X-leg or valgus knee is a malposition of the leg in which the hip has an adduction position (the knee shifts inwards) and internal rotation: with parallel thighs, the ankles move away from each other.

In the first 18 months of life, the knee is in varus position (outwards).
This deformity can also often be observed in football players.

In children between 18 and 24 months, the joints of the hip, knee and ankle are normal or straight (the legs run parallel). If the child is between 2 and 5 years old, a valgus position (inwards) is normal. After that, the knees align neutrally again.

This deformity is more common in girls, but boys can also develop it.
It usually occurs bilaterally, i.e. it is present in both knees.
The malformation can be seen when the child is 2 or 3 years old and can worsen until the age of 4.
The valgus position of the knees can correct itself up to the age of 7 or 8. Rarely, the deformity persists until adolescence.

Before the age of 6, the child should undergo a medical examination, otherwise bone malformations (pathological valgus position of the knees) may persist.
The malformation can become severe.
Being overweight damages the knee joints and can lead to problems walking.


Complications and consequences

Usually, young people do not have problems, but adults or older people may have wear on the cartilage and meniscus on the outside. As a result, they could develop osteoarthritis, especially in the lateral knee area.

Why does a valgus position occur in the knee joint? What are the causes of valgus knee?

Studies confirm that the valgusk knee is caused by four specific factors.
The following are the four causes in order from the most likely to the less likely.

1. Weakness in the pelvis
Muscle weakness in the buttocks (small gluteal muscle, middle gluteal muscle, large gluteal muscle and external rotators of the hip) together with increased muscle tone of the abductors prevents stabilization of the femur. The flanks shift inwards and the hips turn inwards. If the abductors are stronger than the external rotators (gluteal muscle/hip), the knee gets a “pull” in valgus position.

2. Ankle stiffness
The reduction of dorsiflexion (lifting of the toes) of the upper ankle joint and the muscle weakness of gastrocnemius, soleus and tibialis anterior prevent leg extension for proper walking. This leads to pronation of the feet (the foot turns outwards and the ankle turns inwards). This results in an internal rotation and adduction of the hip. The result is an X-leg position.

3. Quadriceps weakness
If the vastus medialis muscle (inner thigh muscle) is weak, it does not stabilize the knee. This leads to a “squinting” patella (the kneecap looks outwards) and the knee tends inwards, i.e. into a valgus position.

4. Weakness of the ischiocrural muscles Weakness of the middle and posterior muscles
of the thigh (semimembranosus and semitendinosus muscles) does not allow stabilization of the knee joint. The joint “shifts” to the middle (similar to what happens with the inner thigh muscle), but on the back side of the thigh.
The knee joint experiences a combination of these factors, but when a malposition forms, it is not only an orthopedic disorder (muscle strength and flexibility), but also a problem of the nerves.

Are there any other factors that favor an X-leg?

Anatomy plays an important role in the valgus knee. Factors that affect this knee position include:

  • Pool width
  • Angle of the acetabulum (part of the pelvis where the femur enters)
  • Shape of the femur
  • Structure of the knee joint
  • Course of the shin
  • Shape of the ankle joint
  • Size of the foot
  • Flaccidity of ligaments

Some people are more prone to X-leg formation.
As we said, the valgusk knee is caused by a loss of strength from the hip or by reduced mobility in the ankle joint.

Symptoms of valguscnies

Usually, the X-B setting is asymptomatic for many years. However, over time, it can cause indoor knee pain.
The person walks with his knees approached, but if there is only a valgus knee on one side (monolateral), the back is misposted, swinging from side to side.
The stability of the knee joint decreases.

Diagnosis of valguscnies

The severity of the valgus position in the knee joint is determined by measuring the intermalleolar distance (distance of the ankles from each other) with closed knees.

  1. Degree (physiological) up to 2.5cm
  2. Degrees (mild) between 2.5 and 5 cm
  3. Degree (moderate) between 5 and 7.5 cm
  4. Degrees (high) above 7.5 cm

What to do? How are X-legs treated?

