- Clinical history
- Physiological knock knees is seen from 3-5 years of age
- it resolves with growth by age 8
- Knocked knees may be familial.
- Physical examination
- Determine the patient’s height and weight percentiles.
- Measure intermalleolar distance in standing with knees together.
- Investigations
- X-ray of knees if:
- unilateral deformity
- progressive deformity
- lack of spontaneous resolution after age of eight
- GP management
- Reassure the parents that the majority of physiological knock knees will resolve with normal development by age eight, with no specific treatment required.
- If concerned, serial measurement of intermalleolar distance every six months to document progression or resolution may be useful
- Indications for specialist referral
- persistence of significant knock knees beyond age eight
- intermalleollar separation more than eight centimetres
- asymmetrical deformity
- progressive deformity or lack of spontaneous resolution
- pain after a traumatic event
- other associated skeletal deformity such as height below fifth centile for age
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