Genu Valgum or Knock Knee: Abnormal condition of the legs

About Genu Valgum

Knock Knee, medically known as Genu Valgum, is an abnormal condition of the legs where the patient is unable to join the knees and the ankles at the same time. This condition, usually found in children aged 3 years, and more common in girls than in boys, often disappears when they reach the age of 7 to 8 years. Seeking medical help is inevitable in case Genu Valgum persists after the age of 8 years. Genu Valgum is a hereditary or genetic disorder and may also result from a metabolic bone disease.

Types of Genu Valgum

The two types of Genu Valgum are:

1. Physiologic Genu Valgum: This type is very common and is a part of the growth & development of many children. It disappears on its own, once the child turns 7 to 8 years of age.
2. Pathologic Genu Valgum: This type of Genu Valgum is a result of other diseases, such as Rickets, Multiple Epiphyseal Dysplasia, an earlier Metaphyseal (Shaft) Fracture of the Proximal Tibia, and more.

Causes

Physiologic Genu Valgum is common in most children, especially healthy ones, as their weight falls to the outside of their knee-joint. As the child grows, there are many changes in the various parts of the body, including the legs. With time the child's legs get normal and do not need any treatment.

However, in case of Pathological Genu Valgum, it is significant to seek medical advice. The main causes of this condition in children include:

1. Various Diseases: Diseases such as Rickets (condition of Vitamin D deficiency), Scurvy (condition of Vitamin C deficiency), and more, lead to deformity of the legs resulting in Genu Valgum.
2. Family History: A genetically transferred skeletal abnormality or a Cohen Syndrome may lead to Genu Valgum.
3. Other Reasons: Other reasons include an injury to the knee, an abnormal bone joint, and more.

This condition is also common in adults. The main reasons for Genu Valgum in adults include:

• Joint Infection
• Fracture of the Shin Bone (Tibia), left untreated
• Osteoarthritis, Rheumatoid Arthritis, or similar joint ailments
• Obesity

Signs and Symptoms

A child with a Knock Knee is unable to stand straight with his knees, and feet together at the same time. A gap of about 10 cm or less is not a cause for concern and usually the deformity disappears on its own. However, if the following symptoms prevail, then it is important to visit a medical practitioner:

1. The gap between the two ankles is more than 10 cm
2. There is a large gap between the lower legs when the child is standing straight
3. The knees protrude inwards or outwards
4. There is pain in the knees
5. There is difficulty in walking or standing

Consultation

A General Physician or an Orthopedic Surgeon is the subject matter expert.

Tests and Investigations

• If the distance between the two ankles of the patient is more than 10cm when he is standing straight, with both knees joined, then there is a risk that the person is suffering from Genu Valgum.
• Physicians diagnose this condition through a physical examination of the legs, including knee symmetry, checking alignment of the leg, hip, & feet, and by getting details of the family history, as well as, the patient's medical history.
• An X-Ray does not help in diagnosing this condition; however, it helps in identifying other underlying problems that may have led to Genu Valgum.

Treatment Modalities Available

• A child below the age of 7 years, suffering from this condition does not need any treatment. A regular check-up every six months is enough as a precautionary measure. However, if the condition persists after the age of 7 years, then the physician may recommend the use of leg braces or orthotic shoes for correction of the deformity.
• Maintaining the ideal body weight helps in restricting the impact of this condition. Physiotherapy may also help some patients.
• If other diseases, such as Rickets or Scurvy, were responsible for the Knock Knee, then the physician would treat those diseases first.
• If the condition worsens later in life, then consulting an Orthopedic Surgeon becomes inevitable. A surgery is the last resort if the pain is uncontrollable and the condition has deteriorated. A Total Knee Replacement and a Surgery of the Lower Femur are the most common surgeries in this regard for adults. For children the surgeon may recommend a Guided Growth which is a surgery that involves placing a small plate inside the knee that aligns it in a few months, or a Osteotomy which involves cutting and realigning the leg bone. A Guided Growth is suitable for adolescents up to the age of sixteen years.

Complication in Management

If left untreated, Genu Valgum may result in chronic knee ailments, such as Osteoarthritis, Chondromalacia, Rheumatoid Arthritis, and more. In this condition the patient becomes more susceptible to injuries and may experience severe pain while standing & walking.

Precautions during Treatment

Smoking cigarettes curbs the supply of blood to the bone, and hence, smokers need to quit smoking for at least two weeks before the surgery & for at least three months after the surgery.

Dietary and Physical Activity Requirements during the Course of the Treatment

For children suffering from Rickets, Scurvy, and other similar diseases, it is important to serve them nutritious food to help them overcome the deficiencies. This would automatically help in curing Genu Valgum. Physiotherapy under a professional's supervision also helps to cure this deformity.

Risk of Infection to other Family Members

This is a genetic or hereditary disorder and may pass down generations.

Prevention to Avoid Occurrence and Recurrence

Knock Knee is a genetic disorder, as well as, a common condition in children, which disappears without any treatment. It is not possible to avoid its occurrence or recurrence. However, maintaining the right body weight, using leg braces or orthotic shoes may help in reducing the impact of the disorder and may cure it too.

Support from Family

All patients, especially children, need assurance and support from their family members. This helps them to recover not only physically, but also psychologically.

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