How to Fix Knock Knees in Adults?
Do your knees touch or “knock” together when you stand, while your ankles remain noticeably apart? If this scenario sounds familiar, you might be living with a condition called genu valgum, more commonly known as knock knees. While often associated with childhood development, this alignment issue can persist or even develop in adulthood, leading to discomfort, an awkward gait, and significant joint pain. It can affect your confidence, limit your activities, and raise concerns about your long-term joint health.
The crucial question for many is: how to fix knock knees in adults? Is it a condition you simply have to live with, or are there effective solutions?
The answer is a resounding yes—effective solutions are available. From targeted physiotherapy and lifestyle adjustments to advanced surgical procedures, modern medicine offers a range of options to correct alignment, relieve pain, and restore function. In this comprehensive guide, we will explore the world of knock knees, guided by the expertise of Dr. Hesham Al Khateeb, an award-winning UK Board Certified Hip and Knee Surgeon. We’ll break down the causes, symptoms, and the full spectrum of treatments available, empowering you with the knowledge to take the first step toward standing tall and moving freely once again.
What are knock knees (Genu Valgum)? A Deeper Look
At its core, knock knee, or genu valgum, is an angular deformity of the legs. When a person with this condition stands straight, their knees angle inward and touch, creating a significant gap between their ankles. Imagine the legs forming an “X” shape; this is the classic presentation of knock knees. This misalignment isn’t just a cosmetic issue; it’s a biomechanical problem that alters the way your body bears weight.
In a perfectly aligned leg, a straight line—known as the mechanical axis—can be drawn from the center of your hip, through the center of your knee, to the center of your ankle. This ensures that weight and force are distributed evenly across the knee joint. In a knock kneed individual, this axis shifts outward. Consequently, the outer (lateral) compartment of the knee bears an excessive amount of pressure, while the inner (medial) structures, such as the medial collateral ligament (MCL), are stretched and strained. This imbalance is the primary source of pain and can lead to progressive damage over time.
It’s important to distinguish between physiological and pathological genu valgum. In young children, having knock knees is often a normal part of growth and development, typically self-correcting by age 7 or 8. However, when knocked knees persist or appear in adulthood, it’s considered a pathological condition that warrants medical evaluation. This condition, often referred to as a valgus knee, can significantly impact mobility and quality of life if left unaddressed.
What Causes Knock Knees in Adults? Uncovering the Root Issues
Understanding the root cause of knock knees is the first step toward finding the right treatment. In adults, the condition doesn’t appear out of nowhere. It’s usually the result of an underlying issue that has developed over time.
Here are the most common knock knees causes in the adult population:
Persistent Childhood Genu Valgum: For some individuals, the natural knock kneed alignment of early childhood simply never self-corrected. This is one of the most frequent reasons for the condition in young adults.
Injury and Trauma: A significant injury to the leg can alter its alignment. A fracture of the thigh bone (femur) or shin bone (tibia) near the knee that doesn’t heal in a perfect position can lead to a valgus deformity knee. Similarly, severe ligament injuries can cause instability that results in the knee collapsing inward over time.
Arthritis: This is a major cause of knock knees in adults, particularly older adults.
Osteoarthritis: When the cartilage on the outer side of the knee joint wears down, the space in that compartment collapses, causing the knee to angle inward. This creates a vicious cycle, where the poor alignment accelerates the cartilage wear, and the worsening arthritis increases the deformity.
Rheumatoid Arthritis: This autoimmune disease causes chronic inflammation that can erode cartilage and bone, leading to joint deformities, including genu valgum.
Obesity: Carrying excess body weight places immense and repetitive stress on the knee joints. This strain can exacerbate a mild, pre-existing alignment issue, transforming it into a more severe and painful knock knee problem. Furthermore, obesity is a significant risk factor for developing osteoarthritis, which in turn can cause knocked knees.
Bone Diseases: Certain medical conditions that affect bone health can lead to deformities. Rickets, a condition caused by severe vitamin D deficiency in childhood, can result in soft, weak bones that bend under pressure. In adults, a similar condition called osteomalacia can also cause bones to soften and lead to a k leg or x legs deformity.
