Bow Legs Aren't Just About Leg Shape. They're About Your Knees

There's something to check before leg shape

Key points in 30 seconds

1. Before bow legs are a question of shape, they're a question of your knees. When the legs curve outward, body weight piles onto the inner side of the knee.
2. In a large study, bow legs raised the risk of developing knee arthritis by 1.5 times and the risk of existing arthritis getting worse by 3.6 times.
3. How bowed the legs look depends on both bone angle and posture, muscles and walking habits. How much each one contributes differs from person to person.
4. Posture, muscles and walking habits are things we can work on. That's the part we treat. Bone angle itself, however, is hard to change without surgery.
5. Bow legs in babies are almost always normal. But if they get worse after age two or three, or only one leg curves, an exam comes first.

What we often hear

• "My pants never sit right."
• "My legs look bent in photos."
• "I don't feel comfortable wearing skirts."
• "The inside of my knee aches."
• "Some places say it can be corrected and some say it can't. I don't know who to believe."

Many people come in because of how their legs look and are surprised when we start talking about their knees.

Here's what happens on your first day

• How different the look is from the actual angle. We check your whole-body alignment with a posture analysis, and measure the angle with standing X-rays in partnership with the radiology clinic on the 2nd floor of the same building.
• Whether it's bone angle or posture and muscles. That question gets answered that day.
• What can change, and by how much. The share that comes from posture and muscles is the part we can help you change. If bone angle is the main factor, we tell you that plainly too.

You've looked at your legs in the mirror, haven't you?

People tell us their pants never sit right. They say their legs look bent in photos. Some say they don't feel comfortable wearing skirts.

Most people who come in for bow legs come because of how they look. Then, a little hesitantly, they ask one more thing: "Is it bad for my health, too?"

That's actually the more important question. And the answer is clear.

Why bow legs really matter

Before bow legs are a question of shape, they're a question of your knees.

When the legs curve outward, every step shifts your body weight toward the inner side of the knee. The load that the whole knee should share ends up concentrated on the inner cartilage.

Here's what that looks like in numbers. In a large study of 4,265 knees:

	Knees with bow legs
Risk of arthritis developing	about 1.5 times
Risk of existing arthritis getting worse	about 3.6 times

And there's one more thing worth noticing. The more damaged the joint already was, the more harm the same bow legs did. One analysis found the risk was 4 times higher in early arthritis, rising to as much as 10 times in more advanced arthritis.

In other words, putting it off costs you.

So how much can bow legs improve?

"How much will it improve?" is a question you can only answer by measuring. Even with the same bow legs, what's behind them is different for each person.

Two things are mixed together in how bowed the legs look.

One is bone angle. This is the angle between the thighbone and the shinbone, and once you've finished growing, much of it is set by the shape of the bones. The way to change it significantly is surgery that cuts the bone to change the angle. We don't tell anyone we can change this part.

The other is posture, muscles and walking habits. How much the pelvis and hip joints are rotated, muscle imbalance around the knee, the shape of the feet, and how you stand and walk. This is something we can work on, and it's the part we treat. A Korean study of 47 middle-aged women with bow legs and knee pain reported that 12 weeks of exercise improved some alignment measures and knee pain.

That's why measuring comes first. Standing X-rays and a posture analysis show which of the two contributes how much. If functional factors make up a large share, there's that much more room for the visible shape to change too. If bone angle is the main factor, the goal needs to be set differently. Answering "yes, it can be fixed" or "no, it can't" without measuring is actually the less accurate answer.

For the record, some methods looked promising but failed. One was an insole that raises the outer edge of the shoe to take load off the inner knee. The theory made sense, but an analysis pooling several trials found it didn't reduce pain. Managing the load on the knee isn't simple.

The evidence that bow legs are bad for the knees is strong, and what can change, and by how much, can only be known by measuring.

Bow legs in children are a different story

Babies' legs are naturally bowed. Once they start walking, the legs straighten out on their own by around age two, then actually swing toward knock knees before settling into the adult shape around the time they start school. This is normal development.

So what children need isn't correction but screening. If any of the following apply, an exam comes first:

• The legs are getting worse after age two or three
• Only one leg is bowed
• The child is in pain or limping
• The child is clearly shorter than kids the same age

What we want to be clear about

Large studies have confirmed that people with bow legs have more knee arthritis. But no study has yet shown that treating bow legs prevents arthritis.

