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
