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Varus position of the knee: bow legs
If one, which is medical expression Genu varum, are also known as the varus position of the knee. With a healthy leg, the load axis runs exactly in the middle through the knee joint. In the case of bow legs, the knee joint deviates outwards in relation to the load axis. We speak of bow legs if the inner angle between the thigh and lower leg is smaller than the physiological angle of 186 ° of healthy legs.
Bow legs are not always obvious
Bow legs do not necessarily have to appear on both sides or be equally pronounced on both sides. Often, a kink and sinker is diagnosed, which only results from the position of the compensation for the undiagnosed varus position of the knee. Knee pain, pain in the feet, hip, in the back area can be indications of invisible bow legs, because the deformity of the knee joints is not always so pronounced that it can only be determined by visual diagnosis.
Causes: How do you get bow legs?
Bow legs are natural in infants and toddlers, but early childhood bow legs should recede by the age of three at the latest. In a normal course of skeletal development, we can observe that the bow legs temporarily turn into x legs. The normal leg axis is formed around the age of ten. Bone diseases can lead to bow legs, e.g. B. achondroplasia, osteogenesis imperfecta, tumors or trauma (broken bones), especially if they affect the growth plates.
Another cause is rickets. Likewise, general vitamin D deficiency and the lack of calcium in the growth phase favor a knee deformity. Bow legs can, however, simply be congenital. Paralysis that leads to muscular imbalance can also be the cause of bow legs. Last but not least, being overweight (obesity) can promote the formation of bow legs.
Bow legs through football?
In adulthood, one-sided training can also lead to misalignment of the legs. The best-known example of favoring bow legs is the sport of soccer. Here the muscle group of the adductors on the inside of the thigh is trained more than the outside abductors. For example, typical movements that soccer players frequently perform during training sessions and games overstress the adductors of the thigh. Since these muscles attach to the inside of the leg, the growth joints at the knee joints are stressed on one side. Cleats on the shoes further intensify this effect, since the force cannot be derived from an external rotation of the foot. An investigation from the German Medical Journal in 2018 came to the conclusion that intensely practiced football in adolescents tends to increase the risk of bow legs, while adults are more likely to be at risk of osteoarthritis in the knee.
With strong trained legs, we can see the misalignment of the knee joints. The bow legs always lead to excessive stress on the knees and feet. The typical symptoms are knee pain during exercise and morning pain when standing up or sitting up. Diagnosed osteoarthritis can be caused by bow legs. Even with a slight malposition, pain can result from the strain on the ankles. The formation of kink-lowering feet is very often favored by bow legs. A one-sided bow leg usually causes damage to the spine, which can be affected by the inclined posture. The signs of wear on the cartilage can cause inflammation, which causes burning pain in the joints. Headaches caused by incorrect body posture and sciatica complaints can also indicate knee misalignment. However, there are also many cases in which people do not have any of the typical symptoms and live symptom-free with light bow legs.
The diagnosis is made by the specialist, the orphan. Since the diagnosis cannot be made by eye diagnosis if the bow legs are not very pronounced, the doctor will have a medical history interview. The typical symptoms such as knee pain and, in the case of advanced wear, arthrosis are not always associated with the course of the varus position of the knee. The doctor will ask questions about skeletal development, complaints in the area of the joints, legs and feet in the back. With the help of special running tests and X-rays, malpositions of the knee can be determined. In the diagnosis of bow legs in children and adolescents, a blood count is always taken in order to rule out metabolic diseases and hormonal disorders. If the usual diagnostic methods cannot be determined immediately in an adult, the diagnosis of the blood count is also recommended here in order to rule out diseases such as tumor formation and other bone diseases. Since insoles that have already been prescribed that have not been made to fit, can favor bow legs or worsen the deformity of the knee, the specialist will also ask about insoles that have currently been prescribed or have been used in the past as a form of therapy, such as for an expansion foot .
