Correcting knock knees: How orthopaedic experts can help restore prope

While knock knees is a common condition in young children, it can persist into adulthood or occur as a result of injury, arthritis, or other underlying conditions.

In this article, Mr Jonathan Wright, a consultant paediatric orthopaedic and limb reconstruction surgeon, explores how orthopaedic experts can help restore proper knee alignment to improve both function and quality of life.

What are knock knees?

Knock knees, also known as genu valgum, refer to a misalignment of the knees where they tilt inward, touching each other when standing.

For some, this condition is simply a natural part of childhood development, typically seen between the ages of 2 and 5, and the knees will straighten out as they grow.

However, if the condition persists into adulthood, it can result in joint pain, difficulty walking, and a theoretical increased risk of developing arthritis.

Causes of knock knees

The causes of knock knees vary, and the condition can arise due to several factors:

Genetics: some individuals are genetically predisposed to misalignment due to their family history.
Injury: fractures, ligament damage, or knee surgery in the past, can cause long-term alignment issues.
Arthritis: conditions like osteoarthritis and rheumatoid arthritis can cause degeneration of the knee joint, leading to misalignment.
Obesity: excess weight can place added stress on the knees, worsening misalignment.
Bone diseases: conditions like rickets or other bone-related disorders, can lead to knock knees.

Assessing and diagnosing knock knees

An orthopaedic specialist will typically start by taking a detailed medical history and conducting a physical examination.

During this examination, the doctor will assess the alignment of the knees and legs while standing and walking, also looking for any signs of pain, instability, or limited movement.

In some cases, diagnostic imaging such as X-rays or MRIs may be recommended to examine the knee's bone structure, check for cartilage damage, or assess the severity of the misalignment.

Treatment options for knock knees

Treatment for knock knees depends on the severity of the condition, the patient's age and whether it is causing functional problems. While in children the alignment may correct itself over time, for adults or more severe cases, treatment options include:

Non-surgical approaches

In many cases, non-surgical treatments can be effective in improving knee alignment and managing symptoms.

Physical therapy: strengthening the muscles around the knee (quadriceps, hamstrings, and calf muscles) can help improve stability and reduce pain.
Braces or supports: in some cases, orthotic devices like knee braces or custom insoles may provide additional support and help redistribute pressure on the knee joint.
Weight management: reducing excess weight can decrease stress on the knees, alleviating pain and improving alignment.

Surgical procedures

When non-surgical treatments are ineffective or the condition causes significant pain or difficulty with movement, surgical intervention may be necessary.

Guided growth surgery (Hemiepiphysiodesis): In the growing child, we can utilise the growth remaining to guide the leg to grow straighter. This involves placing a small metal plate and screws on either side of the bone’s growth area. As the child grows, it acts as a hinge, gradually guiding the leg to straighten. Once corrected, the plate and screws are removed in another small procedure, allowing normal growth to resume.
Osteotomy: it involves cutting and realigning the bones of the knee to correct the angle. This may be used if there is insufficient growth remaining to use guided growth methods, if the deformity is significant and there are resulting problems with pain or function.
Knee replacement: for severe cases, if arthritis has worn away the cartilage, a total knee replacement may be recommended to restore function and relieve pain. If arthritis is caused by alignment issues, it is preferable to correct the alignment before the arthritis becomes severe enough to require a knee replacement. However, for older patients, a knee replacement can still be a suitable option.

The recovery process

After surgery, recovery involves a structured rehabilitation process to ensure that the knee heals correctly and that the new alignment is maintained.

Physical therapy is often a key part of recovery, helping to restore strength, stability and flexibility in the knee.

The timeline for recovery varies depending on the type of surgery and the individual’s overall health. With proper care, most patients can gradually return to their regular activities, including walking and low-impact exercise, within a few months.

Regular follow-ups with your orthopaedic surgeon will help track your recovery and ensure the best outcomes.

Knock knees can be a bothersome condition, but with right treatment and the guidance of an experienced orthopaedic surgeon, it is possible to restore proper knee alignment and improve mobility.

Mr Jonathan Wright, alongside his four expert colleagues who are leading paediatric orthopaedic consultants, form the Childrens Orthopaedic private practice. Mr Jonathan Wright, Miss Sarah McMahon, Mr Daniel Reed and Mr Gregory Firth are based at The Portland Hospital, HCA Healthcare, to provide expert diagnosis, treatment and support for children and their families. Together, they ensure a coordinated approach to treatment, offering expert care across a wide range of orthopaedic needs with efficiency and reliability.