Knocked Knees (Genu Valgum)

Back of two feet and ankles with a highlighted red area over the Achilles tendinopathy showing pain

Noticing your child walking with knees facing in towards one another raises alarm bells for many parents who wonder if it’s normal, whether they’ll grow out of it, and what may have caused it. The good news is that for most children, knocked knees are a normal part of growth and development. For some, however, they may also present some unwanted side effects, such as an increased risk of tripping and falling. Sometimes, knocked knees can continue into adulthood. Here’s what you should know about knocked knees.

What Are Knocked Knees?

Medically referred to as genu valgum, knocked knees describes a knee position where the knees remain close together when standing, despite the ankles being spaced apart. This position tends to be most pronounced around the age of four years, before naturally resolving during the early primary school years. The severity of knock knees can vary greatly, ranging from mild and only slightly noticeable, to severe.

Knocked Knees Symptoms

The symptoms of knocked knees are focused around the unique position of the knees, as well any resulting differences in gait. You may notice:

  • The knees face in towards one another
  • There is a notable distance between the ankles, while the knees are together 
  • The feet may turn outwards
  • Differences in gait as a person tries to keep the knees from hitting against one another
  • A limp may be present when walking

Pain is not a typical feature of knock knees in early childhood, though it can develop, especially if the symptoms persist. If knock knees persist into adulthood, there may be some associated stiffness in the knee joints, instability and an increased risk of knee osteoarthritis - though this varies from person to person.

What Causes Knocked Knees?

In children between the ages of 2 and 7 years old, knock knees are a normal variation as part of their development, as are bow legs, where the legs bow out away from one another. In this instance, the knees normally straighten out without any intervention. Both positions can help children in their walking confidence by giving them added stability - like how an inward tilt at the knees can help balance, particularly if other gait differences are present.

In some cases, particularly if the knocked knee position persists into adolescents, bony conditions such as osteomalacia and rickets may be involved, and should be assessed. 

Risk Factors

Other risk factors that may contribute to the development of knock knees include: 

  • Joint hypermobility
  • A knee injury or infection
  • Nutritional deficiencies - such as in calcium or Vitamin D
  • Metabolic disease
  • Kidney failure
  • Trauma (physical injury), including to the growth plates in the knee
  • Arthritis
  • A bone infection 
  • Poorly healing fractures

Diagnosing Knocked Knees

In children, diagnosing knocked knees is relatively straightforward, involving a clinical examination that looks at the alignment of the knees when standing, their gait and their foot posture. In adulthood, more tests will likely be carried out, such as a knee x-ray, nutritional deficiencies, and evaluating your medical history to help understand the cause and the best approach to treatment.

How To Treat Knocked Knees

If knock knees are present in childhood and do not cause any problems or pains, then it is likely that they will not require any treatment, aside from monitoring by parents to ensure the knee position or foot posture is not causing regular tripping, falling, pains or other issues.

Treating knocked knees that persist into adulthood will involve addressing the cause, such as treating nutritional deficiencies, and then managing the symptoms, which is where your podiatrist can help. 

Regardless of age, your podiatrist can help with:

  • Assessing the impact that your knee position is having on your knees, feet, your gait and your pain levels
  • Prescribing custom foot orthotics to help improve your comfort on your feet, and help ease the stress on the knees
  • Prescribing an exercise program to help improve strength and range of motion at the knee joint
  • Helping you feel fully informed about why you or your child are experiencing knocked knees, how you can stay comfortable on your feet, and what the long-term plan is to support your knee and leg health
  • Supporting your child with knee bracing options if needed
  • Recommending good, supportive footwear to help optimise your foot and leg health
  • Referring you to a specialist for a surgical consultation if needed. In very few cases, if knocked knees do not resolve naturally, surgery may be considered to help straighten the legs by adjusting the angle of the knee bones

You can book in with one of our podiatrists in Brisbane City or Newmarket here.


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