O-legs - causes and treatment

Axial misalignment of the legs: O-legs

O-legs, the medical term "genu arum", are also referred to as the varus position of the knee. The load axis runs in the middle of a healthy leg exactly in the middle of the knee joint. In O-legs, the knee joint deviates outward with respect to the loading axis. We speak of O-legs when the internal angle between upper and lower leg is smaller than the physiological angle of 186 ° of healthy legs. O-legs do not necessarily have to be bilateral or equally pronounced on both sides. Often, a kinking and countersunk foot is diagnosed, which is merely the composite posture to the undiagnosed varus position of the knee. Knee pain, pain in the feet, the hip, in the back can be evidence of invisible O-legs, because not always the malalignment of the knee joints is so pronounced that you can determine this only by the optical diagnosis.

contents

• Axial misalignment of the legs: O-legs
• causes
• symptoms
• diagnosis
• Therapy in children
• Therapy in adults
• Prevention of O-legs
• Exercise with O-legs

causes

O-legs are natural in infants and toddlers, however, the early childhood O-legs should regress at the age of three. In a normal course of skeletal development, we can observe that the O-legs temporarily turn into X-legs. About the age of 10, the normal leg axis is formed. Bone diseases can lead to O-legs, z. As achondroplasia, osteogenesis imperfecta, tumors or traumas (bone fractures), especially when they affect the growth joints.

O-legs in childhood are normal, but should have disappeared from the age of three. (Image: Jeanette Dietl / fotolia.com)

Rickets is another cause. Likewise, general vitamin D deficiency and the lack of calcium in the growth phase favor knee misalignment. O-legs, however, can also be innate. In adulthood, one-sided training can also lead to misalignment of the legs. The most well-known example of favoring O-legs is the sport football. Here, the muscle group of adductors on the inner thigh is trained more than the outer abductors. We can see in paralyzes, which lead to muscular dysbalance, that also often cause O-legs. Last but not least, strong overweight can favor the formation of O-legs.

symptoms

For strong trained O-legs, we can see the malalignment of the knee joints. The O-legs always lead to excessive stress on the knees and feet. The typical symptoms are knee pain under stress and morning pain when getting up or sitting up. A diagnosed osteoarthritis may be caused by O-legs. Due to the overloading even at a low malposition, pain can be caused by the overload in the hocks. The training of kink-lowering feet is very often favored by O-legs. A one-sided O-leg usually causes damage to the spine, which can be affected by the one-sided oblique posture. The signs of cartilage wear can cause inflammation that causes burning pains in the joints. Headaches caused by the malposition of the body as well as sciatica can also be evidence of ankle injury. However, there are many cases in which people do not have the typical symptoms and spend their lives uncomplicated with light legs.

diagnosis

The diagnosis is made at the specialist, the Ortophäden. Since the diagnosis can not be made by eye diagnosis if the O-legs are not pronounced, the physician will conduct a medical history interview. The typical symptoms are not always like knee pain, and in case of advanced wear the osteoarthritis, along with the course of the varus position of the knee. The doctor will ask questions about skeletal development, complaints in the area of ​​the joints, legs and feet in the back. On the basis of special running tests and X-rays misalignments of the knee can be determined. Children and adolescents are generally diagnosed with O-legs in order to rule out metabolic and hormonal disorders. If the common diagnosis methods in an adult can not determine the cause immediately, then the diagnosis of the blood picture is recommended here in order to exclude diseases such as tumor formation and other bone diseases. Since already prescribed deposits that have not been made to fit, favor O-legs or worsen the malposition of the knee, the specialist will also ask for deposits that were currently prescribed or have been used in the past as a form of therapy, such as for a Spreißfuß.

Therapy in children

For children it is important in their development to discover themselves through movement and to gain experience. This promotes their fine and -Grobmotorik, creativity and social skills, gives them self-confidence and the joy of reinventing itself again and again and to recognize their limitations in natural processes. Through the movement, they consciously perceive their body, this is essential to promote, because only in childhood we learn to perceive natural warning signals and react when something deviates from our normal feelings. The foundation for the natural process of the wonderful warning system of our body lies, among other things, in the conscious experience of the movement.

In most cases, a therapy in children is not necessary because the O-legs disappear in the course of growth. However, it is important to observe and document this in order to be able to intervene early in the case of an unforeseen development. But what do we do if it is a congenital deformity and disease or the result of a trauma (bone fracture)? The forms of therapy are always determined by a physician on the basis of the respective diagnosis by evaluating the running tests, blood pictures, X-rays, ultrasound images or MRTs. The goal of the therapy is to avoid arthrosis, to normalize the movement processes, to evenly build up the muscles, to correct the possible compression postures and to walk, stand and walk without pain.

Therapy in children with congenital O-legs
The growth of the legs may possibly be exploited to effect an axis correction. In the early stages, degenerative development can usually be counteracted by increasing the outer edge of the shoe. This form of therapy is coordinated with the pediatrician and the specialist. If it is necessary to make an operative correction of the axis in the case of higher-grade deformities, the method of epiphysealesis is often used. This will obliterate the growth joint of the O-legs.

Due to an exact one-sided obliteration of a growth gap, the O-leg grows straight until the end of growth. In order to find the right time, which guarantees a correct outgrowth, the bone age must be determined. This is possible through the body size determination. In determining body size, the maturity of the bones is determined in addition to the biological age. This is done by comparing normal values, the individual characteristics of the patient, and X-ray images of the left hand. In children one finds on the bones, on the sides between the middle and end pieces, the so-called growth joints (Epiphysenfugen). These features in bone growth allow you to determine how long the bone will grow and what size the growth plates will close. The bone age is determined. While there is still growth, the method may also be suitable for adolescents and young adults.

