What is malalignment of the lower extremity?

The knee joint is composed of three bones that are joined together by tendons, ligaments, and cartilage tissue. Malalignment of the lower extremity refers to a condition where these bones do not line up properly. Ideally, the knees should follow an imaginary straight line from the center of the hip to the center of the ankle, called a neutral mechanical axis. While poor positioning of these bones can occur in any direction outside of the neutral position, the most common types are bowlegged (varus) and knock-kneed (valgus) malalignments.

  • Bowlegged (Genu-varum): In this form of malalignment of the lower extremity, the knees tilt outside of the midline of the body. The imaginary line falls on the inside (medial) part of the knee, while the rest of the knee falls on the outside (lateral) aspect of this line. This causes the inside portion of the knee to carry the majority of the body’s load and can accelerate cartilage wear, leading to painful arthritis.
  • Knock-Kneed (Genu-valgum): This form of malalignment of the lower extremity, the knees tilt inward, towards the midline of the body. In this case, the imaginary line drawn from the center of the hip falls on the outside (lateral) part of the line, while the rest of the knee falls inside (medial) of the line. This forces the lateral aspect of the knee to carry the majority of the body’s load.

Malalignment of the lower extremity creates an uneven distribution of body weight across the knee, which can make certain ligaments more prone to injury and part of the knee joint more prone to painful arthritis. Dr. Joseph Lamplot, orthopedic knee specialist, treats patients in Arlington Heights, Kildeer, Lake Zurich, Barrington, and the surrounding Northwest Suburbs of Chicago, IL, who have experienced malalignment of the lower extremity.

What causes the lower extremity to become malaligned?

There are a variety of reasons that a patient may experience malalignment of the lower extremity. Bowlegged and knock-kneed deformities can be the result of a birth-related issue such as a congenital defect. Trauma or injury to the knee or leg can also result in malalignment issues. Other patients may experience genu-valgum or genu-varum over time as a part of the aging process.

What are the symptoms of malalignment of the lower extremity?

Many malalignment conditions associated with the knee are visible when the patient stands or walks. However, there are other symptoms the patient may feel including, but not limited to:

  • Pain in/around the knee joint
  • Swelling and stiffness of the knee
  • Feelings of the knee “locking” or “catching” when walking or running
  • “Clicking” or “grinding” sounds or sensations during movement of the knee

How do I know if I have malalignment of the lower extremity?

Dr. Lamplot will need to evaluate the patient to diagnose malalignment of the lower extremity. He will review the patient’s medical history, their concerns, as well as perform a physical examination. He may also order further diagnostic imaging such as a specialized full leg-length X-ray or MRI scan in order to diagnose the patient’s condition. At this point, Dr. Lamplot will be able to diagnose the condition and make recommendations for the patient.

How is malalignment of the lower extremity treated?

Many patients can be treated without surgery by conservative measures. However, some patients may require more extensive, surgical treatment for their condition.

Non-surgical treatments:

  • Specialized “unloader” bracing to redistribute the weight across the knee
  • Exercise through low-impact activities
  • Pain management through rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs).
  • Physical therapy to strengthen the muscles around the knee

Surgical treatments:

  • Knee Osteotomy: This surgery allows for the redistribution of weight across the knee by cutting and shifting the thigh (femur) and/or tibia (shin) bone, allowing Dr. Lamplot to realign the bones into a proper position. He may insert a bone graft in the shape of a wedge to allow for realignment and secure the bones with surgical screws and plates to allow the knee to heal properly.
  • Partial or total knee replacements