Visual inspection for lower limb malalignment diagnosis is unreliable

Review written by Dr Jarod Hall info

Key Points

  1. Visual inspection of lower limb alignment is a common practice in musculoskeletal care for various pathologies including, but not limited to, knee pain, hip pain, ankle pain, and low back pain.
All key points available for members only


It has previously been established that varus malalignment of the knee is present in 53% to 76% of individuals with unicompartmental knee osteoarthritis (OA) (1). Currently, this malalignment is thought to increase the risk of both the development and progression of OA due to loading imbalance of the knee joint (2,3).

During physical examination, several methods are available for the assessment of lower limb alignment (4,5). All these alternatives for whole leg radiographs (WLRs) have been tested and compared with the measured leg axis on WLRs for correlations with results ranging from low, moderate to good. In the case of suspected malalignment, physicians often choose to obtain additional WLR which exposes patients to unnecessary radiation and increases health care costs.

This study aimed to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without the addition of tools and other physical examinations. The authors’ hypothesis was that only a visual inspection of the lower limb is not sufficient for the detection of lower limb malalignment.

Varus malalignment of the knee is present in 53% to 76% of individuals with unicompartmental knee osteoarthritis.
The overdiagnosis of normal anatomic presentation as pathological or dysfunctional has the underlying potential for long ranging iatrogenic effects.


  • For this study, patients were recruited at the outpatient clinic of the University Medical Center (UMC) Utrecht.
to unlock full access to this review and 989 more