What should you know about physiological knock knees?

The knees come together while the ankles remain apart when a child stands. This can occur as part of normal leg development. A clinician checks the child’s age, symmetry, walking pattern, pain and whether the alignment is improving or becoming more pronounced. The examination may include the hips, knees, feet and leg lengths, because the visible angle can be influenced by more than the knee itself.

Use normal comfortable activity and avoid trying to force the legs straight with devices or exercises. Note changes in the stance, running and walking, and arrange a review if the child tires easily or struggles with balance. Paediatric physiotherapy may help with movement skills when there is a separate weakness or coordination difficulty, but it does not replace assessment of the alignment.

Arrange medical review for one-sided alignment, persistent worsening, pain, limping, repeated falls, restricted movement, or difficulty bearing weight. Seek urgent care after significant injury or if the child suddenly cannot walk. A clinician can decide whether observation, imaging or another treatment discussion is appropriate.

Is the alignment symmetrical and appropriate for my child’s growth? What changes should we watch between visits? Would physiotherapy address a functional difficulty, and when would an osteotomy ever be considered?