What is Valgus and Varus Knee Alignment?

Valgus (knock knees) and varus (bow legs) are alignment issues where the knees angle inward (valgus) or outward (varus). These conditions can alter biomechanics, increasing stress on the knee joint and surrounding tissues.

What happens with abnormal knee alignment?

In valgus alignment, the inner knee structures (MCL, meniscus) are overloaded. In varus alignment, the outer knee (LCL, lateral meniscus) takes excess load. Both can contribute to arthritis, instability, and sports-related injuries.

Common causes

  • Congenital bone structure
  • Developmental conditions in children
  • Osteoarthritis in older adults
  • Previous fractures or injuries
  • Muscle weakness (glutes, quadriceps) contributing to dynamic valgus

Who is most affected?

  • Children and adolescents with congenital variations
  • Athletes in pivoting sports with poor biomechanics
  • Older adults with degenerative changes (OA)
  • In Australia, valgus alignment is strongly associated with ACL and patellofemoral pain in netball and football players

Symptoms of Valgus/Varus Knee Alignment

  • Knee pain during activity
  • Frequent injuries (meniscus, ligament tears)
  • Uneven wear of cartilage
  • Visible inward or outward angling of the knees

📞 If you notice knock knees or bow legs with knee pain, book an assessment at Spinal and Sports Care Bella Vista or Parramatta.

Diagnosis

Clinical assessment of standing and walking posture.

  • Measurement of Q-angle and alignment
  • X-rays for bony alignment
  • MRI if associated cartilage or ligament injuries are suspected

Treatment options

Non-surgical:

  • Physiotherapy to strengthen hips, glutes, and quads
  • Orthotics to correct foot mechanics
  • Bracing in some cases to reduce pain

Surgical:

  • Osteotomy in severe cases, more common in older adults with arthritis

Role of physiotherapy

  • Strengthen glutes and hip stabilisers
  • Correct dynamic valgus with neuromuscular training
  • Address poor landing mechanics
  • Guide athletes back to sport safely

Recovery timeline

  • Mild biomechanical cases: 6–12 weeks
  • Chronic structural issues: long-term management with rehab

Prevention

  • Neuromuscular injury prevention programs (PEP, FIFA 11+, Netball Knee)
  • Strengthening quads, hamstrings, and glutes
  • Correct footwear and orthotics
  • Early screening in athletes

Taping and bracing

  • Knee braces can support alignment in older adults with arthritis
  • Taping may help control dynamic valgus in sport

When to see a physiotherapist or chiropractor

📞 If knee alignment is causing pain, instability, or repeated injuries, book a biomechanical assessment at Spinal and Sports Care.

Frequently Asked Questions

Inward angling of the knees (knock knees).

Outward angling of the knees (bow legs).

Valgus alignment is common in netballers; varus is more common in older adults with arthritis.

Yes, they increase the risk of ACL and meniscus injuries.

Through clinical assessment and imaging.

Only severe structural cases are usually in older adults.

Yes, dynamic valgus can be corrected with strengthening and retraining.

Yes, they can reduce symptoms and improve function.

Many children outgrow mild valgus alignment.

If knee pain or instability develops with abnormal alignment.