Genetic and Congenital Conditions: In rare cases, knock knees can be a symptom of an underlying genetic condition, such as skeletal dysplasia or other metabolic bone disorders that affect normal bone growth and development.
What are the symptoms of knock knees in adults?
The most obvious sign of genu valgum is the visual appearance of the legs. However, the condition presents a range of other symptoms that can affect your daily life. Recognizing these is crucial for seeking timely medical help.
Common knock knees symptoms include:
Visible Misalignment: When standing straight with your knees lightly touching, there is a noticeable gap of several inches between your ankles. This is the hallmark sign of a knock knee syndrome.
Knee Pain: Pain is a frequent complaint, often localized to the outer side of the knee due to the increased compression in that area. However, some people experience pain on the inner side of the knee from the ligaments being stretched. The pain typically worsens with activity, such as walking, running, or climbing stairs.
Abnormal Gait: To avoid their knees hitting each other, individuals with severe knock knees may develop an awkward walking pattern. This can involve swinging the legs outward in a circular motion (circumduction), which is inefficient and can lead to fatigue.
Joint Instability: The altered mechanics of the knee can make it feel unstable or as if it might “give way.” This can make walking on uneven ground particularly challenging.
Stiffness and Swelling: The affected knees may become stiff, especially in the morning or after periods of inactivity. Swelling can also occur, particularly after strenuous activities, due to inflammation within the joint.
Pain in Other Joints: The body works as a connected chain. The misalignment at the knees forces the hips, ankles, and feet to compensate, which can lead to secondary pain and problems in these areas, as well as in the lower back.
Difficulty with Physical Activities: Running, jumping, and squatting can become difficult and painful, often forcing individuals to give up sports and hobbies they once enjoyed.
How are knock knees diagnosed in adults?
If you suspect you have knock knees, the first step is a thorough evaluation by an orthopedic specialist. A proper diagnosis is key to developing an effective treatment plan. A specialist like Dr. Hesham Al Khateeb will use a combination of methods to assess the severity and cause of your condition.
Here’s how to check knock knees in a clinical setting:
Patient History and Discussion: The consultation begins with a detailed conversation about your symptoms. Your doctor will ask about when you first noticed the alignment, the nature and location of your pain, what activities make it worse, and if you have a history of injuries, arthritis, or a family history of similar issues.
Physical Examination: This is a hands-on assessment to evaluate your leg structure and function.
Visual Assessment: The doctor will observe your legs while you stand, walk, and lie down to assess the overall alignment.
Measurement: A simple knock knee test involves measuring the distance between your ankles (the intermalleolar distance) while you stand with your knees touching. This measurement helps quantify the severity of the valgus knee deformity.
Gait Analysis: You will be asked to walk so the doctor can observe your walking pattern and identify any compensations or abnormalities.
Range of Motion and Stability Tests: The doctor will gently move your knee through its range of motion to check for stiffness and test the ligaments to assess for any instability.
Advanced Imaging Studies: To get a precise picture of your bone structure and joint health, imaging is essential.
Standing Alignment X-rays: This is the gold standard for diagnosing knock knees. You will stand for a special long-leg X-ray that captures your entire leg, from hip to ankle. This image allows the surgeon to measure the mechanical axis precisely and determine whether the deformity originates from the femur (thigh bone), the tibia (shin bone), or both. This information is critical for planning any potential knock knee correction surgery.
Magnetic Resonance Imaging (MRI): If the doctor suspects damage to the soft tissues—such as the cartilage, meniscus, or ligaments—an MRI may be ordered. This is particularly useful when knock knees are associated with advanced arthritis or a previous injury.
How to Fix Knock Knees in Adults Without Surgery
For many individuals with mild to moderate genu valgum, or for those who are not candidates for surgery, non-operative treatments can be highly effective at managing symptoms and improving function. The goal of these conservative methods is to strengthen supporting muscles, improve biomechanics, and reduce stress on the knee joint. If you’re wondering how to fix knock knees in adults without surgery, these strategies are your first line of defense.
1. Physiotherapy and Targeted Knock Knees Exercises
A customized physical therapy program is the cornerstone of non-surgical knock knee treatment. A skilled physiotherapist will design a regimen of knock knees exercises to address the specific muscle imbalances that contribute to the condition.
