You’re watching your toddler waddle through the backyard and suddenly notice — their knees touch, but their feet don’t. You wonder, “Is this normal?” or worse, “Will they need surgery?”
As a mum and a podiatrist who’s worked with hundreds of children (including my own!), I can assure you: knocked knees, or genu valgum, is often just a normal stage of growth.
But like many things in the body, there’s a tipping point where “typical” can become “trouble.” Here’s what I often explain to families at Well Heeled Podiatry — from what’s part of healthy development to what might need a closer look.
A Common Phase for Kids
Growth Quirks (Not Faults)
From the age of two to around seven, it’s completely normal for children’s knees to angle inward slightly when they stand. Their bodies are growing fast, and sometimes the legs can’t quite keep up with each other — especially as the tibia (shinbone) and femur (thighbone) grow at different rates.
What You Might See
If your child’s knees seem to bump together while their ankles stay apart, you’re likely seeing this natural phase. Some kids even look a bit bow-legged before this phase, especially between 18 months and 2 years. By the time they reach 8 years old, the legs typically realign on their own.
I remember one little Auskick-loving patient, Cooper, who came in with textbook genu valgum. His mum was worried he’d never be able to run properly. Fast forward two years — Cooper’s running rings around his mates on the footy field and his knees are beautifully aligned.
When It’s Not Just Growing Pains
Most kids grow out of knocked knees. But there are times when we need to take a closer look:
| Sign | What it Might Mean |
| Knees remain significantly knocked past age 8 | Possible underlying biomechanical issue |
| One leg worse than the other | Could signal trauma or growth plate injury |
| Knee pain or difficulty walking | Misalignment affecting joint function |
| Child is overweight or has flat feet | Risk of long-term stress on joints |
If you’re unsure, early assessment is better than waiting and hoping. A simple biomechanical check and gait analysis can give clarity fast — and often, we can correct things gently before it becomes a bigger issue.
When Genetics or Health Conditions Play a Role
While most kids’ knees straighten naturally with growth, there are times when an underlying condition is involved. I’ve seen this especially in cases tied to genetic bone disorders or nutritional deficiencies like rickets — both of which are thankfully rare but worth knowing about.
1. Skeletal Dysplasias: When the Blueprint is Altered
Some children inherit conditions that affect how their bones form and grow. These are called skeletal dysplasias, and there are over 400 different types — from mild to quite complex.
In one case I treated, a little girl named Isla had a form of skeletal dysplasia that caused her thigh bones to grow at slightly different angles. Her knees turned in sharply, and her gait was quite unsteady. After collaborating with her paediatrician and orthopaedic team, we used custom orthotics and targeted foot mobilisation therapy, and by her next growth spurt, she was moving more freely and pain-free.
What to Watch For:
- Persistent or worsening knock-knees after age
- Family history of bone growth issues
- Short stature or visibly disproportionate limbs
- Pain during walking or standing
Treatment can include physiotherapy, monitoring by a paediatric orthopaedic specialist, and in some cases, guided growth surgery — especially if the misalignment worsens with age.
2. Rickets: A Nutrient Deficiency We Still See
Believe it or not, rickets still pops up in Melbourne — even though it’s often thought of as a historical condition. It happens when there’s a deficiency in vitamin D, calcium, or phosphate, which weakens the bones and makes them bend more easily under the body’s weight.
Kids with rickets may walk later than usual, tire easily, or show signs like:
- Bowlegs or knock-knees
- Swollen wrists and ankles
- Bone pain, especially in the legs
- Delayed growth
Australian Tip: We get plenty of sun here, but with the rise of SPF50+ and indoor living, vitamin D deficiency can sneak up — especially in winter or in children with darker skin who absorb sunlight less efficiently.
Quick Checklist: Rickets Prevention at Home
| Strategy | Details |
| Daily Sun Exposure | Around 15–20 minutes in short sleeves and shorts (avoid peak UV times) |
| Balanced Diet | Ensure enough dairy, leafy greens, eggs, and fish |
| GP Check | Blood test if there are signs of fatigue, bone pain, or slow growth |
| Supplements | Consider if dietary intake is low or sun exposure is limited |
With early diagnosis, rickets is very treatable — and in most cases, we can guide the bones back to proper alignment with nutrition, movement therapy, and support from your GP or paediatric team.
