Knocked knees, medically known as genu valgum, is a condition where the knees touch each other when the legs are straightened. While it’s commonly observed in young children, it can sometimes persist or develop in adults. Let’s delve deeper into the causes and implications of this condition.
Let’s get straight to the point.
Knocked knees (genu valgum) is a condition where the knees touch when the legs are straightened. It’s common in young children (ages 2-4) and usually resolves on its own by age 7-8. However, it can persist or develop in adults due to genetic conditions, obesity, or foot structure issues like flat feet.
Left untreated, it can lead to joint pain, arthritis, and walking difficulties. Treatment options include physical therapy, orthotics, and in severe cases, surgery (osteotomy or joint replacement). Regular monitoring and early intervention are important for managing the condition.
A Normal Developmental Stage
Knocked knees is a condition that many children naturally go through as part of their growth and development. Here’s a deeper look into this phase:
- Growth Patterns: As children grow, their bones, muscles, and joints change. The legs, in particular, might only sometimes grow uniformly. This can result in periods where the knees appear closer together, even if the ankles are apart.
- Age Factor: Typically, children between the ages of two to four exhibit signs of knocked knees. It’s during this age bracket that the condition is most pronounced. Parents might notice their child’s walk seems a bit different or that when they stand with their ankles together, their knees touch.
- Natural Resolution: For most children, knocked knees is a temporary phase. As they age seven to eight, the legs generally straighten out independently. This natural correction happens as the bones continue to grow and mature.
- Why It Happens: The exact reason why children develop knocked knees during these ages isn’t entirely clear. Some experts believe it’s related to a combination of factors, including the rapid growth of the shinbone (tibia) compared to the thighbone (femur), and the body’s natural way of adapting to a more upright posture as the child starts walking and running more frequently.
- Observation is Key: While it’s a normal part of development, parents should still monitor their child’s leg alignment. If the condition seems to be worsening or doesn’t start to correct itself by age eight, it might be a good idea to consult a pediatric orthopedic specialist. They can guide on whether any intervention is needed or if the condition will likely resolve independently.
Genetic Conditions
Genetic conditions can play a significant role in the development of knocked knees. While various genetic disorders can influence bone structure, two of the most commonly associated with knocked knees are Skeletal Dysplasias and Metabolic Bone Diseases like rickets. Let’s delve deeper into these conditions:
1. Skeletal Dysplasias
- Definition: Skeletal dysplasias are a group of more than 400 disorders affecting bone and cartilage growth and development. These conditions can lead to bone structure, stature, and shape abnormalities.
- Cause: Most skeletal dysplasias are inherited and caused by specific gene mutations. These mutations can affect bones’ growth and development, leading to various skeletal abnormalities.
- Relation to Knocked Knees: Some types of skeletal dysplasias can cause the legs to grow in a way that results in knocked knees. The misalignment might be due to the abnormal growth of the femur (thighbone), tibia (shinbone), or both.
- Management: Managing skeletal dysplasias often involves a multidisciplinary approach, including orthopedic interventions, physiotherapy, and sometimes surgery. The specific treatment depends on the type and severity of the dysplasia.
2. Metabolic Bone Diseases (Rickets)
- Definition: Rickets is a condition that affects bone development in children. It causes the bones to become soft and weak, leading to bone deformities, including knocked knees.
- Cause: Rickets is primarily caused by prolonged vitamin D, calcium, or phosphate deficiency. These nutrients are vital for the proper mineralisation of bones. Without them, bones can’t harden and strengthen as they should.
- Relation to Knocked Knees: Due to the weakened state of the bones in children with rickets, the weight-bearing bones of the legs (like the femur and tibia) can bow out or in, leading to conditions like bowlegs or knocked knees.
- Prevention and Treatment: The best way to prevent rickets is to ensure children get enough vitamin D, either from their diet, supplements, or sun exposure. Treatment for rickets often involves replenishing the deficient nutrients through dietary changes, supplements, or both. In severe cases, surgical intervention might be necessary to correct bone deformities.
