Genu Valgum: Causes And How To Treat A Child With Knock Knees

What Is Genu Valgum (Knock Knees)?

Genu Valgum (Knock Knees)

Knee joint is a quite complex joint consisting of bones, menisci, capsule and ligaments. It is one of the major and important joints in the human body. It involves the shin bone (tibia) and the proximal end of the thigh bone (femur). 

Genu valgum is one of the coronal plane anomalies of the lower limbs It is also known as knocked knees. The most common reason for genu valgum is idiopathy. The cases of Genu valgum are frequently reported in third-world and developing nations. 

Typically, the knees in genu valgum (knock knee) are bowed toward the body's midline and come into contact with each other when the legs are straightened out or in weight bearing position. Flat feet and occasional medial foot and knee pain come first before the development of knock knee. 

By age 2, children begin to develop physiologic genu valgum, which becomes most noticeable between the ages of 3 and 4. By the age of seven, it typically stables to a slight valgus position. Only a little or no change is expected in the adolescent age group. 

A person may require formal treatment if genu valgum develops later in life or does not resolve on its own.

In majority of the cases, it is not possible to prevent genu valgum. However, if the underlying condition is timely identified and treated, it may be possible to prevent knock-knee.

Treatment options such as pain reduction, stretching and strengthening exercise may be helpful to ease some of the symptoms.

Causes

There isn't generally an apparent reason for genu valgum, yet there are a few possible causes, including metabolic bone issues and hereditary problems. However, the majority of genu valgum cases are not harmful.

Risk factors for genu valgum include:

• Physiological 
• Congenital 
• Iliotibial band contracture
• Traumatic injury
• Knee Infection 
• Rheumatoid Arthritis of knee 
• Bone dysplasia 
• Osteogenesis imperfecta
• Metabolic bone disease
• Obesity

Symptoms

Watch out for these symptoms

Typically, genu valgum up to 7 years of age is considered as physiologic and not pathologic. It should subside by this age. However, problem arises when child reaches to adolescent or the child’s age is  over 8 years of age and there is still moderate to severe knock-knees. 

There may be pain in the thigh and/or calf along with easy fatigability. Genu valgum is a cosmetic deformity that can also impact gait. The patient exhibits rubbing of knees together, feet are apart and one leg swings around the other during walking running or jogging. This not only appears as a limping gait but also creates a problem with balance.

Malalignment of knee joint and an increased Q angle of the quadriceps extensor mechanism may cause lateral subluxation of patella. Therefore, instability and altered biomechanics of the patellofemural joint may also be seen. 

Genu valgum also leads to early and rapid progression to osteoarthritis. 

Diagnosis

A physical examination, during which a doctor examines the patient and collects a comprehensive medical history, typically marks the beginning of a diagnosis. The doctor will examine the child's leg growth pattern if the patient with symptoms is young.

A doctor will probably ask the patient to describe the location, severity, and frequency of their pain if it is present. Knee alignment when standing, gait pattern and leg length discrepancy is also taken in to consideration.

Genu valgum also cause irregular weight distribution. Hence, uneven wear patterns on the soles of a person’s shoe should also be observed as well. Radiological studies including X-ray, MRI or CT scan can also be obtained to examine the structure of joint and bone.

Other medical examinations should be done to determine whether there is an underlying cause of Genu valgum or not.

Treatment Options 

Treatment for genu valgum depends on the underlying cause along with severity of the condition.

Below are some suggestive treatment options which may be adapted by healthcare provider: 

1. Observation

Physiological varus or valgus is not considered as a true deformity. It is only a variation of knee alignment and usually corrects spontaneously. Therefore, careful observation and reassurance are the first treatment option.

To keep an eye on the deformity, these patients should have a clinical exam every three to six months. Radiologic studies like X-rays should be repeated regularly if worsening of clinical condition is suspected. 

Data suggest that in patients with physiologic Genu valgum use of shoe wedges or bracing is not effective. It is poorly tolerated as well as unnecessary in cases of physiological deviation. 

2. Medications and supplements

We have observed above that trauma, infection and dysplasia etc can also lead to development of Genu valgum. In these cases of pathological Genu valgum, the treatment of underlying disease is needed to correct the leg alignment. Doctors will use various medications and supplements as part of the treatment plan.

3. Regular exercise

Regular exercise may help in strengthening of knee muscles.  Strengthening of hip and knee muscles can improve posture and balance in people with knock-knee. Butterfly flutters, wall squats, side lunges and other low intensity exercises should be encouraged to strengthen lower limb muscles. Cycling will also benefit the patient with Genu valgum.

Running, jogging, volleyball, basketball, soccer and other form of strenuous exercise should be avoided. 

4. Weight loss

Obesity and overweight can be a contributing factor in Genu valgum. The condition of Genu valgum can be worsen due to excessive weight along with angular deformity.

Life style and diet modification along with regular exercise should be encouraged to control and reduce body weight.

5. Orthotics

Orthotics are shoe inserts that help a person improve their gait—the way their foot strikes the ground when they walk or run—by adjusting how they walk and run. Orthotics becomes useful for individuals who exhibit leg length discrepancy. 

There are mixed results when it comes use an orthotics to control or correct genu valgum. However, data suggest that Knee Ankle Foot Orthosis (KAFO) can be used to support the knee ligaments. Orthotics are used to prevent overstretching and mostly recommended in pathologic genu valgum. 

6. Surgery

Surgery is the last option for the treatment in cases of Genu valgum. It is recommended only in cases of severe Genu valgum. Surgery can also be opted for patients where conservative treatment such as exercise, stretching, and weight are not providing any improvement or unable to relieve pain.

Hemiepiphysiodesis and Osteotomyare the two surgical treatment strategies for coronal angular deformities around in growing children.

Typically, angular deformities are corrected through guided growth with hemiepiphysiodesis. Genu valgum is also treated with osteotomies on the distal femur. An average shutting wedge osteotomy or a horizontal opening wedge osteotomy can be performed when the distortion is primarily about the distal femur (most common).

A knee replacement may be suggested by a doctor in rare instances. The genu valgum will be resolved in this instance by an artificial knee that is properly aligned. 

Conclusion

Angular deformities like Genu valgum of the lower extremities are seen in children till the age of 3-4 years. This should subside spontaneously or stable till the age of 7 years. These conditions usually cause parents great concern. In most cases, these deformities are normal changes in a child's growth and development. Therefore, the only treatment is to monitor and reassure the parents. The majority of pathologic causes require proper treatment from an orthopedic surgeon, despite the benign nature of the physiologic or exaggerated physiologic genu varum and genu valgum.

Frequently Asked Questions

How do you fix genu valgum?

Genu valgum is malalignment of knee joint. This can also lead to decrease stability also. Therefore, after careful assessment of knee joint and gait, doctor, physiotherapist or occupational therapist will suggest you some exercise. These exercises may include strengthening and stretching of knee, hip and back muscles. Surgery may also be considered if required.

Do knock knees cause hip problems?

Angular deformity at knee like Knock knees or Genu valgum may create leg length differences. This leg length discrepancy will result in uneven weight distribution while standing or walking. Therefore, leg length discrepancy may also cause hip and back pain.

What can worsen knock knees?

Genu valgum should be subsided by the age of 8 or before adolescence. However, in case of obese or overweight children and children with flat feet knock knees may worsen. 

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