Knock Knee Treatment in Delhi, India

Knock-knees, also known as genu valgum, is a condition where the knees angle inwards and touch one another when the legs are straightened. This condition is common in young children and is often part of normal growth and development. However, in some cases, it can persist into adolescence and adulthood, potentially requiring medical intervention.

There are several factors that can contribute to the development of knock-knees, ranging from normal growth patterns to medical conditions.

• Physiological Development: In most children, knock-knees are a normal part of development. Children often develop a bow legged stance at birth, which transitions to knock-knees around the ages of 2 to 4. By the age of 7, most children naturally outgrow this condition.
• Genetic Factors: A family history of knock-knees can increase the likelihood of an individual developing this condition. Genetic predisposition plays a significant role in its persistence beyond childhood.
• Injury or Trauma: Severe injury to the growth plate in the knee can disrupt normal development, potentially leading to knock-knees.
• Nutritional Deficiencies: Lack of vitamin D and calcium can lead to rickets, a condition that softens bones and can cause knock-knees.
• Obesity: Excess weight can place additional stress on the knees, contributing to the development or exacerbation of knock-knees.
• Underlying Medical Conditions: Conditions such as osteoarthritis, rheumatoid arthritis, or certain skeletal dysplasias can lead to knock-knees in adults.

Here are certain risk factors that can increase the likelihood of developing knock-knees or exacerbate the condition:

• Obesity: Carrying excess weight puts additional pressure on the knees, potentially worsening or contributing to the development of knock-knees. The increased strain on the joints can affect alignment, leading to further complications.
• Family History: As mentioned earlier, genetic predisposition can play a role. Individuals with a family history of knock-knees are more likely to develop the condition themselves, and it may persist beyond childhood.
• Nutritional Deficiencies: Inadequate intake of calcium and vitamin D, which are essential for healthy bone development, can lead to conditions like rickets, increasing the risk of knock-knees, especially in children.
• Injury or Trauma to the Knee: Injuries that affect the growth plate or damage the bones and cartilage around the knee can result in improper healing, leading to knock-knees. This risk is especially prominent in children whose bones are still developing.
• Underlying Medical Conditions: Individuals with bone or joint diseases such as osteoarthritis, rheumatoid arthritis, or metabolic bone disorders are at higher risk of developing knock-knees, particularly in adulthood.
• Age: In children, knock-knees can be a temporary developmental phase. However, in adults, ageing can contribute to the wear and tear of the joints, leading to alignment issues like knock-knees, especially in those with preexisting joint problems.
• Improper Footwear or Gait Issues: Poor posture, improper gait, or wearing unsupportive footwear over a long period can affect knee alignment and contribute to knock-knees.

These risk factors are important to consider, as addressing them early on can help manage or reduce the severity of knock-knees and prevent further complications.

The symptoms of knock-knees can vary, but typically involve noticeable changes in knee alignment and associated discomfort.

• Age: Knock-knees are most common in children aged 2 to 4 years old. The condition often corrects itself as the child grows. However, if the condition persists beyond the age of 7 or into adulthood, it may require medical attention.
• Genetics: A family history of knock-knees or other skeletal abnormalities increases the risk of developing the condition.
• Nutritional Deficiencies: Inadequate intake of vitamin D and calcium during childhood can lead to rickets, increasing the risk of knock-knees.
• Obesity: Carrying excess weight can strain the knee joints, potentially causing or worsening knock-knees.
• Injury: Trauma to the knee, particularly during the growth phase in children, can result in knock-knees.
• Medical Conditions: Conditions like rickets, osteomalacia, osteoarthritis, and other metabolic or skeletal disorders can predispose an individual to develop knock-knees.

Diagnosing knock-knees involves a thorough clinical evaluation and, in some cases, imaging tests to determine the extent and underlying cause of the condition. Here’s what one can expect during the diagnostic process.