Therapy in children
It is important for children in their development to discover themselves through movement and to gain experience. This promotes their fine and gross motor skills, creativity and social skills, gives them self-confidence and the joy of reinventing themselves again and again and recognizing their limits in natural processes. They consciously perceive their bodies through the movement, this must be encouraged, because this is the only way we learn to perceive and react to natural warning signals in childhood when something deviates from our normal perception. The cornerstone for the natural process of our body's wonderful warning system lies, among other things, in the conscious experience of movement.
In most cases, therapy in children is not necessary because the bow legs disappear as the child grows. However, it is important to monitor and document this in order to be able to intervene at an early stage in the event of a development that is not forecast. But what do we do if it is a congenital malposition and disease or the result of a trauma (broken bone)? The forms of therapy are always determined by a doctor on the basis of the respective diagnosis by evaluating the running tests, blood pictures, X-rays, ultrasound pictures or MRIs. The therapy goal is to avoid osteoarthritis, to normalize the movements, to build muscle evenly, to correct any compression postures and to walk, stand and walk without pain.
Therapy in children with congenital bow legs
The growth of the legs can possibly be used to correct the axis. Usually, the degenerative development can be counteracted in the initial stage by increasing the outer edge of the shoe. This form of therapy is coordinated with the pediatrician and the specialist. If it is necessary to perform a surgical axis correction in the case of higher-grade malpositions, the method of epiphysesis is often used. The growth plate of the bow legs is desolated.
Due to an exact unilateral obliteration of a growth plate, the bow leg grows straight until the end of growth. In order to find the right time that guarantees correct growth, the bone age must be determined. This is made possible by determining the body size. When determining the body size, the maturity of the bones is determined in addition to the biological age. This is done by comparing normal values, the individual characteristics of the patient and X-ray images of the left hand. In children, the so-called growth joints (epiphyseal joints) are found on the bones, on the sides between the middle and end pieces. These peculiarities in bone growth make it possible to determine how long the bone will continue to grow and with what size the growth plates will close. The bone age is determined. As long as there is still growth, the method may also be suitable for adolescents and young adults.
In addition, physiotherapy is usually prescribed for congenital bow legs to counteract compression postures. A balanced, child-friendly diet that enables adequate calcium and phosphate intake and is tailored to the individual needs of the child favors a positive course. The diet should be coordinated with the pediatrician and therapist.
Therapy in children with rickets
The good news is that rickets (derived from the Greek term "rhachis", which means spine) is practically extinct in Germany. Rickets is a metabolic disorder caused by vitamin D deficiency. Vitamin D is absolutely necessary so that the blood can absorb calcium and phosphate and transport it to the bones. The vitamin D deficiency means that the vitamin in the skin cannot be converted. The bones in growth remain soft in rickets and become crooked under stress, a malposition of the knee is one of the possible consequences. With rickets, the spine is primarily affected, but also the legs. That is why it is important to diagnose the cause of the vitamin D deficiency. Causes can include malnutrition, insufficient sun exposure or incorrect nutrient absorption in the gastrointestinal tract. There is also a special form of rickets that is not due to a metabolic disorder. The therapy goal here is to achieve normal calcification of the bones. Sick children usually receive high doses of vitamin D and calcium in a period determined by the doctor. Sunlight and natural sunlight are absolutely necessary. After this intensive therapy, a special diet is put together by the doctor, which ensures a high absorption of calcium and other trace elements. Sufficient sunlight must still be taken.
Orthopedic measures and accompanying physiotherapy treatments that are individually tailored to the needs of the child are taken during the treatment. Swimming is often recommended as a gentle method for targeted muscle building. Again, the goal is to counteract the degenerative development.
Therapy in adults
The type of therapy depends on the cause, the extent of the malposition and of course the age of the patient. In the case of rachitic bow legs, the underlying disease must first be combated by appropriate therapy. The same applies to tumors if they are the cause of the bow legs. If overweight is the cause, the joints must be relieved by consistently reducing body weight. At the same time, appropriate orthopedic measures are taken and physiotherapeutic treatments such as lymphatic drainage are prescribed. After a detailed diagnosis, your doctor will discuss and coordinate this with you, for example, if there is a kink-flat foot for compensation, this will also be treated. This is done by straightening the foot using a shoe insert with a raised inner edge.
