Bowed Legs and Knee Arthritis
Do you or your children have bowed legs? Should you be concerned about bowed legs and is there anything you should do if you have bowed legs? The medical term for bowed legs is genu varum and is when the legs curve outward at the knees while the feet and ankles touch.
Genu varum is normal in toddlers and typically corrects itself by age 2. Children who start walking at a young age have more noticeable bowing. Bowed legs don’t usually bother young children, because the condition doesn’t cause pain and doesn’t affect a child’s ability to crawl, walk or run. Bowed legs usually correct themselves as a child grows. Between 24-36 months of age, toddlers legs become aligned. When should parents be concerned about bowed legs?
• The bowed legs continue to get worse after the age of 2
• There is an asymmetric appearance of the bowing
• The child has a limp when walking
• The child complains of knee or hip pain
• The child is below the 5th percentile in height
If your child has any of these symptoms they should be evaluated by their pediatrician. Otherwise, know that bowed legs are a normal part of a young child’s development. Most children with bowed legs grow out of the condition and are able to walk, run and play with no problems!
Are you someone whose bowed legs did not resolve by the age of 2? Let’s start with the bad news first. Adults with bowed legs often develop arthritis in their knees. But there is good news!! There are many options to help prevent the development and progression of arthritis in individuals who are bowlegged.
In people with normal knee alignment, the inside (medial side) of the knee supports 60-70% of their body weight when walking. When someone has bowed legs the pressure on the medial knee increases to 90% of their body weight. The increased compressive force placed on the medial knee can significantly accelerate the development of osteoarthritis.
What can you do if you have bowed legs? To lessen the potential for developing knee arthritis, you need to control the increased pressure created along the inner knee. One of the easiest ways to do this is to use a cane in the opposite hand of your worst knee. This is helpful and recommended, but unfortunately very few people are willing to walk with a cane in the early stages of osteoarthritis.
An alternative technique for reducing medial knee pressure is the use of a knee brace. A knee brace can help with knee alignment and is effective at reducing pain and improving walking tolerance. However, the braces are often cumbersome and bulky and many patients stop using them.
Another approach for managing genu varum is the use of orthotics in your shoes. An orthotic placed beneath the outside of your heel may lessen the forces at the knee. A trial of orthotics to determine if they are helpful in reducing symptoms maybe recommended.
Canes, braces and orthotics are all external devices that can help lower the stress on the knee. Another option is to strengthen your hip muscles so they help to stabilize the outside of the knee. Stronger hip muscles have been shown to slow the progression of knee osteoarthritis. Conservative management of genu varum should always include strengthening of the hip muscles.
Of course, you want to choose hip exercises that do not place extra stress on the knees. For example, squats and lunges are good at strengthening the hip muscles, but they place significant stress on the knees and aren’t the best exercise for someone with knee arthritis. On the other hand, lateral step-ups are a great exercise for the hips and barely load the knees at all! There is no perfect exercise for everyone, but Dr. Iodice can help determine the best exercise program for you to slow the progression of knee arthritis!
It is important for people with even slightly bowed legs to keep their hips strong starting at an early age. This can be accomplished by performing hip exercises just twice a week. Ideally, bowlegged individuals can avoid painful knee arthritis by committing to a long-term hip strengthening program when they are young!
References
1. Michaud, Tom. Bowed Legs and Knee Arthritis.
2. Boston Children’s Hospital
