Genu Valgum: The Straight Facts About Knock Knees

  • Genu valgum is a leg misalignment that turns the knees inward and often leads to osteoarthritis.
  • Typically regarded as a temporary condition affecting toddlers, 1% of the population does not naturally outgrow their childhood knock knees.
  • The only cure for the condition is major surgery, but symptoms can be kept under control through several means.

Typically viewed as a benign, temporary condition primarily effecting toddlers between the ages of one and 4, genu valgum, also known as knock knees, is not exclusive to children.

While it’s true that all children experience varying degrees of the condition while growing up — a perfectly natural process which aids in the development of a child’s lower extremities — by age 8 a full 99% of kids will have grown out of it.

If it doesn’t correct itself or is left untreated in childhood, addressing genu valgum as an adult is a considerably more challenging – and potentially unpleasant – affair.

What causes adults to develop knock knees?

Genu valgum is essentially a leg misalignment that turns the knees inward. If you stand with your knees together and can measure a gap of 3 inches or more between your ankles (because your knees are bent so far inward), it’s possible you could have the condition.

There’s a wide variety of reasons why an otherwise perfectly healthy individual might find themselves burdened with knock knees long after childhood. For starters, if they never outgrew the condition as a toddler and it wasn’t medically treated at the time, depending on it’s severity they could be suffering chronic pain, and aesthetically it would be pretty hard to miss.

Peter DeNoble, MD, an orthopedic surgeon at Advanced Orthopedics & Hand Surgery Institute in eastern New Jersey, says obesity is often a factor with genu valgum in both the pediatric and adult populations.

“Valgus deformities also develop in adults as a result of degenerative changes in the knees or ligamentous injuries,” says DeNoble. “In my own practice I often see adults with advanced knee osteoarthritis, which can cause a valgus deformity over time.”

Some of the catalysts leading to knock knees in later life are:

  • Obesity (creating extra pressure on the knees)
  • Osteoarthritis (arthritis in the knee)
  • Vitamin deficiencies (primarily calcium, along with vitamins D and C)
  • An infection in the leg or knee
  • Bone malformation stemming from rickets
  • Childhood injuries that weren’t treated properly at the time

How is genu valgum diagnosed?

When found in adults (or children older than 8 years) it’s important to check if there’s an underlying cause for the condition. While genu valgum can be unpleasant enough in itself, should it be the result of, for example, a bone disease, this underlying cause will also need to be treated — perhaps urgently.

“It may not be obvious to an adult patient if they have developed knock knees because it usually occurs gradually,” explains DeNoble, “although it would be perfectly clear to an orthopedic doctor after examination. Symptoms vary depending on the patient, but they can experience pain, change in gait, or obvious visual deformity of the leg.”

To confirm a diagnosis of genu valgum you will first need to undergo a physical examination. Your doctor will want to observe how you stand and walk to better determine if there is any inequality in the length of your two legs.

He or she will also want to assess your knee alignment angle, and may ask to inspect the soles of your shoes to check for uneven wear – often a strong indication something could be off-kilter.

Your physician will further inquire about your family medical history to check if your knock knees might possibly stem from hereditary factors. It’s also not unusual for doctors to order an X-ray or MRI scan to look at a patient’s bone structure in cases where genu valgum is suspected.

How is genu valgum treated?

The bad news is that there’s no real cure for adult genu valgum outside of major surgery, possibly even a knee replacement. As such, surgery is usually only considered a viable option in the most severe of cases.

The bottom line is that the course of treatment is largely determined by the cause of the condition and the severity of its symptoms. While genu valgum in adults isn’t easily prevented, its effects can at least be minimized.

According to DeNoble, treatment in adults should generally be more focused on managing symptoms rather than correcting the deformity surgically. “This can be done with therapy, bracing, weight loss, cortisone injections, or viscosupplementation,” she says. “However, if conservative management like this doesn’t work then surgical intervention may be needed.”

Most treatment plans to combat genu valgum incorporate one or more of the following:

Weight loss

For those who are notably large or obese, all that extra weight being carried around every day puts a lot of stress on the knees, which only serves to make the symptoms of genu valgum that much worse.

