Knock knees OR Genu Valgum

Knock knees is a condition in which the knees touch, but the ankles do not touch. The legs turn inward.
In the valgum deformity, the knees are tilted toward the midline i.e Legs curve inwardly so that the knees are closer
together than normal. It can result from injury or septic destruction of the lateral half of the lower femoral epiphyseal
plate, results in arrested growth of the lateral condyle of the femur.
The continued growth of the medial condyle results in unilateral knock knees.
The typical gait pattern is circumduction, requiring that the individual swing each leg outward while walking in order
to take a step without striking the planted limb with the moving limb. Not only are the mechanics of gait
compromised but also, with significant angular deformity, anterior and medial knee pain are common.
These symptoms reflect the pathologic strain on the knee and its patellofemoral extensor mechanism.

Bilateral Valgum deformity can result from condition which softens bone tissue.

Causes -

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Rickets
Osteomalacia
Rheumatoid Arthritis
Injury of the shinbone (only one leg will be knock-kneed)
Muscular paralysis of semimembranosus or semitendinosus
Fracture
May be secondary to flat foot, osteoarthritis

Diagnostic test
The Q angle which is formed by a line drawn from the antero-superior iliac spine through the center of the patella and a line drawn from the center
of the patella to the center of the tibial tubercle, should be measured next. In women, the Q angle should be less than 22 degrees with the knee in
extension and less than 9 degrees with the knee in 90 degrees of flexion. In men, the Q angle should be less than 18 degrees with the knee in
extension and less than 8 degrees with the knee in 90 degrees of flexion.

Treatment of Genu Valgum

Degree of deformity, muscle chart and ROM are measured. In mild cases of Genu Valgum in young children,
wearing of boots with the inner side of heel raised by 3/8" inch and elongated forward heel (Robert Jones heels)
corrects the deformity.
In more complicated cases, the child requires a supracondyles closed wedge osteotomy.

Post operative Physiotherapy

Gradual knee mobilization is the main part of the treatment.

Some heat modalities may be given for relief of pain.
Strengthening exercises for quadriceps, hamstrings and gluteus muscles are given.
When the patient is able to walk, he is given correct training for standing, balancing, weight
transferring and walking.