• Medical History: The doctor will start by taking a detailed medical history, including any family history of skeletal abnormalities, previous injuries, and any symptoms experienced by the patient.
• Physical Examination: A physical examination is crucial to assess the alignment of the knees and legs. The doctor will observe the patient's gait, measure the distance between the ankles when the knees are touching, and evaluate the range of motion and strength of the knee joints.
• Imaging Tests: If the physical examination suggests abnormalities, imaging tests such as X-rays or MRI scans may be ordered. X-rays can reveal bone structure and alignment, while MRIs can provide detailed images of soft tissues and help identify any underlying conditions like ligament injuries or growth plate issues.
• Measurement of Intermalleolar Distance: During the physical exam, the doctor may measure the intermalleolar distance, which is the space between the inner ankles when the patient stands with their knees together. A significant gap can indicate the presence of knock-knees.
• Assessment of Growth Patterns: For children, doctors will also assess growth patterns to determine if knock-knees are a part of normal development or if they indicate a more serious issue. This may involve tracking the condition over time to see if it improves as the child grows.
• Evaluation of Nutritional Status: In some cases, blood tests may be performed to check for nutritional deficiencies, such as low levels of vitamin D or calcium, which can contribute to bone deformities like knock-knees.

By combining these diagnostic methods, healthcare providers can accurately diagnose knock-knees and develop an appropriate treatment plan tailored to the patient's needs.

Treating knock-knees involves a combination of approaches depending on the severity, underlying cause, and the age of the patient. Here are the primary treatment options:

• Observation and Monitoring: For young children, knock-knees often resolve on their own as they grow. Regular monitoring by a healthcare provider ensures that the condition is improving over time without intervention.
• Exercise and Physical Therapy: Specific exercises and physical therapy can help strengthen the muscles around the knees, improve alignment, and reduce discomfort. This approach is often recommended for mild cases in both children and adults.
• Orthotic Devices: Custom orthotic devices, such as braces, insoles, or shoe modifications, can help correct knee alignment. These are particularly useful for children who are still growing.
• Medication: If the knock-knees are caused by an underlying condition like rickets, supplements such as vitamin D and calcium may be prescribed to address the deficiency.
• Weight Management: For overweight individuals, losing weight can significantly reduce the stress on the knees, potentially improving the condition or preventing it from worsening.
• Surgical Intervention: In severe cases or when other treatments have not been effective, surgery may be required. Surgical options include:
• Osteotomy: This procedure involves cutting and realigning the bones to correct the knee alignment.
• Guided Growth Surgery: Small metal plates are temporarily inserted near the growth plates to gradually correct bone growth in children.
• Total Knee Replacement: In adults with severe knock-knees due to arthritis, knee replacement surgery might be necessary.
• Lifestyle Modifications: Adapting daily activities to reduce stress on the knees can be beneficial. This may include avoiding high-impact sports and incorporating low-impact exercises like swimming or cycling.
• Pain Management: Over-the-counter pain relievers or prescribed medications can help manage discomfort associated with knock-knees.

Each treatment plan is individualised, taking into account the specific needs and circumstances of the patient. Early intervention and appropriate management can lead to significant improvements in symptoms and quality of life.

If left untreated, knock-knees can lead to several complications, particularly if the condition is severe or persists into adulthood. Here are some potential complications:

• Joint Pain: Misalignment of the knees can lead to chronic pain in the knees, hips, and ankles due to abnormal stress and pressure on these joints.
• Osteoarthritis: Persistent knock-knees can accelerate the wear and tear on the knee joints, increasing the risk of developing osteoarthritis at an earlier age.
• Difficulty Walking: Severe knock-knees can affect gait and mobility, making it difficult to walk, run, or participate in physical activities.
• Lower Extremity Injuries: The altered alignment and biomechanics of the legs can lead to an increased risk of injuries such as ligament tears, meniscus injuries, and stress fractures.
• Back Pain: The imbalance caused by knock-knees can extend to the spine, potentially leading to lower back pain.
• Poor Quality of Life: Persistent pain, mobility issues, and the need for ongoing medical treatment can significantly impact an individual's quality of life, limiting daily activities and social interactions.

