Knock Knees

What are knock knees?

Knock knees are angular deformities at the knee, in which the head of the deformity points
inward.  A standing child whose knees touch but whose ankles do not is usually said to have
knock knees. During childhood, knock knees are a stage in normal growth and development
(physiologic valgus).
Between birth and 18 months, an outward-turning (varus) alignment from hip to knee to ankle is
normal. Between about 18 and 24 months, this alignment normally becomes neutral. When the
child is between 2 and 5 years old, an inward-turning (valgus) alignment is normal. The
alignment returns to neutral as the child grows.

What are the symptoms of knock knees?

A standing child of average weight whose knees touch, but whose ankles do not, is usually
considered to have knock knees. An abnormal walking gait can also be a sign of the condition.
The condition usually becomes apparent when a child is 2 to 3 years old, and it may increase in
severity until about age 4. It usually self-corrects by the time a child is about 7 or 8 years old.
But if the condition doesn’t appear until a child is 6 or older, it could be a sign that there is an
underlying bone disease.
During early childhood, knock knees actually help a child to maintain balance, particularly when
the child begins to walk, or if the foot rolls inward or turns outward. When a child has knock
knees, both knees usually lean inward symmetrically. One knee, however, may "knock" less than
the other or may even remain straight.
Occasionally, knock knees persist into adolescence. The condition is slightly more common in
girls, although boys can develop it, too.

What causes knock knees?

Knock knees are usually part of the normal growth and development of the lower extremities.
Some cases, especially in a child who’s 6 or older, may be a sign of an underlying bone disease,
such as osteomalacia or rickets. Obesity can contribute to knock knees — or can cause gait
(walking) problems that resemble, but aren’t actually, knock knees. The condition can
occasionally result from an injury to the growth area of the shin bone (tibia), which may result in
just one knocked knee.
In the course of developing normal alignment of their lower extremities, all young children have
knock knees to some degree for a period of time. At the age of 3, more than 20 percent of
children have at least a 5-centimeter gap between their ankles. By the age of 7, only 1 percent of
children have this gap.

How we care for knock knees

Doctors at Boston Children's closely monitor your child’s leg development, to make sure that her
legs straighten themselves naturally. In the unlikely event that the condition doesn’t self-correct,
your child’s doctors may suggest corrective leg braces. Only children with the most severe cases
may need surgery.
As a national and international orthopedics referral center, our Orthopedic Center has vast
experience managing all aspects of knock knees including the diagnosis, treatment and care for
every severity level.