Correcting knock knees: How orthopaedic experts can restore proper alignment

What is knock knees?

The condition we call ‘knock knees’, clinically known as genu valgum, refers to a misalignment of the knees that means they tilt inward, touching each other when the patient is standing. There’ll often be a pronounced gap between the patient’s ankles when they stand with knees touching.

Having knock knees is a normal part of childhood development. It’s common to see it in children between the ages of 2 and 5, with the knees naturally straightening out as a child grows. However, if the condition persists into adulthood, it can result in joint pain and difficulty walking and it may increase the risk of developing arthritis.

What causes knock knees?

Knock knees can arise for a whole range of reasons including:

• Genetics: some people’s family history means that they’re genetically predisposed to knee misalignment.
• Injury: fractures, ligament damage or past knee surgery can all cause long-term alignment issues.
• Arthritis: conditions such as osteoarthritis and rheumatoid arthritis can lead to the knee joint degenerating meaning that knees become misaligned.
• Obesity: excess weight can place added stress on the knees, worsening misalignment.
• Bone diseases: conditions like rickets or other bone-related disorders can also lead to knock knees.

How is knock knees assessed and diagnosed?

An orthopaedic specialist will always start by taking a detailed medical history and conducting a thorough physical examination. They’ll want to visually assess how a patient’s knees and legs are aligned while they’re standing and walking. They’ll also be looking for any signs of pain, instability or limited movement which can provide useful information.

They’re likely to recommend diagnostic imaging such as an X-ray or MRI too. This can help us to closely examine each knee's bone structure, checking for cartilage damage and assessing the location of the misalignment and its severity.

What are the treatment options for knock knees?

The best treatment for knock knees will depend on the patient's age, the severity of the condition and whether it’s causing functional problems. For children, a mild misalignment may correct itself over time and we’ll just want to monitor it. For adults or more severe cases, there’s a range of non-surgical approaches we’ll probably want to try before opting for a surgical solution.

Proven non-surgical approaches

In many cases, knee alignment can be significantly improved, and knock knees can be effectively managed using a combination of the following approaches: 

• Physical therapy: strengthening the muscles around the knee (quadriceps, hamstrings and calf muscles) can help increase stability and reduce pain.
• Braces or supports: in some cases, orthotic devices such as 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.

A choice of surgical solutions

If non-surgical treatments don’t help or the condition is causing significant pain or mobility problems, then we may consider surgical intervention. There are different approaches we can take, depending on the patient’s age and physical circumstances including what may have caused the condition:

• Guided growth surgery (Hemiepiphysiodesis): if a child is still growing, we project how much growth we think remains and use this to guide each leg to grow straighter. This involves placing a small metal plate and screws on either side of a knee bone’s growth area. As the child grows, the plate acts as a hinge, gradually guiding the leg to straighten. Once the condition has corrected itself, the plate and screws are removed in another small procedure, allowing normal growth to resume.
• Osteotomy: this involves cutting and realigning the bones of the knee to correct the angle. It’s a good approach if a child is almost fully grown, meaning there’s insufficient growth left to support guided growth surgery. It’s also a good approach if the knee misalignment is significant and causing problems with pain or function. 
• Knee replacement: a total knee replacement may be recommended to restore function and relieve pain in severe cases of knock knee, where arthritis has worn away the cartilage. If arthritis has been caused by an alignment issue, we’d always seek to correct this before the arthritis becomes so severe that a knee replacement is necessary. However, for older patients, this can be the best option.

What’s the recovery process?

After surgery, patients always need a structured rehabilitation programme 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.

Each patient’s recovery timeline will differ depending on the surgery they’ve had and their age and 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.

How good are the results for knock-knee treatment?

Knock knees can be a bothersome condition, but with right treatment and the guidance of an experienced orthopaedic surgeon, it’s possible to get good results, restoring proper knee alignment and improving pain and mobility.