Setting Things Straight - Correcting Deformities

There comes a time in a person’s life when they have to take a pause and re-evaluate matters and, when necessary, set things straight.  When certain aspects do not line up, no matter how small it may seem at first, it may set in motion a chain of reactions which could eventually lead to a bigger problem with more devastating effects.

“Setting things straight” is a metaphorical term used to describe the process of fixing, correcting or to amend something. It doesn’t necessarily mean you physically straightening something out. Well, not always anyways. Let us take the human body for example, our legs (or the lower limbs as we call it scientifically) should generally appear straight when looked at from the front.

Every so often there may be deformities to our limbs which cause the alignment to deviate away from its normal axes. So what is a normal axis? The fancy way to describe the alignment of the entire legs when looked at from the front is called the “lower limb axis”. Although this condition can be detected from physical examination of a patient, it is more accurately calculated by performing xray radiographs of the entire lower limb.

This is a special type of radiograph whereby the entire limb, from the pelvis all the way to the feet is shot in a single xray.

From this special xray, your doctor will be able to calculate some angles. He or she would identify the centre of the hip and the ankle on the xrays and draw straight line connecting them. This line is called the mechanical axis and should run through somewhat the centre of the knee. There are many other lines and angles and axes, but I'm not going to bore you with too many details here (if I haven’t already). When this line does not bisect the centre of the knee, one maybe diagnosed to have a valgus deformity (knocked knee) or a varus deformity (bowed knee). There could be many reasons why a patient could develop such a condition, it could be congenital, developmental, as a result of a trauma or as we see quite commonly, as a result of arthritic degeneration of the knee joint.

As mentioned earlier on, when things do not line up, it can sometimes result in other conditions. But before that, let us take a step back to see why this line plays such an important role. One simplified explanation for it is that the forces passing through the knee should ideally be well distributed throughout the knee. When the line falls on either side of the knee instead, the forces will also go through that side of the knee more. This will lead to excessive pressure on the affected side which could lead to injuries to the structures in the knee joint like the meniscus and the cartilage. Another role it plays is in stabilising the patella (knee cap), a condition I will describe more of in my next article.

So how can we treat this malalignment? Well, we set it back straight! Your doctor may recommend performing an osteotomy (fancy way to say breaking the bone), correct it’s alignment to the desired amount and then hold it in place with a plate and some screws. Osteotomy of the tibia (leg bone), femur (thigh bone) or both may be required. In the same setting, any concomitant injuries involving the joint itself could be addressed arthroscopically.

So, while the phrase “setting things straight” may be just metaphorical in most instances, here it is used quite literally. When this line is no longer straight like what we want it to be, there can be interventions performed to set it straight and prevent any further possible insults to the limb.