Starter for 10: what does a perfectly aligned knee look like?
Well, the textbook answer might go something like this. Draw a line between the centre of your hip and the middle of your ankle – if the dead centre of your knee sits precisely on that line, congratulations, you have perfect alignment.
In practise, though? Few of us are built like that. In fact, if you examine most people’s knees closely enough, you’d likely find some misalignment (or malalignment, as it’s also termed). It basically comes in two forms:
Varus – your knees turn slightly outwards, giving the legs an arched appearance (‘bow-leggedness’)
Valgus – your knees turn inwards, pushing the joints closer together (‘knock knees’)
Parents often notice varus or valgus knees in their toddlers, when misalignment can be more pronounced. In almost all cases, young children’s legs will straighten out as they grow older. But often – as we’ve seen above – they won’t end up absolutely and perfectly straight in adulthood. So to the second question…
Is misalignment a problem?
And the short answer is: no, not necessarily.
Although many of us have some degree of misalignment, few of us will go on to experience serious problems because of it. The misalignment might even be quite prominent. You may have noticed that many professional footballers, for instance, seem to have varus knees. (This is probably because heavy sporting activity during their growth years causes a partial growth arrest on the inner side of the shinbone). But that doesn’t automatically mean they’ll have knee issues. (For completeness, we should add that malalignment can also be caused by certain congenital conditions, such as Blount’s disease (tibia vara), or by the Vitamin D-deficiency disorder rickets – but these are less common.)
So when does it cause problems?
With all that said, misalignment does have the potential to cause knee problems over time. Think about what your knees are doing for a moment. They’re flexing to provide movement. But they’re also absorbing weight from your upper body – and taking even more strain when you do something joint-strenuous, like walking down stairs. If that weight is spread unevenly across the joint – as happens with bowlegs and knock knees – then one part of the knee sustains more impact. Over time this can cause cartilage wear, leading to osteoarthritis. For varus knees, this damage is likely to be on the medial (inner) side of the knee; for valgus knees, on the lateral (outer).
Is there anything I can do about it?
The simple answer is that we need to do the obvious things to keep our knees strong and pain-free, whatever our alignment. Things like: regular exercise, a balanced diet, avoiding cigarettes and not drinking to excess (for more tips on maintaining bone health, check out this blog). Weight has a big impact on knee joints, so it follows that keeping to a healthy bodyweight will provide optimum protection for our knees. Maintaining strong leg muscles, similarly, helps to support the joint and avoid excessive load.
Perhaps it sounds obvious, but malalignment is usually only a problem if it starts to cause pain. Sometimes the source is obvious; an injury, such as a distal femoral or proximal tibial fracture, can be both painful and a trigger for knee misalignment. Sometimes, though, the discomfort can build slowly over months, as with arthritis. In either case, living with ongoing, un-investigated pain isn’t a good idea. If you think misalignment might be causing you problems, consider getting it checked out. A ‘long-leg alignment x-ray’ (taken while you’re standing up) can help to determine the degree of deformity in your knees and the issues it might be causing. Physiotherapy can also be very useful. Sometimes a knee brace can be used to offload one side of the knee and to help to alleviate pressure on the affected part of the joint (you can find out more about braces in this article.)
In cases of serious cartilage damage there are surgical options available too, including osteotomies and joint replacement. But, fortunately, these are generally remedies of last-resort. For most of us, the key thing is to focus on keeping active and exercised.
Do you have any concerns about misalignment or knee pain? We’ll be very happy to take a look and see what we can do to help. Just make an appointment on the website, or call assistant Cheryl on 01962 8261207.
Where can I see you in clinic? Find your nearest location here.