If you are able to bring your weight down substantially it will make a huge difference to your comfort and energy levels. Not only will it help with your knees, but getting down to a reasonable weight will boost your health on numerous fronts.

Your doctor or licensed nutritionist can construct a personalized diet plan that over the long term will help you shed many of those unwanted pounds.


Orthotics can work wonders for any number of conditions, including genu valgum. One common symptom of genu valgum is one leg being longer than the other, potentially leading to other skeletal problems down the road and possibly causing considerable discomfort in the meantime.

If this is your situation, a simple heel insert into the shoe of your shorter leg will equalize the length of your legs and work to regularize your gait, ideally relieving most or all of your pain in the process.

Orthotics, by their nature, obviously come in all shapes and sizes. Their quality, price, and efficacy also vary enormously. As such, you might be wise to begin with an inexpensive temporary gel insert that can be purchased at most pharmacies for under $20. While the efficacy of the considerably more expensive permanent orthotics is not to be discounted, by experimenting with a few temporary inserts you may find one that works for you.

Custom orthotics can cost quite a bit more than many might expect, so you will want to do your homework and make sure you have the perfectly shaped insert for your specific problem before taking out your wallet.


Most people suffering from genu valgum benefit greatly from physical exercise, which help realign and stabilize the knees. After evaluating your gait, your doctor (or physiotherapist) can create an exercise plan designed specifically to strengthen the muscles most compromised by genu valgum: the legs, hips and thighs.

Stretching is another valuable asset when it comes to relieving symptoms of genu valgum. Simple strengthening exercises like leg lifts and stretches should help to relieve symptoms both immediately and over the long term.

When is surgery required?

Finally, when genu valgum is particularly severe and none of the above treatments have proven effective, there is surgery.

There’s little question surgery will, once and for all, correct knock knees. However, it’s usually only performed in the most serious of cases, when the gap between the ankles is greater than 10cm.

“Severity of genu valgum among my patient population is usually determined by the patient’s pain and how they respond to the more conservative management I mentioned,” says DeNoble, referring to the exercise, weight reduction, orthotics and other less drastic approaches to deal with the condition. “But when treating a recalcitrant case, surgical options to correct the deformity need to be considered.”

Which particular surgery is best for your specific condition, however, is something to be discussed with your doctor, as there are several options to choose from.

Knock knees, after all, are more than a cosmetic problem. The primary negative health consequences comes from the increased strain genu valgum puts on the knee joint. And as with all severe leg malpositions, over the long term this extra pressure on the knees leads to premature wear of the joint cartilage. When this happens, osteoarthritis of the knee joint is likely to develop.


One of the most common surgical procedure physicians rely upon to treat non-pediatric genu valgum is called an osteotomy. This option involves cutting and straightening bones in the leg so as to correct the angle of the knee.

Once the procedure and recovery process is complete, the knee will be left straighter and the patient’s body weight spread more evenly across the joint cartilage, further helping with the condition.

Guided growth

The second option is called “guided growth.” While similar to an osteotomy, with this surgery a small permanent metal plate that will realign the knees and adjust the leg bones is inserted in to the knee, essentially serving as a brace. After approximately one year the correction should be fully realized.

Knee replacement

Finally, while rare, sometimes with older adults doctors will recommend a knee replacement. In these instances the problem knee is replaced with an artificial knee that has been correctly aligned.

While a major endeavour, once the artificial knee has been inserted and the recovery from the procedure complete, patients can take comfort in the knowledge they will never again be burdened by knock knees.

What does post-surgical recovery involve?

All surgical options require patients to undergo a regimen of physiotherapy as part of their recovery process. These physiotherapy sessions are typically focused on strengthening and balancing exercises, knee mobilization, and learning how to walk and stand correctly – all important things patients need to re-adapt to now that they’re no longer compromised by genu valgum.

In conclusion, while genu valgum comes with it’s fair share of hardship, sufferers can take comfort in the knowledge that their symptoms can be lessened through weight reduction, orthotics and specific exercises, and that if the situation becomes unbearable, their legs can be straightened through surgery, permanently ridding them of the condition.

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