Straightening Crooked Legs: Diagnosis and Treatment Options

Dr. Daniele Pili

If you are wondering whether bow legs or knock knees can be straightened, the answer is yes.

Bow legs and knock knees can be corrected through femoral or tibial osteotomies using plates, intramedullary nails, or external fixators. The most appropriate technique depends on the location and complexity of the deformity.

Can bow legs be corrected?

Yes, bow legs can be corrected in most cases through targeted orthopaedic surgery using either open or minimally invasive techniques. Lower limb deformities may involve the femur, the tibia, or both, and include conditions such as bow legs (genu varum) and knock knees (genu valgum). These deformities may result from trauma, fractures, congenital conditions, or growth disorders. Besides causing cosmetic concerns, they may lead to pain, instability, gait abnormalities, and premature joint degeneration, eventually resulting in severe knee osteoarthritis and hip osteoarthritis, which in advanced cases may require a total hip replacement or a total knee replacement.

Treatment consists of correcting the mechanical axis of the limb through an osteotomy, a surgical procedure that precisely realigns the bone. Depending on the location of the deformity, the patient’s age, and the complexity of the case, correction may be performed on the femur, the tibia, or both, using plates, intramedullary nails, or external fixators. The choice of technique must be individualized and based on careful clinical and radiographic planning.

For this reason, every patient should be evaluated by an orthopaedic surgeon experienced in lower limb deformity correction, who can accurately identify the cause of the deformity and recommend the safest and most effective treatment.

The surgical technique is selected together with your surgeon and depends on the location and complexity of the deformity.

What Is Meant by Crooked Legs?

The term crooked legs refers to any abnormal alignment of the lower limbs in which the femur and tibia are not properly aligned with the center of the hip joint, the center of the knee, and the center of the ankle. This condition may be present from birth, develop during growth, or occur later in adulthood as a result of trauma, fractures, bone diseases, or joint degeneration.

A lower limb deformity is not only a cosmetic concern but also a functional problem that can significantly affect walking, physical activity, and long-term joint health.

What Are the Most Common Types of Crooked Legs?

The most common deformities are bow legs (genu varum), in which the knees remain apart while the ankles touch, leaving a visible gap between the knees, and knock knees (genu valgum), where the knees touch while the ankles remain noticeably separated. However, more complex deformities may also occur, involving multiple planes of the limb, including rotational deformities, recurvatum, procurvatum, or limb length discrepancy.

Bow Legs (Genu Varum): What Problems Can They Cause?

Bow legs increase the load on the medial compartment of the knee. If left untreated, they may lead to medial knee osteoarthritis, even in relatively young patients. In advanced stages, when joint-preserving procedures are no longer effective, a total knee replacement may become necessary.

Knock Knees (Genu Valgum): What Problems Can They Cause?

Knock knees increase the load on the lateral compartment of the knee. If the deformity is not corrected, it may lead to lateral knee osteoarthritis, often at a relatively young age. In severe cases, patients may require a total knee replacement much earlier than expected, with all the challenges associated with the limited lifespan of the implant and the possible need for one or more revision surgeries during their lifetime.

Femoral and Tibial Deformities

Not all crooked legs have the same origin. The deformity may involve the femur, the tibia, or both bone segments, and accurately identifying its location is essential for planning the most appropriate treatment. In general, knock knees (genu valgum) are more commonly associated with a femoral deformity, whereas bow legs (genu varum) more frequently originate from the tibia. However, this is not an absolute rule, and many patients present with combined deformities or deformities arising from different anatomical locations.

For this reason, a thorough evaluation of lower limb alignment is essential and includes a specialist examination together with weight-bearing full-length X-rays of the lower limbs. The choice of surgical technique depends primarily on the location of the deformity. For tibial deformities, an external fixator often represents the most versatile and precise solution, particularly in complex or multiplanar cases. In contrast, femoral deformities are frequently better treated with an intramedullary nail, which allows accurate realignment without external devices and generally provides a more comfortable recovery for the patient. Nevertheless, every case requires individualized planning to achieve the most accurate anatomical correction possible.

How Are Crooked Legs Corrected?

In adults, crooked legs are corrected through an osteotomy, a surgical procedure in which the bone is carefully cut and realigned to restore the normal mechanical axis of the lower limb.

