Knock knees

What are knock knees?

The medical term for knock knees is 'genu valgum' - genu meaning 'knee' in Latin, and valgum meaning 'bending outwards'. In knock knees, if the knees touch it is the lower leg which seems bent outwards. So if you have knock knees you are unable to stand with your knees AND your ankles together.

As children grow up, they tend to start off 'bow-legged'. This means if their feet are together, their knees are apart, leaving a diamond shape between the legs. This is normal in babies and toddlers until the age of about 2 years.

As the child's leg bones grow and develop, they then tend to take on a 'knock-kneed' shape. Now if their knees are together, their feet and ankles are apart. It tends to be most obvious around the age of 3 or 4 years, usually gradually improving to the correct position after that, as the child stands for longer periods of time. Knock knees are normal up to the age of 7 or 8 years, although the condition may last longer.

Valgus

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Knock knees in children do not cause problems. If the condition is severe, or caused by an underlying problem, it may cause pain or difficulty walking.

In most cases, knock knees are purely caused by the normal phase of growth and development. Occasionally - in either older children or adults - there can be an underlying problem causing the condition. For example:

• Vitamin deficiency (particularly vitamin D deficiency causing rickets). Vitamin C and calcium deficiency can also affect the way bones grow.

• Rheumatoid arthritis or other types of arthritis.

• Wear and tear (osteoarthritis).

• Obesity.

• Operations or injuries to the knee or legs.

• Inherited (genetic) conditions which affect the way that the knees develop.

You do not need to see a doctor if your child is at an age where having knock knees is normal (aged more than 2 years and less than 8 years) and if the deformity is not very severe. If your child lies on their back with their knees together, you can measure the distance between their ankles.

If it is less than 10 cm around age 4 years, this is likely to correct itself as they grow. If you take photos of your child every 3-6 months, standing with their knees together, you should see that the legs gradually become straighter from the age of 4 years or so.

See a doctor if:

• Only one leg is affected.

• Your child has knock knees before the age of 2 years or after the age of 8 years.

• There is a larger gap between the ankles than that described above.

• Your child has pain in the lower legs or knees.

• Your child has problems walking or walks with a limp.

• You develop knock knees as an adult.

The diagnosis of knock knees can be made by just looking at a child. If it is particularly severe, or if it occurs outside the normal age range, then further tests may be needed. This might include X-rays or blood tests.

The severity of the knock knees can be assessed by measuring the distance between the ankles when the child is standing with knees together. or by measuring other angles of the legs.

In most cases no treatment is needed. For children who develop knock knees as a normal part of their childhood growth, the condition corrects itself as they continue to grow. They do not need any special shoes or braces, and do not need to avoid any sporting activities. They do not need any physiotherapy or other special treatment.

If the condition is severe, or caused by an underlying problem, then treatment may be needed. This will then depend on the underlying condition, the severity of the deformity and the stage of growth that the child is in.

If the knock knees are caused by a metabolic problem, such as Vitamin D deficiency, the deformity may correct with vitamin replacement.

If the angle of bone growth is around 15-20 degrees in a child who is less than 10 years old, guided growth may be suitable to treat knock knees. Plates, or screws or staples may be implanted into the bone to aid correct growth.

Occasionally an operation to correct the deformity is needed. This is called an osteotomy and is usually followed by physiotherapy.

Children who have knock knees as part of their normal growth pattern do very well without any medical assistance. Children who have an underlying condition can also do very well as long as their condition is recognised and treated. Complications only usually occur when an underlying condition is missed.