictions and thus severe limitations in their everyday life. Furthermore, this can lead to teasing or bullying, especially in children or young people. As a result, many patients also suffer from depression or psychological upsets. Performing strenuous activities or sports is also not possible for the patients without further ado. This also significantly restricts child development. The knock-knees also cause considerable damage to the joints in the knees, which can lead to osteoarthritis. Bone fractures also occur more frequently, so that those affected have to protect themselves more from accidents and other dangers. As a rule, knock-knees can be treated relatively well with the help of surgical interventions. The earlier the operation is performed, the better the chances of complete recovery. Complications do not occur. However, patients are still often dependent on examinations and the wearing of orthotics.The knock knees do not negatively affect the patient’s life expectancy.
When should you see a doctor?
X-legs are a visual change in body shape in direct comparison to the norm. Nevertheless, they do not represent any disease value in a large number of those affected. Provided there are no other complaints or impairments in locomotion, no doctor is needed. A doctor should be consulted if there are physical or mental irregularities as well as states of distress. In case of emotional distress due to the visual defect, the affected person needs therapeutic help and support. Dealing with the abnormalities should be learned so that no psychological sequelae or diseases develop. If irregularities in locomotion occur during the child’s growth process, a doctor should be consulted. In the event of pain, gait instability or poor posture, the symptoms should be clarified and examined. A doctor’s visit is advised to prevent long-term damage as well as to prevent uneven posture. If physical activities can only be performed with great effort or if irregularities of the muscular system become apparent, the abnormalities should be discussed with a doctor. If the physical resilience decreases or there are complaints of the joints, medical help should also be sought. The sooner the changes in the skeletal system are discussed with a doctor, the sooner regulatory measures can be taken. Therefore, especially in the case of knock-knees, it is recommended to clarify the development as early as possible.
Treatment and therapy
If X-legs become apparent during the growth phase, therapy is rarely necessary. However, if there is still an axial deviation of more than 20 ° during puberty, surgery may be necessary. There are several options for this:
- One surgically removes a small piece of bone to correct the misalignment.
- One temporarily stiffens the growth plate to stop the leg from growing any further.
X-B adjustment caused by rickets can regress on its own if the deformity is not too pronounced. In the latter case, the muscles will increase the angle to the outside. Another treatment option is to have insoles made for the shoes to correct the foot position a little. In the case of knock-knees, this is done by reinforcing the inside under the respective foot. The knee joint is then loaded more in the outer direction.
Prevention
For the prophylaxis of knock-knees, basically only an operation against the malposition would be possible. Furthermore, if growth is not yet complete, the growth plate can be sclerosed. For this purpose, the bone age must then be determined.
Aftercare
Follow-up care is necessary if the knock knees have been corrected as part of a surgical procedure such as a conversion osteotomy. Following surgery, the patient must remain in the hospital for approximately four to five days. If there are no complications, such as pronounced swelling, during this period, he or she may return home. During the first two to three weeks after the corrective osteotomy, the treated leg must be consistently spared. This means that only loads of no more than 20 to 30 kilograms are allowed. For support, the patient uses forearm crutches for about four to six weeks. Nowadays, stable-angle plate systems are used during the operation, so that the leg can be fully loaded after only three weeks, although this also depends on the individual course of healing. Targeted physiotherapy plays an important role in the aftercare of knock knees. The patient performs special physiotherapeutic exercises that accelerate the healing process. Later, light sports activities such as swimming or cycling are possible again. In younger patients, surgical removal of the inserted metal plates can be performed. However, many patients do not wish to have them removed at all, as the plates do not cause them any problems. After three to four weeks, the patient may return to office work. For heavy physical work, the waiting period is usually three months.
Symptoms, complaints and signs
X-legs are easy to recognize externally.In this case, the legs are shaped like an X and are no longer in the optimal position in relation to the knees. The child then suffers from growth disorders in the legs. Toddlers often also suffer from a bent flat foot. In addition to the knock-knees, in this case the feet are slightly bent outwards so that they lie flat on the ground. As a result, their cushioning to the floor is no longer optimal. Often, the deformations of the legs are so slight that they grow out on their own. Deviations of up to five degrees are still considered normal. Deformities begin at five degrees of deviation. In severe cases, however, surgical intervention is often necessary to correct the deformities. This is the case when the axis of the legs deviates by more than 20 degrees. In mild cases, the knock knees in children and adolescents can often be corrected with the help of physical training. In addition, special shoe inserts often support the correction of the malposition. In adulthood, knock knees are caused by various factors. Often, overweight leads to this. But also tumors and hormonal changes can sometimes contribute to a deformation of the legs. People with knock-knees often suffer from knee pain because of constant inflammation there. In the severe forms, arthrosis can develop.
This is what you can do yourself
In everyday life, general locomotion and gait can be consciously controlled and optimized. Several times during the day, the movement patterns should be reflected and changed if irregularities occur. This is necessary to achieve long-term improvement. Training units or exercises learned in physiotherapy can be performed independently and on one’s own responsibility at any time. Lifting and carrying heavy loads can cause particular strain on the skeletal system. Therefore, especially these movements should be adapted to the needs of the organism. Wearing an optimal footwear it essential to achieve relief of existing irregularities as well as not to trigger deterioration of the overall situation. Therefore, flat and closed shoes should be worn. These should not be too heavy and should be made of materials that are comfortable and permeable to air. To alleviate emotional discomfort, the choice of clothing can help. Pants with a wide leg cut and made of loose-fitting material help to conceal the appearance of the legs. This can trigger an improvement in overall well-being, thereby reducing cognitive stressors. In the long run, support and stabilize self-confidence. As long as the knock knees do not lead to any physical discomfort, it is helpful to reduce the mental state of mind. This leads to an overall improvement in the general quality of life.
