and Function: Leg alignment
by S. Robert Rozbruch, MD
Co-Chief of the Limb Lengthening and Deformity
Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery
Weill Medical College of Cornell University
is well known that form and function go together in the human body.
For example, an athletic body not only
works well but is also
attractive. Healthy and fit individuals have bodies that both feel
good, work well, and look good.
This concept also applies to alignment of the leg. A normally aligned
leg has pressure evenly distributed across the knee. A straight weight-bearing
line from the hip to the ankle typically passes through the center
of the knee establishing this balance (figure 1).
with a bowlegged alignment (genu varum) experience more pressure on
the inside part of their knees since their weightbearing line passes
through the inside part of their knees (figure 2).
contrast, individuals with a knock knee alignment (genu valgum) experience
greater pressure on the outside part of their knees resulting from
their weightbearing line passing through the outside part of their
to severe variations from the normal alignment are both cosmetically
noticeable and functionally compromising. It is not uncommon for an
adult with bowlegs to develop pain on the inside of their knee. Degeneration
of the cartilage in that specific area can be observed and documented
through arthroscopy (a telescope placed into the knee joint) and MRI
scanning of the knee.
scientific studies have, in fact, documented the relationship between
mal-alignment and progression of arthritis on one side of the joint
related to the pressure overload. And, people with these alignment
differences are often unhappy with the appearance as well. So, whether
it has been for cosmetic reasons or to stop pain and progression of
arthritis or both, we have treated many patients with mal-alignment
perform a minimally invasive surgical procedure to correct the alignment
and straighten the leg. Through a one half inch skin incision, the
bone is partially cut and the leg is straightened (figure 3) with
the help of an external fixator. The procedure takes about one hour
and involves a one-night stay in the hospital. The external fixator
is a scaffold on the outside of the leg that is applied through a
few one-quarter inch stab wounds. This is used to help straighten
the leg and to support the healing bone. This is a very functional
treatment in which patients are encouraged to walk, put weight on
their leg during the treatment. No casts are necessary, and exercise
of the knee and ankle are encouraged during the treatment.
have noticed a dramatic improvement in pain that was localized to
one side of the knee as well as improved function and appearance.
With the legs are straightened, patients will often gain one-half
inch in height as a bonus.
whether it is for form or function, correction of mal-alignment is
a minimally invasive procedure that makes people both feel and look
better. (see figures 4 & 5 below)
I. Nicole had a bowleg (varus) deformity of her right knee with pain
on the inside of the knee. After the realignment, her pain was improved.
4: (click photos to enlarge)
II. Michael had bowlegs (genu varum) since childhood. He developed
pain on the inside part of both of his knees that prevented him from
keeping active. The realignment improved the appearance and stopped
(click photos to enlarge)