Malalignment Of Lower Extremity

///Malalignment Of Lower Extremity

Knocked Kneed and Bow Legged
as Lower Extremity Malalignments

A congenital or genetic malalignment of the lower extremity is a common risk factor for a knee injury. Knocked kneed (valgus) and bow legged (varus) are two well-known conditions associated with improper lower extremity alignment. Many individuals have some level of malalignment but it does not lead to  injury or disability, while other specific patients with bow legs or knocked knees are susceptible to a number of knee injuries. Orthopedic knee specialist in the Van Nuys, Thousand Oaks and Los Angeles, California communities, Dr. Mark Getelman specializes in treating patients’ malalignment of the lower extremity.

A knee injury may be caused by two common forms of malalignment of the lower extremity, known as valgus and varus.

  • Valgus (knocked kneed): The majority of the body’s weight passes through the outer (lateral) portion of the knee.
  • Varus (bow legged): The majority of the body’s weight passes through the inner (medial) portion of the knee.

Proper alignment of the knee joint is important for normal function and balance. In a properly balanced knee, the body’s weight is transferred evenly through the middle of the joint. When the knee is not balanced and straight, a knee injury can occur from increased forces related to weight bearing overloading one side of the joint. Patients with an unbalanced lower extremity are prone to knee injuries, such as ligament tears, meniscal tears, osteoarthritis and chondral defects.

Malalignment of Lower Extremity Symptoms

Malalignment, such as knocked knees or bow legs, is often visibly noticeable in patients when compared to patients with normal lower extremity alignment. If severe valgus or varus is present there may be an increased risk of experiencing a knee injury and if not addressed by an orthopedic knee specialist, knee pain, inflammation and swelling may occur over time.

Malalignment of Lower Extremity Diagnosis

Dr. Getelman will perform a complete physical examination to assess knock knees or bow legs, as well as evaluate for any possible knee injury during the his consultation. During the exam, he will examine how weight is distributed throughout the leg and knee area and how the knee is balanced while the patient is in a standing position. In severe cases, full length standing X-rays will be performed to determine the extent of malalignment and help determine proper treatment.

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Malalignment of Lower Extremity Treatment


Lower extremity alignment injuries are typically treated with conservative measures at the beginning of treatment. Dr. Getelman may ask patients to modify activities, brace the knee with an unloader brace, modify shoes, lose weight if overweight and/or perform lower extremity strengthening exercises to help treat patients that are symptomatic related to the bow legged or knocked kneed condition.


If conservative measures do not alleviate symptoms or if a knee injury is associated with malalignment, Dr. Getelman may recommend a surgical procedure for the alignment. Bow legs and knock knees can be addressed with a variety of surgical options, including an osteotomy, unicompartmental knee arthroplasty or total knee replacement (arthroplasty). An osteotomy may be combined with other surgical procedures to treat a knee injury in complex cases. For example, in patients with malalignment and a ligament tear, Dr. Getelman may need to perform the osteotomy to correct the malalignment and then perform the ligament reconstruction to treat the tear as well.

For additional information on bow legs or knocked knees, or for information on treatment options for malalignment of the lower extremity, contact the Van Nuys, Thousand Oaks and Los Angeles, California orthopedic office of knee specialist Dr. Mark Getelman.