Strengthening Weak Muscles: The inward collapse of the knee is often due to weakness in the muscles on the outside of the hip, specifically the hip abductors (like the gluteus medius). Strengthening these muscles helps to pull the knee outward into a more neutral alignment. Key exercises include:
Clamshells: Lie on your side with knees bent and an elastic band around your thighs. Keeping your feet together, lift your top knee.
Side Leg Raises: Lie on your side and lift your top leg straight up, keeping it in line with your body.
Glute Bridges: Lie on your back with knees bent and lift your hips off the floor, squeezing your glutes.
Banded Squats: Place a resistance band around your thighs just above the knees. As you squat, actively push your knees outward against the band to maintain proper alignment.
Stretching Tight Muscles: Tightness in the inner thigh muscles (adductors) and the hip flexors can pull the knees inward. A targeted stretching program can help release this tension.
Improving Balance and Proprioception: Exercises that challenge your balance, such as single-leg stands, help retrain the nerves and muscles around the joint to work more effectively, improving stability.
2. Orthotics and Bracing
Mechanical aids can provide significant support and pain relief.
Custom Shoe Inserts (Orthotics): Many people with knock knees also have flat feet or feet that overpronate (roll inward). This can worsen the knee valgus. Custom-molded orthotics can correct foot posture, which in turn improves the alignment of the entire leg.
Unloader Knee Braces: For knock knees associated with pain from osteoarthritis on the outer side of the joint, an unloader brace can be very helpful. This specialized brace applies a gentle force to the knee, “unloading” the compressed outer compartment and shifting pressure to the healthier inner side of the joint. This can provide substantial pain relief during activities like walking.
3. Weight Management
This is one of the most impactful changes you can make. Excess body weight multiplies the force that goes through your knee joints with every step. Losing even a small amount of weight can make a huge difference. For every 1 kilogram of weight you lose, you reduce the load on your knees by up to 4 kilograms. A healthy diet combined with low-impact exercises like swimming, cycling, or using an elliptical machine can help you achieve a healthy weight without putting additional strain on your inward knees.
4. Activity Modification and Pain Management
Activity Modification: Avoid high-impact activities that cause pain, such as running on hard surfaces or aggressive jumping sports. Switch to lower-impact alternatives to stay active without aggravating your symptoms.
Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation. However, they should be used under medical guidance for short periods.
Injections: For severe pain caused by arthritis-related inflammation, a corticosteroid injection directly into the knee joint can provide temporary but powerful relief.
When Surgery is Needed: Surgical Knock Knee Correction
When non-surgical treatments fail to provide relief, or if the deformity is severe, progressive, or causing significant functional problems, a surgical knock knee correction may be the most effective long-term solution. The goal of surgery is to physically realign the leg, restore a neutral mechanical axis, and alleviate pain.
1. Osteotomy: Realigning the Bone
For younger, active adults (typically under 60) who have knock knees but do not have severe arthritis, an osteotomy is the preferred surgical procedure. The term “osteotomy” literally means “cutting of the bone.” It is a highly precise surgical procedure where the surgeon cuts either the femur or the tibia, realigns it to a corrected position, and then fixes it in place with a strong metal plate and screws. This permanently straightens the leg and rebalances the forces across the knee joint.
Distal Femoral Osteotomy (DFO): This is the most common type of osteotomy for knock knee surgery. The deformity in genu valgum usually originates in the femur (thigh bone). In a DFO, the surgeon makes a cut in the femur just above the knee, removes a small wedge of bone from the inner side, or opens a wedge on the outer side, and then closes the gap to straighten the leg.
High Tibial Osteotomy (HTO): This is less common for knock knees but may be performed if the deformity is primarily located in the tibia (shin bone).
The major benefit of an osteotomy is that it preserves your own natural knee joint, which is ideal for younger patients who wish to remain active.
2. Knee Replacement Surgery (Arthroplasty)
For older adults, or for those whose knock knees are caused by severe arthritis that has already destroyed the joint cartilage, a knee replacement is the best option. During this procedure, the damaged bone and cartilage are removed and replaced with artificial components made of metal and high-grade plastic.