Why Weight and Foot Alignment Matter More Than You Think
Sometimes, genu valgum isn’t just about growing bones or genetics — it can come down to what’s happening below the knees or on the scales. These factors can place extra strain on a child’s or adult’s body, and over time, that misalignment shows up in the knees.
Extra Weight, Extra Pressure
Being overweight — even slightly — can amplify the forces going through the knees every time we stand, walk, or run. It’s not just about aesthetics or the number on the scales. This extra load can change the way the joints move and wear them out faster than they should.
I once treated a teenage boy who loved basketball but was carrying a bit of extra weight after a tough year at school. His knees knocked together so much that it was affecting his game and confidence. After a few months of strength work, tailored insoles, and general fitness support from his GP, he was back on court without that awkward knock-knee drag.
What we see in clinic:
- Altered gait: knees rotating inward, feet flattening
- Earlier onset of joint pain
- Increased risk of early osteoarthritis in the knees and hips
- Poor shock absorption from foot to hip
The good news? Even small changes in strength, weight, and alignment can make a huge difference.
Flat Feet: The Hidden Culprit
Let’s talk feet. When your foot flattens (especially on the inside arch), it often causes the ankle to roll inwards — a movement called pronation. That internal roll travels up the leg, tipping the shin bone inwards and pushing the knees together.
Flat feet — or pes planus — are incredibly common. I see them daily in kids who’ve never worn supportive shoes or have been barefoot a lot (hello, beach-loving families!). But it’s not just kids — I’ve also seen tradies and nurses in their 40s develop knock-knee symptoms from years of poor foot support on hard surfaces.
Signs of Flat Feet Contributing to Knocked Knees:
- Worn-down inner edge of shoes
- Ankles collapsing in when standing
- Fatigue or aching feet at day’s end
- “Waddle” when walking
How We Address This in Clinic
| Treatment | How It Helps |
| Custom Orthotics | Redistributes pressure and corrects arch function |
| Strength Training | Builds support around knees, hips, and arches |
| Foot Mobilisation Therapy | Improves joint movement and alignment |
| Footwear Advice | Ensures correct support for the foot type and activity |
If we catch these patterns early — especially in kids and teens — we can often avoid surgery or long-term joint problems down the track.
What Happens If Knocked Knees Stick Around?
We often brush off knocked knees in children as “something they’ll grow out of” — and in many cases, that’s true. But when the alignment issue continues into late childhood, adolescence, or adulthood, it’s not just a cosmetic concern.
The knock-on effects (no pun intended!) can be significant.
1. Joint Pain That Creeps In
Think of your knees as hinges. When the alignment is off, those hinges take pressure where they’re not designed to — usually on the outer knee. Over time, this uneven load wears down the cushioning cartilage, and that’s when pain starts to settle in.
One of my adult patients, a keen hiker in her 30s, came in with sharp knee pain every time she walked downhill. She’d had knock-knees since childhood, but it was never treated. With a combination of shockwave therapy, gait retraining, and footwear upgrades, she was able to get back to hiking the Dandenongs without limping the next day.
Pain hotspots to watch for:
- Outer edge of the knees
- Under the kneecap (patellofemoral pain)
- Hips and lower back (from altered posture)
2. Early-Onset Arthritis: A Long Game Problem
Misaligned knees are like driving a car with wonky tyres — they wear unevenly. In this case, the cartilage erodes faster on one side of the joint, leading to early osteoarthritis.
Arthritis doesn’t just happen to retirees. I’ve seen it appear in patients as young as 40 — particularly in those with long-standing genu valgum that was never corrected. And in Melbourne’s cooler months, those stiff, aching joints really start to grumble.
