Misalignments of the leg axes are classified based on their orientation and the affected area:

1. Knock-knee (Genu valgum):
   • The knees are closer together, while the ankles are further apart.
   • This typically leads to increased stress on the outer parts of the knee joint.
2. Bow-leg (Genu varum):
   • The knees are further apart, while the ankles are together.
   • This misalignment primarily stresses the inner parts of the knee joint.
3. Torsional misalignments:
   • Rotational deviations of the thigh or shin bones that change the alignment of the legs.
4. Asymmetrical misalignments:
   • Different axis deviations between the left and right leg.

The causes can be divided into congenital and acquired factors:

Congenital causes:

- Genetic predispositions can lead to misalignments that become visible in childhood.

- Developmental deviations during growth, such as uneven bone development, also play a role.

Acquired causes:

- Traumatic events: Improperly healed bone fractures or injuries can permanently alter the leg axis.

- Degenerative diseases: Osteoarthritis or other degenerative joint diseases can impair the stability and alignment of the joints.

- Overweight: Excessive body weight increases the strain on the joints and promotes misalignments.

- Rickets: An insufficient supply of vitamin D or calcium can lead to a weakening of the bones, favoring misalignments.

The symptoms vary depending on the severity of the misalignment and include:

• Pain:
  • Localized pain in the knee or hip joints, which may worsen with exertion.
• Joint wear:
  • Uneven stress promotes cartilage abrasion and increases the risk of osteoarthritis.
• Limited mobility:
  • Affected individuals often report difficulties walking or standing for extended periods.
• Instability:
  • A feeling of uncertainty or instability in the affected joints.
• Aesthetic abnormalities:
  • Visible deviations in leg alignment, which can also have psychosocial impacts.

The diagnosis is made through a combination of clinical examination and imaging techniques:

Clinical Examination:

- The doctor checks the alignment of the legs while standing and walking, as well as the mobility of the joints.

X-rays:

- They are used for precise measurement of the leg axes and identification of bony changes.

MRI or CT:

- These methods provide detailed information about soft tissues and joint structures, especially in cases of accompanying conditions like osteoarthritis.

Gait Analysis:

- To assess the functional impact of the misalignment on the gait pattern.

Conservative Therapy

For mild misalignments or as a supportive measure, conservative methods are used:

• Physiotherapy:
  • Strengthening exercises to stabilize the joints and improve mobility.
  • Manual therapy to correct muscle imbalances.
• Orthopedic aids:
  • Use of shoe inserts or orthoses to relieve the affected joint areas.
• Weight reduction:
  • Reduction of excess weight to decrease the load on the joints.
• Pain management:
  • Taking painkillers or anti-inflammatory medications to alleviate acute symptoms.

Surgical Therapy

For pronounced misalignments or progressive symptoms, surgical correction is necessary:

• Osteotomy:
  • Surgical correction of the leg axis through targeted cutting and realignment of the bones.
• Joint replacement:
  • In severe osteoarthritis, an artificial joint replacement may be required.
• Arthroscopic procedures:
  • Minimally invasive procedures to treat accompanying conditions such as meniscus damage.

To prevent and alleviate discomfort caused by misalignments, the following measures are recommended:

1. Regular exercise: Promoting muscle strength and joint function through targeted exercises.
2. Ergonomic footwear: Wearing orthopedically adapted shoes or insoles to support the natural leg axis.
3. Early treatment: Regular check-ups for children to detect and treat growth disorders early.
4. Weight management: Avoiding overweight to reduce joint stress.
5. Targeted physiotherapy: Training to improve posture and prevent incorrect loading.