Deformity correction may be performed either acutely or gradually. In an acute correction, the bone is completely realigned during surgery and stabilized immediately with internal fixation. In a gradual correction, the deformity is corrected progressively over the following days or weeks, usually using a circular external fixator, which represents the evolution of the principles of the Ilizarov technique. This method allows extremely precise adjustments, even in the most complex multiplanar deformities. The choice between these techniques depends on the location and severity of the deformity, bone quality, and the goals of treatment.

Once the desired correction has been achieved, the osteotomy must be stabilized with an internal fixation device, which maintains the bone in the correct position while it heals. Depending on the location of the deformity and the patient’s individual characteristics, plates, intramedullary nails, or external fixators may be used.

The choice of fixation method is never random. Each device has specific indications. In some patients, a plate is the most appropriate solution; in others, an intramedullary nail provides the best outcome. For more complex or multiplanar deformities, however, an external fixator often offers the highest degree of precision. For this reason, every treatment plan should be individualized following careful clinical and radiographic evaluation.

 

Corrective Tibial Osteotomy

A corrective tibial osteotomy is the surgical procedure used to restore proper lower limb alignment when the deformity primarily involves the tibia. Following the osteotomy, the bone can be stabilized using an external fixator, a plate, or, in selected cases, an intramedullary nail.

In most patients, the external fixator is the preferred option because it allows extremely accurate correction, even for complex deformities, with the possibility of making gradual adjustments after surgery. This approach provides excellent functional and cosmetic outcomes. Plates are an excellent alternative for simpler deformities, whereas intramedullary nails are indicated only in selected situations and are used much less frequently for tibial deformities.

Corrective Femoral Osteotomy

A corrective femoral osteotomy is indicated when the deformity primarily affects the femur. In most cases, stabilization is achieved using an intramedullary nail, while plates are used less frequently. An external fixator is generally reserved for more complex or multiplanar deformities or when gradual correction is required.

An intramedullary nail is often the preferred option because it allows deformity correction in a shorter period of time without the need for an external device and generally provides a faster functional recovery. In addition, it helps preserve knee range of motion, reducing the risk of joint stiffness and allowing earlier rehabilitation compared with other fixation methods. For these reasons, whenever the characteristics of the deformity allow, an intramedullary nail is often considered the treatment of choice for femoral deformities.

When Is an External Fixator Used?

An external fixator is primarily indicated for large deformities, multiplanar deformities, and cases requiring gradual correction. It is used mainly for tibial deformities, whereas in the femur it is generally reserved for the most complex cases or when other surgical techniques are not suitable. This method is one of the most effective techniques for straightening crooked legs.

Because the correction can be adjusted gradually after surgery, an external fixator allows extremely precise realignment of the limb. Modern circular external fixators, based on the principles of the Ilizarov technique, make it possible to treat even the most complex deformities with excellent functional and cosmetic results, and they remain one of the most versatile and accurate tools in lower limb reconstructive surgery.

When Can Plates or Intramedullary Nails Be Used?

Plates and intramedullary nails are used primarily for the correction of femoral deformities. Plates may also be used for tibial deformities, particularly when they are simple and well localized. Their main advantage is that they allow immediate correction, resulting in a shorter treatment period and eliminating the need for an external device.

In more severe or complex tibial deformities, however, plates and intramedullary nails offer less flexibility than an external fixator, which allows gradual and more precise correction. The final cosmetic outcome also depends on the surgical technique used. Although plates avoid an external frame, they require larger surgical incisions and may leave more visible scars, whereas the wires and pins of an external fixator generally leave smaller, more discreet scars. Therefore, the choice of fixation should be based primarily on the location, severity, and complexity of the deformity.

How Long Does Recovery Take?

Recovery time depends on the location of the deformity and the surgical technique used. With an external fixator, treatment generally lasts between 3.5 and 5 months, both for femoral and tibial osteotomies, depending on the extent of the correction and the rate of bone healing.

When correction is performed using an intramedullary nail, particularly in the femur, recovery is usually faster, and patients often return to their normal daily activities in approximately 2 months, thanks to the greater stability of the fixation and better preservation of knee function.

With plate fixation, recovery times are generally similar to those of an external fixator, averaging between 3 and 5 months, although they may vary depending on the type of osteotomy, the patient’s age, and bone quality.

Regardless of the technique used, a structured physical therapy program is essential to restore joint mobility, muscle strength, and a normal gait as quickly and safely as possible.