Weight and Obesity
The relationship between weight and the development or exacerbation of knocked knees is significant. Individuals who are overweight or obese place additional stress on their knees, which can lead to or worsen the condition of genu valgum. The added weight can cause an increased strain on the joints and ligaments, leading to an abnormal gait pattern. This altered gait can further contribute to the misalignment of the knees.
Moreover, the excess weight can accelerate the wear and tear on the knee joint, potentially leading to other complications such as early-onset osteoarthritis. It’s also worth noting that the biomechanics of the entire lower limb can be affected by obesity.
For instance, the arch of the foot may flatten more than usual, contributing to conditions like flat feet, which can further influence the alignment of the knees. Therefore, maintaining a healthy weight is beneficial for overall health and can also play a pivotal role in preventing or managing orthopedic conditions like knocked knees.
Foot Structure
The foot’s structure plays a crucial role in the overall alignment and biomechanics of the lower limb, directly impacting the knees’ positioning. An abnormal foot structure, such as excessively flat feet, can influence the alignment of the knees and contribute to conditions like knocked knees.
Flat feet, medically known as pes planus, is a condition where the arch of the foot collapses, making the entire sole come into complete or near-complete contact with the ground. When the arch collapses, it can cause an inward rotation of the ankle, known as pronation. This inward rotation can lead to an inward angulation of the shinbone, resulting in knocked knees.
Conversely, a high arch, or pes cavus, can also affect knee alignment, though it’s less commonly associated with knocked knees. It’s essential to understand that the foot doesn’t function in isolation.
Any misalignment at the foot level can propagate upwards, affecting the ankles, knees, hips, and spine. Therefore, addressing abnormalities in foot structure, possibly with orthotics or physical therapy, can be a key component in managing and preventing knocked knees.
Implications of Knocked Knees
Knocked knees, often seen as a benign developmental phase in children, can have significant implications if the condition persists or develops in adulthood. The misalignment of the knees can lead to a cascade of complications, affecting the knees and surrounding structures. Here’s a deeper exploration of the potential complications:
1. Joint Pain
The human body is designed for symmetry and balance. When the knees are misaligned, it can lead to uneven weight distribution and stress across the knee joint. This uneven distribution can cause excessive wear and tear on one side of the joint, leading to inflammation, pain, and discomfort. Over time, the cartilage within the knee, which acts as a cushion between the bones, can wear down faster in certain areas. This accelerated wear can result in painful bone-on-bone contact, making everyday activities like walking or climbing stairs painful.
2. Increased Risk of Arthritis
Osteoarthritis, a degenerative joint disease, is often a result of wear and tear on the joints. With knocked knees, the abnormal alignment can speed up this wear and tear process, increasing the risk of developing osteoarthritis at a younger age. Osteoarthritis in the knee can manifest as stiffness, swelling, and a decreased range of motion. As the condition progresses, the pain can become chronic and debilitating, severely impacting one’s quality of life.
3. Walking Difficulties
The alignment of the knees plays a crucial role in our gait or walking. Knocked knees can lead to an abnormal gait pattern, where individuals might experience a waddling motion or feel like their knees are getting in the way of each other. This altered gait can lead to fatigue, as the body has to expend more energy to compensate for the misalignment. Over time, this can strain other parts of the body, like the hips and lower back, leading to additional pain and discomfort. Moreover, an abnormal gait can increase the risk of trips and falls, especially on uneven surfaces.
Treatment Options
Addressing knocked knees, especially when they lead to discomfort or functional limitations, is crucial for ensuring long-term musculoskeletal health. Various treatment options can be considered depending on the severity and underlying cause of the condition. Here’s a deeper exploration of the potential treatments:
1. Physical Therapy
Physical therapy is often recommended for those with knocked knees, especially if the condition is mild to moderate. A trained physical therapist can design a tailored exercise regimen that focuses on the following:
- Strengthening: Targeted exercises can help strengthen the muscles around the knee, such as the quadriceps, hamstrings, and calf muscles. By enhancing muscle strength, the stability of the knee joint can be improved, potentially reducing the severity of the misalignment.
- Flexibility: Stretching exercises can help improve the flexibility of the muscles and tendons surrounding the knee. This can aid in better joint mobility and reduce stiffness or discomfort associated with knocked knees.