Total Knee Replacement (TKR): The surgeon replaces all three compartments of the knee. As part of the procedure, the surgeon also corrects the underlying valgus deformity, using the implants to create a perfectly straight and stable new knee.
Partial Knee Replacement (PKR): In some cases, if the arthritis is confined only to the damaged outer compartment, a partial knee replacement might be possible.
Recovery from either surgery involves a dedicated period of rehabilitation and physical therapy to regain strength and mobility, but the results can be life-changing, eliminating pain and restoring a normal walking pattern.
Contact Dr. Hesham Al-Khateeb for knock-knee correction in Dubai
When considering a complex procedure like knock knee correction, the experience and skill of your surgeon are paramount. Dr. Hesham Al Khateeb is an Award-Winning UK Board Certified Hip and Knee Surgeon with a wealth of experience, having performed over 2,000 joint replacements. His extensive, world-class training, which includes fellowships in London, Canada, Hamburg, and Seattle, places him at the forefront of orthopedic surgery.
Dr. Al Khateeb specializes in the very procedures used to treat knock knees, including hip and knee replacements, revision surgery, and managing sports injuries and trauma. His distinguished career includes roles as a Senior Clinical Lecturer in Ireland and a Consultant in Bahrain, and he is the recipient of prestigious awards like the NHS Innovation Award. This deep expertise ensures that each patient receives a meticulously planned and executed treatment tailored to their unique anatomy and goals.
Conclusion: Your First Step Towards Better Alignment
Living with knock knees in adulthood doesn’t have to mean living with pain and limitations. As we’ve explored, this is a highly treatable condition with a wide array of solutions available. From strengthening exercises and supportive orthotics to transformative surgical procedures like osteotomy and knee replacement, there is a clear path forward.
The most important step is the first one: seeking an expert evaluation to understand the cause and severity of your condition. A thorough diagnosis is the foundation of a successful treatment plan.
Don’t let knock knees dictate your life. If you are in Dubai or the surrounding region and are experiencing discomfort or concern about your knee alignment, we invite you to schedule a consultation with Dr. Hesham Al Khateeb today. Take that crucial first step towards standing stronger, walking taller, and moving with confidence and comfort.
FAQs
Yes, if left untreated, knock knees can worsen over time. The constant, uneven pressure on the outer part of the knee joint can accelerate the wear and tear of cartilage, leading to the development or progression of osteoarthritis. This, in turn, can increase the pain and severity of the alignment deformity. Early intervention is key to preventing this progression.
The impact on daily activities depends on the severity. Mild cases may cause little to no issue. However, moderate to severe knock knees can lead to significant pain, difficulty walking long distances, an unstable gait, and an inability to participate in sports or strenuous exercise. Treatment can dramatically improve function and comfort.
Absolutely. The body’s musculoskeletal system is a connected chain. A misalignment at the knees forces the ankles, feet, and hips to compensate, altering your entire body’s biomechanics. This can lead to secondary issues such as foot pain (from pronation), hip pain, and even lower back pain due to the altered posture and gait.
For mild cases caused by muscle imbalance or poor posture, physiotherapy for knock knees and orthotics can significantly improve symptoms and the visual appearance of the alignment. However, for a structural deformity where the bone itself is angled, these non-surgical methods can only manage the condition, not physically straighten the bone. In such cases, a surgical procedure like an osteotomy is the only way to achieve a complete and permanent knock knee correction.
Recovery time varies depending on the procedure. For an osteotomy, patients are often on crutches for 6-8 weeks to allow the bone to heal, followed by several months of physical therapy. Full recovery and return to all activities can take 6 to 12 months. For a knee replacement, patients are typically walking within a day or two of surgery, and recovery to a point of comfortable daily activity usually takes around 3 months, with continued improvement for up to a year.
Yes, knock knee surgery is not only possible but is often ideally suited for younger adults, including those in their twenties or thirties. Age is less of a factor than the severity of symptoms and the degree of deformity. An osteotomy, in particular, is designed to preserve the natural knee joint, making it an excellent option for young, active individuals who want to correct their alignment, eliminate pain, and prevent future arthritis.