What Are the Risks of Surgery?

Like any surgical procedure, a corrective osteotomy carries potential risks and complications. Fortunately, when the operation is performed by an experienced surgeon and the patient carefully follows the postoperative rehabilitation program, most complications are uncommon.

With an external fixator, the most common complication is superficial pin-site infection involving the pins or wires. In the vast majority of cases, these infections resolve with local wound care and oral antibiotics without affecting the final outcome. Less commonly, delayed bone healing (delayed union) or a fracture after external fixator removal may occur. Although these complications are rare, they should be considered during treatment planning.

With plates and intramedullary nails, the main concern is the risk of deep infection. Although uncommon, these infections may require additional surgery and prolonged antibiotic treatment. During tibial deformity correction using a plate or an intramedullary nail, there is also a small risk of vascular or nerve injury because of the proximity of important neurovascular structures.

Careful preoperative planning, meticulous surgical technique, and appropriate postoperative follow-up significantly reduce the incidence of complications and contribute to the high success rates of modern deformity correction surgery.

How Much Does It Cost to Straighten Crooked Legs?

The cost of crooked leg correction surgery depends on several factors, including the type of deformity, the surgical technique used (plate, intramedullary nail, or external fixator), the complexity of the case, and the hospital or clinic where the procedure is performed.

In Italy, the total cost generally ranges between €15,000 and €25,000, depending on the surgical technique and the length of hospitalization. In some countries where healthcare costs are lower, the same procedure may be performed at a 20–30% lower cost, while still maintaining high standards of care, provided that treatment is carried out in specialized centers with expertise in lower limb reconstructive surgery.

Before planning surgery, a specialist consultation is always recommended. This evaluation is essential to determine the most appropriate surgical technique and to provide a personalized treatment plan and cost estimate based on the patient’s deformity and individual needs.

These price ranges generally apply to bow leg correction (genu varum), knock knee correction (genu valgum), and, more broadly, to lower limb deformity correction surgery.

Frequently Asked Questions

Can crooked legs be corrected in adults?

Yes. In adults, crooked legs are usually corrected through an osteotomy, a surgical procedure in which the bone is carefully cut and realigned to restore the normal mechanical axis of the femur, the tibia, or both.

What Is the Difference Between Bow Legs and Knock Knees?

In bow legs (genu varum), the knees remain apart when the ankles are together. In knock knees (genu valgum), the opposite occurs: the knees touch while the ankles remain separated.

Can Deformity Correction Be Performed Without an External Fixator?

Yes, in many cases correction can be achieved using plates or intramedullary nails. However, an external fixator is particularly useful for complex or multiplanar deformities and for deformities associated with limb length discrepancy.

How Long Does It Take to Walk Again?

This depends on the type of osteotomy, the fixation method used, and the patient’s bone quality. Weight-bearing is individualized and is determined according to clinical progress and follow-up X-rays.

Can Deformity and Limb Length Discrepancy Be Corrected at the Same Time?

Yes. In selected patients, it is possible to correct both the limb alignment and the limb length discrepancy during the same treatment.

How Much Does the Surgery Cost?

The cost depends on the complexity of the deformity, the number of bone segments involved, the fixation device used, the hospital or clinic, and the rehabilitation program required.

Comparison of Surgical Techniques

Technique	Main Indication	Advantages	Limitations
Plate Fixation	Simple, localized deformities	Internal fixation Stable fixation High patient comfort	Possible temporary weight-bearing restrictions Risk of deep infection Less accurate in complex deformities Larger surgical scars
Intramedullary Nail	Selected deformities involving specific bone segments, with or without limb length discrepancy	Internal fixation Stable fixation High patient comfort Faster functional recovery	Not suitable for all deformities Higher implant cost
External Fixator	Complex deformities or deformities associated with limb length discrepancy	Gradual and adjustable correction High versatility	Greater commitment required from the patient Reduced comfort during treatment
Hexapod External Fixator	Multiplanar deformities or deformities associated with limb length discrepancy	Gradual and adjustable correction Extremely high correction accuracy	Higher treatment cost

Medical content reviewed by Dr. Daniele Pili
Consultant Orthopaedic and Trauma Surgeon, specialist in lower limb deformity correction, limb reconstruction, and limb lengthening surgery.

Last updated: July 12, 2026

Dr. Daniele Pili