Medicines for Knock knees

What it is

Knock knees (genu valgum) is when a person stands with their knees together but their ankles apart — the lower legs angle outwards. It is very common in children, and, importantly, is usually a normal part of development. Young children’s legs naturally change shape as they grow: many toddlers have slightly bowed legs, which then often become knock knees around the age of three to four, before the legs straighten out to a more typical alignment by around the age of six or seven. So knock knees in a young child is usually normal, painless, and corrects itself as the child grows, without any treatment. Knock knees can also occur in older children and adults, sometimes persisting from childhood, or related to other factors. In most cases knock knees causes no problems and needs no treatment. However, there are situations where assessment is worthwhile, because occasionally knock knees can be a sign of an underlying problem or be more significant: these include knock knees that are severe or getting worse, that affect only one leg (asymmetrical), that persist beyond the age when they would normally correct (for example after around the age of seven), that are associated with pain or difficulty walking, that occur with short stature or other concerns, or that appear or worsen in an older child or adult. In such cases, assessment can check for and address any underlying cause (such as conditions affecting the bones, or other factors) and consider whether treatment is needed. For the common, normal knock knees of early childhood, reassurance is all that is needed, and the legs straighten with growth. The key messages are that knock knees is common and usually a normal part of childhood development that corrects on its own, and that assessment is worthwhile if it is severe, one-sided, painful, persistent beyond the usual age, or occurs in an older child or adult.

How it is treated

Knock knees is usually a normal part of childhood development that needs no treatment and corrects itself with growth, with assessment reserved for cases that are severe, one-sided, painful, persistent, or occurring in an older child or adult. For the common knock knees of early childhood (typically most noticeable around age three to four, then improving), the approach is usually reassurance: it is a normal stage, is painless, and the legs straighten out on their own as the child grows (usually by around age six or seven), so no treatment — such as special shoes, braces, or exercises — is needed, and these are not generally helpful for normal knock knees. Parents can be reassured, and the child’s development monitored. However, assessment (by a GP, who may refer to a specialist if needed) is worthwhile in certain situations, because occasionally knock knees can indicate an underlying problem or be significant enough to consider treatment: these situations include knock knees that is severe or worsening, affects only one leg (asymmetrical), persists beyond the age when it would normally correct (for example after around age seven), is associated with pain, a limp, or difficulty walking, occurs with short stature or other health concerns, or newly appears or worsens in an older child or adult. In these cases, assessment may include examination and, where indicated, tests (such as X-rays or blood tests) to look for any underlying cause — for example conditions affecting bone development or metabolism (such as rickets), previous injury, or other factors — so that any underlying condition can be treated, which may itself improve the alignment. Where knock knees is significant and does not resolve, or is causing problems, treatment may be considered, guided by a specialist — for example, in some children, a procedure to gently guide the growth of the bone to correct the alignment (guided growth), or, less commonly, other surgery, may be used for significant cases; and in adults with significant knock knees causing symptoms, options are considered based on the situation. For most people, though, no treatment is needed. The reassuring messages are that knock knees is common and usually a normal, painless part of childhood development that corrects on its own with growth, needing only reassurance, and that assessment is worthwhile if it is severe, one-sided, painful, persistent beyond the usual age, or occurs in an older child or adult, so any underlying cause can be checked and treatment considered where needed.