Preventing knock-knees involves addressing risk factors and maintaining overall bone health. Here are some preventive measures:

• Adequate Nutrition: Ensure a diet rich in calcium and vitamin D to promote healthy bone development. Foods such as dairy products, leafy greens, and fortified cereals can help, along with appropriate supplements if necessary.
• Regular Exercise: Engage in regular physical activity to strengthen the muscles around the knees and maintain proper alignment. Activities that promote good posture and leg strength, like swimming, cycling, and walking, are beneficial.
• Weight Management: Maintain a healthy weight to reduce unnecessary stress on the knee joints. This is particularly important for children as they grow and for adults to prevent complications.
• Injury Prevention: Take precautions to avoid knee injuries, especially during sports and physical activities. Wearing appropriate protective gear and following safety guidelines can help.
• Regular Check-ups: For children, regular pediatric check-ups can help monitor bone development and catch any abnormalities early. Early detection allows for timely intervention if necessary.
• Proper Footwear: Wear well-fitting, supportive shoes to ensure proper leg alignment and reduce strain on the knees.
• Posture and Ergonomics: Maintain good posture and use ergonomically designed furniture to support proper alignment of the legs and spine.

While knock-knees are often a normal part of childhood development, these preventive measures can help mitigate the risk of complications and promote overall musculoskeletal health.

1. At what age do knock-knees typically become noticeable?

Knock-knees typically become noticeable between the ages of 2 to 5 years old in children, as part of normal development. They often peak around age 4 and then start to correct themselves as the child grows older.

2. Can knock-knees realign without treatment? 

Yes, in many cases, knock-knees realign as the child grows. By the age of 7 or 8, most children outgrow this condition without needing any specific treatment.

3. Are there non-surgical treatments for knock-knees? 

Yes, non-surgical treatments for knock-knees include physical therapy to strengthen muscles around the knees, orthotic devices (such as braces or shoe inserts) to support proper alignment, and in some cases, weight management and exercises to improve knee alignment.

4. What types of exercises can help correct knock-knees? 

Exercises that focus on strengthening the quadriceps, hamstrings, and hip abductor muscles can help correct knock-knees. Examples include leg lifts, lunges, squats, and hip abduction exercises.

5. Can weight loss improve knock-knees? 

Yes, weight loss can reduce the stress on the knees and improve knee alignment, which can help alleviate symptoms of knock-knees.

6. When is surgery considered for knock-knees? 

Surgery is considered in severe cases where the condition persists into adolescence or adulthood and significantly affects quality of life, or when other treatments have not been successful.

7. How long is the recovery period after knock-knees surgery? 

The recovery period after knock-knees surgery can vary depending on the specific procedure performed. Generally, it can take several weeks to several months for full recovery, including physical therapy to regain strength and mobility.

8. Can physical therapy help after knock-knees surgery? 

Yes, physical therapy is an essential part of rehabilitation after knock-knees surgery. It helps improve strength, flexibility, and range of motion in the knees, ensuring optimal recovery.

9. Can knock-knees cause other health issues? 

Knock-knees themselves typically do not cause other health issues. However, severe or persistent knock-knees can lead to joint pain, osteoarthritis, and mobility issues over time if left untreated.

10. Can knock-knees reoccur after treatment? 

In some cases, knock-knees can reoccur after treatment, especially if the underlying cause was not fully addressed or if there are ongoing issues with bone structure or alignment.

11. Can knock-knees be corrected naturally? 

Mild cases of knock-knees often correct themselves naturally as children grow and their bone structure matures. Non-surgical treatments such as exercises and physical therapy can also aid in natural correction.

12. Is knock-knees surgery dangerous? 

Like any surgical procedure, knock-knees surgery carries risks, including infection, blood clots, and complications related to anaesthesia. However, with proper evaluation and care, risks can be minimised.

13. Do knock-knees cause osteoarthritis? 

Persistent knock-knees can potentially contribute to the development of osteoarthritis in the knees over time, due to abnormal stress and wear on the joint surfaces. However, not all cases of knock-knees lead to osteoarthritis.

Reviewed By Dr. Ramneek Mahajan, Senior Director (Orthopaedics) & Head Joint Replacement (Hip & Knee) Unit on 09 Jan 2025.