What are knock-knees?

Causes and Symptoms

Knock-knees, affecting both knees or occasionally only one, are a normal condition as children mature. Infants’ leg
bones are slightly rotated because of uterine positioning. As toddlers’ legs straighten after having bowlegs, their tibias and knees often temporarily rotate toward the body’s axis, causing the feet to be several inches apart. When knock-knees are not representative of normal physical development, they occur because of health conditions such as infections, obesity, or fractured legs that disrupt knee
growth. Knock-knees are sometimes a symptom of other conditions.

Mobility may be affected with knock-knees. Patients sometimes adjust leg and foot movement to compensate for altered knee positioning and imbalanced centers of gravity. Usually, children walk with their toes turned in for balance when they have knock-knees. Knock-kneed adults sometimes develop arthritis because of the strain on knee joints and ligaments. Knock-knees can also place stress on patients’ backs and hips.

Treatment and Therapy

Medical professionals do not treat most knock-knees unless specific cases seem abnormal, cause pain, or impede movement. Growth usually corrects knee positioning. Physicians measure legs and the distance between ankles to assess the progress of natural correction. X-rays are useful to detect bone problems that may exacerbate knock-knees. Photographs can document leg alignment.

Stretching the leg muscles can aid the natural resolution of knock-knees. Shoes designed with inserts can mitigate the stress on feet and manipulate patients to walk straight. Physical therapy can alleviate cartilage and joint pain associated with knock-knees.

If young patients do not outgrow knock-knees, ankle distances increase to four inches or more, or the condition worsens, particularly in one knee, then medical intervention often becomes necessary to ensure that patients are capable of normal movement. Physicians sometimes advise patients to wear a brace. If such efforts are unsuccessful, then the patient may undergo surgery to adjust leg bones and growth plates.

Treatment is essential for diseases or conditions in which knock-knees is a symptom. Some patients seek medical correction for aesthetic reasons.

Perspective and Prospects

Beginning in the late nineteenth century, physicians routinely recommended therapeutic braces to treat knock-knees. During the 1950s, Soviet doctor Gavril Abramovich Ilizarov devised a fixator that encircles legs and uses tension to correct rotation problems associated with knock-knees. Italian doctor Antonio Bianchi-Maiocchi first used this device in Western countries in 1981. James Aronson brought the method to the United States in the 1980s. In that decade, Ukrainian doctor Veklich Vitaliy adapted Ilizarov’s fixator for a procedure that is often used to correct severe knock-knees.

By the late twentieth century, however, physicians discouraged the use of braces to treat normal cases of knock-knees. Most advised patients to permit natural correction to occur, emphasizing that devices would not quicken that process.

Bibliography:

Atanda, Alfred Jr. "Common Childhood Orthopedic Conditions." KidsHealth.org. Nemours Foundation, Nov. 2011.

Bianci-Maiocchi, Antonio, and James Aronson, eds. Operative Principles of Ilizarov: Fracture Treatment, Nonunion, Osteomyelitis, Lengthening, Deformity Correction. Baltimore: Williams & Wilkins, 1991.

"Bowlegs and Knock-Knees." HealthChildren.org. American Academy of Pediatrics, Nov. 19, 2012.

England, Stephen P., ed. Common Orthopedic Problems. Philadelphia: W. B. Saunders, 1996.

Halpern, Brian. The Knee Crisis Handbook: Understanding Pain, Preventing Trauma, Recovering from Knee Injury, and Building Healthy Knees for Life. Emmaus, Pa.: Rodale Books, 2003.

Herring, John A., ed. Tachdjian’s Pediatric Orthopaedics. 4th ed. 3 vols. Philadelphia: Saunders/Elsevier, 2008.

Kaneshiro, Neil K., et al. "Knock knees." MedlinePlus, Nov. 12, 2012.