What arthritis might feel like:
- Morning stiffness that eases after movement
- Clicking, grinding or a “gritty” feel inside the knee
- Swelling after activity
- Less range of motion over time
3. Gait Changes and Balance Issues
People with significant knocked knees often walk with a waddling or swing-out gait to stop their knees from colliding. This doesn’t just look awkward — it uses more energy, strains the hips and back, and increases the risk of falls, especially on uneven ground.
I recently assessed a 12-year-old boy who was tripping regularly during school sport. His gait had adapted to avoid his knees clashing, but it left him unstable and unsure on his feet. With a combination of strength work, balance retraining, and some clever adjustments to his school shoes, we turned things around within a school term.
Signs of gait compensation:
- Swaying hips while walking
- Frequent stumbles or trips
- Feeling clumsy or “off balance”
When to Act: A Quick Decision Guide
| Symptom | Suggested Action |
| Mild knock-knees in a child under 7 | Monitor with yearly checks |
| Knock-knees worsening after age 8 | Seek podiatry or orthopaedic opinion |
| Pain during or after walking | Book an assessment ASAP |
| Family history of joint issues | Early screening is wise |
The earlier we intervene, the more options we have to treat the issue conservatively — without jumping to surgery.
How We Treat Knocked Knees: From Exercises to Surgery
Not every case of knocked knees needs intervention — but when the knees cause pain, movement issues, or simply don’t correct with time, treatment is worth considering.
At Well Heeled Podiatry, we take a conservative-first approach, focusing on realigning movement and reducing strain before considering surgery.
1. Physical Therapy: The First Step for Many
Good physio is often the first port of call — and for many people, it’s all that’s needed. We collaborate with trusted local physios to build targeted exercise programs that support real-world movement, not just textbook strength.
What we aim to improve:
- Strength in quads, glutes, and calves
- Flexibility through hips, IT bands, and hamstrings
- Gait patterns and foot control
I remember one young dancer we worked with — her knock-knees were causing pain during rehearsals. With a combination of gait retraining, foot mobilisation, and pre-pointe strength work, she made it through recital season pain-free.
2. Orthotics: A Game-Changer When Feet Are Involved
If the foot’s alignment is part of the issue (think flat feet or excessive pronation), orthotics can help shift things back into balance.
Custom orthotics aren’t just about cushioning — they correct load, guide better joint alignment, and reduce the chain reaction that leads to knee strain.
Orthotics can help:
- Reduce pronation and arch collapse
- Improve knee tracking
- Relieve pressure on overloaded joint zones
In kids, we often combine orthotics with growth monitoring, so we can adjust the support as their bones and gait patterns mature.
3. Hands-On Therapies: Mobilisation and Muscle Release
At Well Heeled Podiatry, we also use manual therapies to complement the above:
- Foot Mobilisation Therapy (FMT): Helps restore joint alignment, especially in stiff or overpronated feet.
- Dry Needling & Trigger Point Release: Can relieve muscle tightness and improve symmetry in leg movement.
- Shockwave Therapy: Occasionally used in chronic cases where tendons are overloaded from misalignment.
Patients often describe that “lightness” after FMT — like their foot is finally moving the way it should.
4. Surgical Options: When Conservative Management Isn’t Enough
Surgery is rarely the first line of treatment — but in some cases, particularly when pain is severe or the deformity is worsening, it may be necessary.
Common Surgical Procedures:
| Procedure | What It Involves | Typically For |
| Osteotomy | Bone is cut and realigned | Severe misalignment in teens or adults |
| Guided Growth | Plate inserted to gradually adjust growth | Children with growth potential left |
| Joint Replacement | Damaged joint surfaces replaced | Adults with arthritis from long-term misalignment |
We always refer to Melbourne-based orthopaedic surgeons with strong paediatric and musculoskeletal expertise, and we stay involved to support post-op recovery with gait retraining and footwear optimisation.
Early Action = Easier Fix
If you or your child is showing signs of persistent knocked knees — especially with pain, fatigue, or movement changes — don’t wait.
I’ve seen firsthand how early, hands-on intervention can save someone years of discomfort and even prevent surgery. Whether it’s a 6-year-old in prep or a 55-year-old teacher who stands all day, treatment is worth it.
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.
