How to treat X-leg O-leg?

X leg = knee valgus O leg = knee varus

As a parent, have you observed your child’s legs and walking gait? After observation, you may find that your child’s legs are not straight, and he walks in an inward or “8” out-of-eight gait, which is commonly referred to as knee varus or knee valgus.

Knee varus and knee valgus, clinical manifestations of “O”-shaped legs and “X”-shaped legs, are common reasons for children’s orthopedic visits.

Q: What is knee varus or knee valgus?
A: Knee varus and knee valgus are angled deformities of the knees outward and inward, which are more common in children with lower extremity deformities. Knee varus lesions are mostly at the upper end of the tibia and fibula, and knee valgus lesions are mostly at the lower end of the femur.

Q: What are the causes of knee varus?
A: There are two types of causes: physiological and pathological.
Physiological knee varus is a normal physiological process in the developmental stage of children. At the toddler age, most children have a slight inversion, with an angle ranging from 0 degrees to 15 degrees. Because inversion is a stable state, it is easy to stand firm. At the age of 1-2 years, this kind of inversion will change into a valgus angle. In general, children within 2 years of age have legs that are not straight. If it is not particularly serious, it is mostly a physiological knee varus.


Within 2 years of age, there is a normal range of tibia-femoral angle for physical development. At this time, children’s normal tibia-femoral angle varies greatly, ranging from 2 degrees inversion to 20 degrees of valgus. After 7 years of age, the normal range of valgus is 0°-12°.

Over 2 years old, children’s leg muscles develop, their balance ability is significantly improved, and physiological knee varus will be corrected naturally.

There are many reasons for pathological knee varus, such as rickets, trauma, inflammation, congenital skeletal growth disorders, skeletal softening, skeletal dysplasia, type IV mucopolysaccharidosis, or ectoderm dysplasia, tumor, polio And cerebral palsy, and so on.

There are many causes of disease, such as rickets, calcium deficiency, heredity, premature walking, use of walkers, etc., and a small number of them are caused by trauma, inflammation, tumor, or congenital dysplasia of the epiphysis, which can occur on one side or both sides. Side limbs.

Under normal circumstances, the child’s lower limbs are in a straight standing position, and when the patella is facing straight ahead, the knees and the two medial malleoli (medial malleolus) should be brought into contact with each other. If the bilateral medial malleolus is close together, the two knees cannot touch and are separated, it is knee varus; if the bilateral medial malleolus cannot touch and there is a distance between the knees, it is knee valgus.

Knee varus, also known as “O”-shaped legs, is mainly manifested by bending the lower limbs outwards, the wide distance between the knees, swaying while walking, and the toes deviated to the inside; lying in the supine position, the lower limbs are straight, the patella is straight up, both When the lateral medial malleolus are brought together, there is a distance between the knees. The greater the distance, the heavier the inversion.

Knee Varus Orthotic Insoles

Knee valgus is also called “X”-shaped leg. If it is unilateral, it is called “K”-shaped leg. It is mainly manifested as awkward walking, knees colliding with each other when walking, easy to fall, and toes tilted inward; supine position, lower limbs Straighten the patella straight up, and when the knees are brought together, there is a distance between the medial malleolus. The greater the distance, the heavier the varus.

If your child has the above symptoms, he should be checked as soon as possible to determine the cause and degree of the deformity for early treatment.

Normal children have mild knee varus from birth to 1 year old, and their lower limbs become straight at 1 and a half years old. This is a physiological knee varus and generally does not require treatment; from 2 to 2 and a half years old, due to With the development of bones, both knees will experience mild valgus, and then the lower limbs will gradually straighten, and they will be close to the normal level at the age of 7. This is a physiological knee valgus and generally does not require treatment. Beyond this range, patients who still have knee varus or knee valgus deformity need treatment. Commonly used treatment methods are as follows:

1. Manipulation correction: suitable for young children with very mild varus and rickets that have not healed. Fix the upper and lower ends of the affected limb, and apply gentle pressure 20-30 times at the most obvious place of the deformity. The pressure should be moderate. Violence should be taboo. Do this continuously and uninterruptedly 3-4 times a day.

2. Bracing treatment: The three-point correction theory of the brace is used for treatment, and a special orthopedic brace is customized according to the patient’s specific condition, and it is worn at night. Note that a dedicated brace maker is required to make it, but due to the difference in the level of the maker, the quality and effect of the brace are also quite different. And when wearing some braces, the legs need to be kept tight continuously to limit curling and movement.

3. Orthotic shoes + orthopedic insoles: use orthopedic insoles (or paired with orthopedic shoes), there is a slope difference between the inner and outer sides of the sole so that the line of force to the knee joint can be decomposed into inward or outward growth force to change the weight load when walking Line, so that the deformity is gradually corrected, which is suitable for some children with mild disease.

Knee Varus Orthotic Insoles

4. Bone-breaking method: only suitable for children with knee varus under 5 years of age. At the most obvious part of the calf bending on both sides, forcefully break the tibia and fibula fracture, and then fix it with a plaster. Generally, it will heal after 1.5-2 months of fixation.

5. Surgical correction method: It is suitable for knee varus over 4 years old, knee valgus over 8 years old, or patients with severe internal and external degrees. Generally, wedge osteotomy is used for correction, and the osteotomy site is selected at the most obvious deformity.

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