Understanding bow legs and knock knees in context

With bow legs, the knees sit further outwards in relation to the hips and ankles; the medical term is varus alignment. With knock knees, they point further inwards, known as valgus alignment. A pronounced difference can distribute load unevenly through the knee: more towards the inner side with bow legs and towards the outer side with knock knees. However, this does not automatically explain every pain. Muscle control, ligament stability, cartilage and the menisci also contribute to function. A slight difference in shape without symptoms is assessed differently from increasing misalignment with reduced walking ability. The examination aims to identify these distinctions.

An adult leg alignment determined by the bones cannot simply be straightened through muscle training. Training can still help improve strength, movement control and capacity for activity. It then has a functional purpose and is not ineffective just because the outward shape remains the same. Separately, a knee may move inwards during movement without the same fixed alignment being present when standing. We therefore also look at walking, standing up and other relevant movements. A photograph or the wear on a shoe alone is not enough for a reliable treatment decision.

We discuss when the alignment first became noticeable, whether it has changed and which journeys or activities have become difficult. Previous fractures, operations and known joint conditions are relevant too. We then assess leg alignment, mobility and stability together. If a precise alignment assessment would affect treatment, standing X-rays of the whole leg may be helpful. They show the relationship between the hip, knee and ankle under load. Further imaging is guided by specific questions, such as rotational misalignment or an associated injury. These investigations are arranged selectively; not every visible difference requires every test.

For symptoms, a non-surgical plan may initially aim to change activities that place strain on the knee and support joint function. This can include individually chosen exercises, an adapted increase in activity and, where appropriate, aids. An unloading orthosis may be considered for certain knee findings. It is not a universal solution for every case of bow legs or knock knees. If osteoarthritis is already present, its symptoms and your leg alignment are considered together. We want to agree with you on a realistic first step: managing longer distances better again, standing up more confidently or finding a tolerable sporting activity. How well a measure helps is assessed over time, not solely by the outward shape of the legs.

For selected patients, a realignment operation may be appropriate. The bone is cut in a controlled way and fixed in a different position to redistribute load through the knee. Whether correction would be needed in the thigh bone, shin bone or both depends on the location of the misalignment. This type of operation is not automatically the right answer to osteoarthritis. Joint condition, mobility, stability, other medical conditions and personal needs influence the choice. It requires bone healing and appropriate aftercare. Possible risks and alternatives must be discussed with a specialist surgeon. It cannot reliably rule out the need for a joint replacement later.

Misalignment that becomes more pronounced over time or is clearly one-sided, repeated instability and persistent limitations are reasons for an orthopaedic assessment. If a visible deformity develops after an injury, it needs immediate medical assessment. Use the urgent care route rather than waiting for a routine consultation. This page mainly describes adults. In children, leg alignment changes during growth. Assessment and possible treatment involve different considerations; recommendations for adults cannot simply be applied. Bring existing images and details of previous treatments to your appointment.