In congenital O-legs, physiotherapy is usually prescribed to counteract compression postures. A well-balanced child-friendly diet, which allows sufficient calcium and phosphate intake and is tailored to the individual needs of the child, favors a positive course. The diet should be coordinated with the pediatrician and therapist.

Therapy in children with rickets
The good news is that rickets (derived from the Greek term "rhachis", which means spine) is virtually extinct in Germany. Rickets is a metabolic disease caused by vitamin D deficiency. Vitamin D is essential for the blood to absorb calcium and phosphate and transport it into the bones. Due to vitamin D deficiency, the vitamin in the skin can not be converted. The growing bones remain soft in rickets and become crooked under load, a malposition of the knee is one of the possible consequences. In rickets especially the spine, but also the legs are affected. That's why it's important to diagnose the cause of vitamin D deficiency. Causes can include protein malnutrition, too little sun exposure or a faulty nutrient absorption in the gastrointestinal tract. There is also a special form of rickets that is not due to a metabolic disease. Here, the therapy goal is to achieve a normal calcification of the bones. Diseased children are usually given vitamin D and calcium in high doses at a doctor-appointed time. Height solar radiation and natural sunlight are absolutely necessary. After this intensive therapy, a special diet is compiled by the doctor, which ensures a high intake of calcium and other trace elements. In this case, sufficient sunlight must continue to be used.

Even during the treatment, orthopedic measures are taken and accompanying physiotherapeutic treatments that are individually tailored to the needs of the child. Swimming is often recommended as a gentle method for targeted muscle growth. Again, the goal of degenerative development is counteracted.

Therapy in adults

The type of therapy depends on the cause of the disease, the extent of the malposition and, of course, the age of the patient. In the case of rachitic O-legs, the underlying disease must first be combated by appropriate therapy. The same is true for tumors if they are cause of the O-legs. If obesity is the cause, by consequent reduction of the body weight the relief of the joints must take place. Correspondingly, appropriate orthopedic measures are taken and physiotherapeutic treatments as well as possible lymph drainages are prescribed. This will be discussed with their doctor after thorough diagnosis with them and vote. If, for example, a kinking foot for compensation before, this will also be treated. This is done by an erection of the foot by means of a shoe insert with increased inner edge.

If severe signs of wear and tear are associated with severe pain, surgical intervention is usually necessary. In this case, the conversion operation (osteotomy) is often used. Under general anesthesia, the surgeon cuts the tibia below the knee joint and shifts the lower leg outwards into an overcorrection position. With titanium plates and screws, the correction is secured so that the freedom of movement and processes are guaranteed. After two weeks, the sport swimming can be performed to build muscle, but only after consultation with the doctor. Already three months after the operation, the full load on the legs is possible again. The metal parts remain in the body for approx. 1.5 years and then have to be removed in a minor intervention under general anesthesia. Due to the operative correction, the wear process can be slowed down or even stopped. The already occurred cartilage damage, however, can not be cured. In the case of long axial deviations and end-stage arthrosis, often only the artificial joint replacement is able to allow a pain-free function of the knee joint.

It often comes after a trauma to a leg shortening, which makes it necessary to extend the bone to correct the leg deformity again. The so-called callus distraction is used more and more frequently as a complex and lengthy procedure. Another form of therapy is sensorimotor body therapy, which is used by specially trained therapists. This therapy has been developed to reduce chronic pain and has been very successful in the past. Specially developed forms of therapy make it possible in certain cases to correct the deformity and thus provide relief.

Prevention of O-legs

The children should be presented regularly to the check-ups with your pediatrician. This can accompany and document the course of development. If necessary, therapeutic measures can be initiated immediately. Children should walk barefoot whenever possible. The foot undergoes relief without shoes. It will be fun for your child to feel and feel the surfaces. It supports the development of a healthy and natural posture of the child. For adults, running barefoot is often a new and exonerating experience. You experience a completely new feeling of running, which makes a natural posture and natural rolling over the foot possible. Important and indispensable are matching shoes, the bars must sit properly, the size must be suitable. Children adjust their feet to the footwear and simply bend their toes when it gets too tight. Check several times whether the shoes fit properly and let the feet of specialized personnel directly in a shoe store to measure. For small children you should do without shoe purchases on the Internet. All shoes are different from the size, a try on accompanied by professionals is indispensable to the perfect matching shoe for your child
to find.

A well-balanced diet rich in vitamin D and calcium will support healthy and necessary bone strength. She will gladly support and advise her pediatrician and therapist individually. Exercise and exercise are the best ways to promote a healthy posture. In sports, however, especially in unilaterally onerous sports such. Football will be paid attention to a workout that compensates for this. Sport therapists and paediatricians advise on this.

Exercise with O-legs

Special exercises are always to be agreed with your therapist or doctor.

Note daily in everyday life!
Never overstretch knees in the stance, even if one leg is more loaded. Turn feet slightly outwards, whether standing or walking or jogging.

The following exercises can be performed in three sets of 15 repetitions and performed three to four times a week:

Training of the arch of the arch of the foot
Put your foot on a bath towel, let your heel stand and use your toes to lift the bath towel.
Initial position for the training of the arch of the arch of the foot: Place a foot on a bath towel, make the toes long and relax. End position for the training of the arch of the arch of the foot: raise toes, big toe balls try to retract until the arch of the foot is higher - slight spasm in the arch of the foot can be felt.

Training of the functional leg-length screw connection
Position the feet hip-widthwise, slightly outward-rotated 11 °, lift the little toes slightly and load the toe joint more = pronate the feet, bend the knees slightly and rotate outwards without changing the foot load. In the one-legged position bend the knee slightly, pronate the foot and turn the knee outside, guide the free leg far forward and lightly touch the ground with the heel, then swing the back leg as far as possible and lightly touch the ground with the toe. (CA)