- Gait Training: Physical therapists can provide gait training for those with an abnormal walking pattern due to knocked knees. This involves teaching individuals how to walk in a manner that reduces strain on the knees and improves overall biomechanics.
2. Orthotics
Orthotics are custom-made shoe inserts designed to correct foot alignment and improve the biomechanics of walking. Since foot structure can influence knee alignment, orthotics can be pivotal in managing knocked knees. By providing arch support and redistributing pressure across the foot, orthotics can:
- Reduce Pronation: For those with flat feet, orthotics can help reduce excessive inward rolling of the foot, which can contribute to knocked knees.
- Improve Knee Alignment: By correcting foot posture, orthotics can indirectly influence the alignment of the knees, reducing the severity of the genu valgum.
- Relieve Pain: By improving overall biomechanics, orthotics can alleviate pain not only in the feet but also in the knees, hips, and lower back.
3. Surgery
Surgical intervention might be considered in severe cases of knocked knees, especially when other treatments haven’t provided sufficient relief. The type of surgery will depend on the patient’s age, the severity of the misalignment, and the underlying cause. Common surgical procedures include:
- Osteotomy: This involves cutting and reshaping the bones to correct alignment. The bone is then fixed in its new position using plates or screws until it heals.
- Guided Growth Surgery: Often used in children, this procedure involves placing plates and screws to guide the growth of the bone and correct the alignment over time.
- Joint Replacement: A total knee replacement might be recommended in cases where knocked knees have led to severe osteoarthritis. This involves replacing the damaged knee joint with artificial components.
Conclusion
While knocked knees is a common developmental stage in children, it’s essential to monitor the condition as they grow. If you or your child experiences pain or walking difficulties, or if the condition persists beyond childhood, it’s crucial to seek medical advice. Most individuals with knocked knees can lead active, pain-free lives with the right treatment and care.
Frequently Asked Questions
What Are Knocked Knees And How Do They Develop?
Knocked knees, also known as genu valgum, is a condition where the knees angle inward, causing the lower legs to spread apart when standing. This misalignment can develop due to several factors, including genetics, growth abnormalities, injury, or certain health conditions like obesity or rickets. In children, knocked knees are common and often resolve with age, but in adults, it can be caused by joint degeneration, muscle imbalances, or previous injuries.
How Can Prolotherapy Help With Knocked Knees?
Prolotherapy can be beneficial for individuals with knocked knees, especially if the condition is related to weakened ligaments or tendons around the knee joint. The injections stimulate the body’s healing response, encouraging tissue repair and strengthening the ligaments that may be contributing to the misalignment. By improving the stability and function of the knee joint, prolotherapy can help reduce pain, improve mobility, and prevent further degeneration of the knee structures.
What Are The Potential Implications Of Untreated Knocked Knees?
Untreated knocked knees can lead to several complications, including increased stress on the knee joints, which may accelerate wear and tear, leading to osteoarthritis. The misalignment can also cause uneven pressure on the ligaments, tendons, and muscles, leading to chronic pain, instability, and difficulty walking. Over time, individuals with untreated knocked knees may develop other joint issues in the hips or lower back due to compensatory movements.
Is Prolotherapy Effective For Treating The Underlying Causes Of Knocked Knees?
Prolotherapy can be effective in treating the symptoms of knocked knees, particularly if the condition is caused by ligament or tendon weakness. While it may not correct the structural alignment of the knee completely, it can significantly reduce pain, improve knee stability, and slow the progression of joint degeneration. For more severe cases, prolotherapy can be combined with other treatments, such as physical therapy or braces, to support joint alignment and function.
Are There Any Risks Or Considerations With Prolotherapy For Knocked Knees?
While prolotherapy is generally considered safe, it’s important to have a thorough evaluation before beginning treatment. For individuals with severe knee deformities or joint instability, prolotherapy may need to be combined with other treatments, such as surgery or physical therapy, for optimal results. As with any procedure, there are minor risks such as soreness, bruising, or swelling at the injection sites. It’s essential to discuss the potential risks and benefits with a healthcare professional to determine if prolotherapy is the right treatment for your specific condition.