Among the natural remedies, there are corrective exercises for the gym or at home:

1. Exercise
The patient lies on the side of the affected knee joint. He bends the healthy knee to the right angle and supports the foot in front of the valgus knee, then he stretches the lower leg, the foot must be in hammer position.
Then lift the leg lying on the ground, always keep it stretched (you can feel the effort on the inside of the thigh). 10-12 repetitions, then leg changes.

2. Exercise
Perform an adduction of the legs (move knees to each other), sitting with a ball on a chair. Position the ball between the knees and squeeze the legs tightly.
Perform 10 repetitions.

3. Exercise
The exercise begins lying down (supine position). Raise both legs, knees together and stretched. As soon as they form a right angle with their backs, open and close the legs. Perform 10-12 repetitions and rest for 30-40 seconds. Repeat the exercise 3 times.

4. Exercise
This exercise is similar to the previous one. You start in the supine position and lift one leg. It is best to bend the other leg so as not to put excessive strain on the back. With the raised leg, 5-8 circles are now made clockwise (as if you were drawing an O) and 5-8 circles counterclockwise. Put down the leg and repeat the same exercise with the other leg.

Exercises to strengthen the muscles of the outer thigh (abductors) should be avoided if possible.

Sports allowed include cycling (cycling) and moderate-intensity swimming.
In the case of a high-grade valgus position, jogging is not recommended.

The orthopedist sometimes prescribes a rigid knee brace to keep the joint in its axis, but the child (or adult) does not tolerate it for long periods of time.
The doctor may recommend insoles that support the foot and improve the alignment of the knee joint.

Osteopathy is a manual type of therapy that can improve the alignment of the knee by relieving existing muscle tension and unblocking the joints.


When to operate?
If the valgus position is greater than 8°, the orthopedist recommends surgery.

Among the solutions for hallux valgus, proximal (high) osteotomy of the shin aligns the knee joint and increases strength.
Wedge osteotomy is an open surgical procedure that has been used for 30 years. The surgeon removes a lateral bone wedge from the shin.

In recent years, wedge osteotomy is performed with resistant fastening plates. The doctor cuts in the tibia, straightens the knee and fills the “void” that has arisen with autologous (iliac crest) or synthetic material (hydroxyapatite).
This technique preserves the anatomy of the proximal tibia and bone tissue. This allows a future operation of a knee prosthesis and a more accurate correction of the joint. And, finally, it prevents injury to the peroneal nerve and femoropatell joint.

HTO technology
The patient is positioned in the supine position and the procedure is prepared. An arthroscopy is used to assess the menisci and articular cartilage.
In the surgical procedure, the surgeon makes a vertical incision over the base of the pes anserinus between the medial edge of the kneecap ligament and the posterior edge of the tibia (tibia).

The sartorius muscle is cut in to expose the biceps femoris.
A “guide wire” is inserted into the proximal part of the tibia from the inside out. The guide wire is positioned at the level of the tibial tuberculum and penetrates it obliquely by about 1 cm. The guide wire ends under the common joint line (space between the two bones) on the side of the shin.

The osteotomy is continued with a surgical saw by following the guide wire to prevent a joint fracture. Just before the osteotomy is completed, the doctor fastens the 2 wedges with screws.
The guide ensures that the part of the shin that supports the weight of the body is not incised.
The plate is fixed in the upper part with 6-7 mm long screws and in the lower part with 4-7 mm long screws.
The iliac crest or synthetic substrate is inserted into the wedge opening to avoid pseudarthrosis or healing delays

Postoperative course

Hospitalization in the orthopedic department lasts 2-5 days.
Internal fixation allows the patient to immediately begin physiotherapy exercises and rehabilitation and allows for a speedy recovery. The range of motion is sufficient to start strengthening.
The physiotherapist mobilizes the leg the day after the operation.
A passive/active mobilization on the stretched leg is started. The orthosis is removed on the second day. From then on, you can stretch your leg.

Exercises for rehabilitation

At the beginning, the physiotherapist performs passive movements, but as soon as possible, the patient must actively cooperate.

In the last part of rehabilitation, it is customary to strengthen the muscles with aids: leg press and hamstring.
In the first 3 weeks, rehabilitation should be done without weights. These should only be used after an X-ray control.
The person concerned starts walking without walking aids at the end of the third month.
When rehabilitation is performed correctly, muscles are strengthened and stretched, while coordination and walking are improved.

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