Knock Knees (Genu Valgum): Specialists, Diagnosis, and Treatment Options

What kind of doctor fixes knock knees?

Orthopedic surgeons are the primary medical specialists who diagnose and treat knock knees (genu valgum), often working in conjunction with pediatric orthopedic surgeons for children, and collaborating with physical therapists and other allied health professionals for comprehensive management.

Understanding Knock Knees (Genu Valgum)

Genu valgum, commonly known as knock knees, is a condition where the knees angle inward, touching or nearly touching, while the ankles remain separated when standing with the feet together. This misalignment places increased stress on the outer (lateral) compartment of the knee and can alter the biomechanics of the entire lower kinetic chain, from the hips down to the ankles and feet. While a mild degree of genu valgum is a normal developmental stage in toddlers (typically resolving by age 7-8), persistent or progressive knock knees can lead to pain, gait abnormalities, functional limitations, and an increased risk of long-term joint degeneration, such as osteoarthritis.

The Primary Medical Specialists for Knock Knees

When seeking medical attention for knock knees, the following specialists are typically at the forefront:

• Orthopedic Surgeon: This is the primary specialist for diagnosing and treating genu valgum in adolescents and adults. Orthopedic surgeons are experts in the musculoskeletal system and are equipped to evaluate the severity of the condition, recommend appropriate non-surgical interventions, and perform corrective surgery if necessary. They have a deep understanding of joint biomechanics and the various techniques to restore proper alignment.
• Pediatric Orthopedic Surgeon: For children with persistent or severe knock knees, a pediatric orthopedic surgeon is the most appropriate specialist. They possess specialized knowledge of skeletal development and growth plates, which is crucial for managing genu valgum in growing children. They can differentiate between normal developmental variations and pathological conditions requiring intervention, often employing growth modulation techniques to correct alignment as the child grows.

When to Seek Medical Attention for Genu Valgum

While mild knock knees in young children often resolve spontaneously, it's important to consult a doctor if you observe any of the following:

• Persistence beyond age 7-8: If knock knees do not improve or worsen after this age.
• Asymmetry: If one leg is more affected than the other.
• Pain: Especially in the knees, hips, or ankles.
• Gait abnormalities: Limping, tripping, or an awkward walking pattern.
• Limited mobility: Difficulty running, jumping, or participating in physical activities.
• Rapid progression: A sudden increase in the severity of the knee angle.
• Underlying conditions: If knock knees are associated with other health issues, such as rickets or metabolic bone disorders.

The Diagnostic Process

A medical evaluation for knock knees typically involves:

• Medical History: The doctor will ask about the onset of the condition, any associated pain or symptoms, family history, and past medical conditions.
• Physical Examination: This includes observing the patient's gait, assessing the degree of genu valgum (often measured by the intermalleolar distance – the distance between the inner ankles when the knees are touching), checking joint range of motion, and evaluating muscle strength and flexibility.
• Imaging Studies:
  • X-rays: Full-length standing X-rays of the legs are crucial to accurately measure the mechanical axis of the limb and determine the precise angle of misalignment.
  • MRI: Less commonly, an MRI may be used to assess soft tissues, growth plates, or identify underlying causes if suspected.

Comprehensive Treatment Approaches

Treatment for knock knees depends on the patient's age, the severity of the condition, the presence of symptoms, and the underlying cause.

Conservative Management

For many individuals, especially those with mild to moderate knock knees and no significant pain or functional limitation, non-surgical approaches are the first line of treatment.

• Physical Therapy: A physical therapist can design a targeted exercise program to:
  • Strengthen muscles that support knee alignment, such as the gluteus medius (hip abductors), quadriceps, and core muscles.
  • Stretch tight muscles, including the hip adductors and iliotibial (IT) band, which can contribute to valgus alignment.
  • Improve gait mechanics and educate on proper movement patterns.
• Orthotics and Bracing: Custom-made shoe orthotics can help correct foot pronation, which sometimes contributes to knock knees. In some pediatric cases, night braces may be used to provide gentle corrective forces.
• Weight Management: For individuals who are overweight or obese, losing excess weight can significantly reduce the stress on the knee joints and may help improve alignment.
• Activity Modification: Avoiding high-impact activities that exacerbate pain or stress the knees can be recommended during symptomatic periods.

Surgical Interventions

Surgery is typically considered when conservative treatments fail, in severe cases, or when there is progressive deformity that is likely to lead to future joint problems.

• Guided Growth (Hemiepiphysiodesis): This procedure is performed in growing children. A small plate or staple is surgically placed on one side of the growth plate (epiphysis) of the femur or tibia, temporarily slowing growth on that side. This allows the other side to continue growing, gradually correcting the alignment over time. Once corrected, the plate is removed.
• Corrective Osteotomy: For adolescents and adults with significant genu valgum, an osteotomy involves surgically cutting and realigning the bone (usually the femur or tibia) to correct the angle. The bone is then stabilized with plates and screws until it heals in the new position. This procedure aims to reduce pain, improve function, and prevent or delay the onset of osteoarthritis.

The Interdisciplinary Team Approach

Effective management of knock knees often involves a collaborative effort from various healthcare professionals:

• Physical Therapists: Essential for rehabilitation, exercise prescription, and gait training, both pre- and post-surgery.
• Podiatrists: Can assess foot mechanics and prescribe custom orthotics to address contributing factors from the feet.
• Occupational Therapists: May be involved if the condition significantly impacts daily activities and requires adaptive strategies.
• Nutritionists/Dietitians: Can provide guidance on weight management if obesity is a contributing factor.

Prognosis and Long-Term Considerations

The prognosis for knock knees varies depending on the cause, severity, and timeliness of intervention. Developmental genu valgum often resolves on its own. For more severe or pathological cases, early diagnosis and appropriate treatment can significantly improve outcomes, reduce pain, enhance function, and mitigate the risk of long-term complications like premature osteoarthritis. Adherence to physical therapy programs and maintaining a healthy lifestyle are crucial for both conservative and post-surgical success.

Empowering Your Joint Health

While some forms of knock knees are not preventable, proactive steps can support overall joint health and potentially minimize progression or symptoms:

• Maintain a Healthy Weight: Reduces stress on knee joints.
• Regular Exercise: Focus on exercises that strengthen the hips, core, and quadriceps, while maintaining flexibility.
• Proper Footwear: Choose supportive shoes and consider orthotics if recommended.
• Listen to Your Body: Address any persistent pain or functional limitations with a healthcare professional promptly.