So we don't tell you, "Correct it and you won't get arthritis." What we can say is that reducing the load on the inner knee is something you can do now, and it can be measured and checked.

How we work

One. We measure first.
What looks like bow legs and the actual angle can be different. We check whole-body alignment with a posture analysis and measure the angle with standing X-rays in partnership with the radiology clinic on the 2nd floor of the same building. This is where we find out whether it's a bone problem, a posture and muscle problem, or a mix. We don't talk about correction without measuring.

Two. On your first day, we tell you what can change and by how much.
With the results in front of us, we explain how much of it comes from functional factors. That share is the part we can help you change. If bone angle is the main factor, we tell you that plainly too. We don't exaggerate what's possible, and we don't say something can't be done when it can.

Three. We actually work on what can change.
We use Chuna (Korean manual therapy) to release stiffness and improve the alignment of the pelvis and hips, give you exercises to strengthen the muscles around the knee and hips, and work with you on how you stand and walk. If you're in pain, we use acupuncture and pharmacopuncture (herbal acupuncture) to manage pain where the load is concentrated. Some people find the visible shape of their legs changes during this process. Not because the bones change, but because the conditions that made the legs look that way change.

Four. We measure again the same way and show you.
We repeat the same measurements taken before treatment, using exactly the same method. We judge by numbers, not by how photos look.

Five. For children, screening comes first.
If only one leg is bowed, it's getting worse, or the child is in pain, we arrange imaging and a referral before any correction program.

If you don't check now

Bow legs themselves don't usually hurt right away. That makes them easy to put off.

But the numbers above tell us something. The more the joint is damaged, the more harm the same bow legs do. What's 4 times now becomes 10 times later. Once your knees start to hurt, you have fewer options.

On the other hand, if you know what the problem is now, you can start with what can be changed. Even if bone angle can't change, the load on your knees can be reduced. Body weight and muscle strength are areas where benefits have been confirmed regardless of alignment.

What changes

Not worrying about your legs when you have your photo taken. That's nice too.

But what we're really aiming for is this: still walking on your own knees 10 or 20 years from now. Not reaching for the handrail when you go down stairs. Not getting caught in the cycle of being unable to walk because it hurts, then getting weaker because you don't walk.

That's the real reason to deal with bow legs.

How much can change, and how fast, varies from person to person depending on what's behind your alignment, your age, weight and muscle strength.

Come see us if you

• Are bothered by the shape of your legs
• Have started to feel aching on the inside of your knee
• Have never gotten a straight answer on whether it can be corrected
• Are a parent worried because your child's legs look bowed

We don't say "it can be fixed" without measuring. On the day, we measure the angle, and you go home knowing how much of it can change. For children, screening comes before correction.

Sources for this article

Source	What was studied	Findings
Sharma et al., 2010	Large study following 4,265 knees	Bow legs: 1.5x arthritis onset, 3.6x inner-knee progression
Sharma et al., 2001	Knee arthritis patients followed for 18 months	Bow legs linked to inner-knee arthritis progression and loss of function
Cerejo et al., 2002	377 knees followed	4x in early arthritis, 10x in more advanced arthritis
Tanamas et al., 2009	Pooled analysis of multiple studies	Confirmed link between malalignment and arthritis
Parkes et al., 2013	Pooled analysis of insole trials	Insoles raised on the outer edge did not improve pain
Moon et al., 2023	47 women with bow legs and knee pain, 12 weeks of exercise	Some alignment measures and pain improved (one small study)

References

1. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286(2):188-195. doi:10.1001/jama.286.2.188. PMID: 11448282

2. Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L. The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis & Rheumatism. 2002;46(10):2632-2636. PMID: 12384921

3. Tanamas S, Hanna FS, Cicuttini FM, Wluka AE, Berry P, Urquhart DM. Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Care & Research. 2009;61(4):459-467.

4. Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TDV, Hietpas J, Lynch J, Nevitt M. Varus and valgus alignment and incident and progressive knee osteoarthritis. Annals of the Rheumatic Diseases. 2010;69(11):1940-1945. PMID: 20511608

5. Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis. JAMA. 2013;310(7):722-730. doi:10.1001/jama.2013.243229. PMID: 23989797

6. Moon HH, Seo YG, Kim WM, et al. Effect of combined exercise program on lower extremity alignment and knee pain in patients with genu varum. Healthcare (Basel). 2023;11(1):122. doi:10.3390/healthcare11010122

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If the shape of your legs bothers you, come in and get measured. We'll tell you how much of it can change that same day.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.