If there are already severe signs of wear and tear that go hand in hand with severe pain, surgery is usually necessary. The changeover operation (osteotomy) is often used here. The surgeon cuts the shin beneath the knee joint under general anesthesia and shifts the lower leg outwards into an over-correction position. The correction is secured with titanium plates and screws in such a way that freedom of movement and processes are guaranteed. After two weeks, the sport of swimming can be carried out to build muscle, but only after consulting the doctor. The legs can be fully loaded again just three months after the operation. The metal parts remain in the body for about 1.5 years and then have to be removed again under a general anesthetic. The operational correction can slow down or even stop the wear process. The cartilage damage that has already occurred can no longer be cured. If there are long axis deviations and osteoarthritis in the end stage, often only the artificial joint replacement is able to enable painless function of the knee joint.
After a trauma, there is often a shortening of the leg, which makes it necessary to lengthen the bone in order to correct the misaligned leg. The so-called callus distraction is used more and more frequently as a complex and lengthy process. Another form of therapy is sensorimotor body therapy, which is used by specially trained therapists. This therapy was developed to reduce chronic pain and has had excellent results in the past. Specially developed forms of therapy make it possible to correct the malposition in certain cases and thus provide relief.
Prevention bow legs
The children should be regularly presented to your pediatrician for checkups. This can accompany and document the course of the development. If necessary, therapeutic measures can be initiated immediately. Children should walk barefoot whenever possible. The foot is relieved without shoes. It will be fun for your child to feel and feel the surfaces. The development of a healthy and natural posture of the child is supported. For adults, walking barefoot is often a new and relieving experience. You experience a whole new feeling of walking, which makes a natural posture and natural rolling over the foot possible. Matching shoes are important and essential, the lasts have to fit properly, the size has to be suitable. Children adapt their feet to the footwear and simply bend their toes when it gets too tight. It is better to check several times whether the shoes still fit properly and have the feet measured by specialist staff directly in a shoe store. With young children, one should refrain from buying shoes on the Internet. All shoes vary in size, trying on accompanied by specialist staff is essential to find the perfect shoe for your child
A balanced diet that is rich in vitamin D and calcium will support healthy and necessary bone strength. Her pediatrician and therapist will be happy to support and advise you individually. Exercise and plenty of exercise are the best way to promote healthy posture. In sports, however, especially in one-sidedly stressful sports such as Football should be paid attention to a training that compensates for this. Sport therapists and pediatricians advise on this.
Exercise with bow legs
Special exercises must always be coordinated with your therapist or doctor.
Note every day in everyday life!
Never stretch your knees while standing, even if you put more weight on one leg. Rotate your feet slightly outwards, whether standing or walking or jogging.
The following exercises can be carried out in three sets of 15 repetitions and three to four times a week:
Training the arch muscles
Place your foot on a bath towel, let your heel stand and try to lift the bath towel with your toes.
Starting position for the training of the arch muscles: place your foot on a bath towel, make your toes long and relax. End position for the training of the arch muscles: Raise the toes, the ball of the big toe tries to pull back until the arch is higher - slight cramp in the arch is noticeable.
Training the functional leg longitudinal axis screw connection
Place your feet at the width of your hip, slightly rotated 11 °, slightly lift the small toes and put more strain on the base of the big toe = pronate your feet, bend your knees slightly and rotate outwards without changing the load on your feet. In the one-leg stand, bend your knees slightly, pronate your feet and rotate your knees outside, bring your leg forward and touch your heel lightly, then swing your leg back as far as possible and touch your toes lightly with your toe. (CA)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Thaller, Peter Helmut / Fürmetz, Julian / Chen, Fuhuan / u.a .: bow legs and intensive football training in growing age, Dtsch Arztebl Int, 2018, aerzteblatt.de
- Steffen Ruchholtz, Dieter Christian Wirtz: Orthopedics and trauma surgery essentials: Intensive course for further training, Thieme, 3rd edition, 2019
- American Academy of Orthopedic Surgeons: Bowed Legs (Blount's Disease) (accessed: August 29, 2019), orthoinfo.aaos.org
ICD codes for this disease: E64, M21, Q74ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.