Genu Valgum: Causes, Symptoms, Treatment and Cost

Genu valgum, also known as 'knock knees,' is a condition in which the knees angle inward and touch each other when a person stands with their feet and legs together. The inner edges of the feet may also spread outward.

Genu valgum is usually caused by physical traits or medical conditions and is most common in children between ages 2-8, although it can occur at any age. It usually resolves on its own by age 10 to 12 but may not resolve completely in some people.

There are three main types of genus valgum classified by the underlying cause or aetiology: physiologic genu valgum, mechanical genu valgum, and pathologic genu valgum.

• Physiologic Genu Valgum: This type of Genu Valgum occurs in children who are younger than ages 9-13 due to rapid growth and development. The increased curvature is largely caused by immature joints that are not yet rigid enough to support the weight of the body against gravity during standing position, leading to a greater bending inward at the knee joint.
• Mechanical Genu Valgum: This type of Genu Valgum occurs when a person develops a more pronounced curvature than what would normally be expected from their age range from abnormal alignment or walking patterns due to disturbances such as abnormal leg length differences (heel-knee-hip asymmetries).
• Pathologic Genu Valgum: This type of Genu Valgum results from diseases that affect bone density, joint capsule laxity or connective tissues such as Blount’s disease (abnormal tibial growth plates) Osteogenesis Imperfecta (brittle bone disease) and Rheumatoid Arthritis (inflammation caused by autoimmune dysfunction).

Genu Valgum is caused by the weakening of tendons and muscles in the lower leg, or due to imbalances of muscles or bone structure in children and adolescents— usually during periods of rapid growth and development.

Bad posture, such as slouching while sitting or standing, can also lead to Genu Valgum if done excessively without proper treatment/correction.

In more serious cases, diseases such as rickets or vitamin D deficiency can be linked to Genu Valgum.

• Bowed knees and knock-knees.
• Wider than normal space between the knees when standing.
• Knees touching or crossing when sitting.
• Joint pain in the knees and legs.
• Gait abnormalities such as foot inversion and rotation.

• Increase the amount of exercise- especially those that target the hip and knee muscles, including squats, calf raises, and lunges.
• Wear orthotics or special shoes to support the knees and arches.
• Use Kinesio tape to help stabilise the knee joint while exercising.
• Avoid wearing shoes with excessively high heels or ones without support for long periods of time.
• Practise good posture while standing, sitting, and walking to help build strong muscles around the knees and reduce stress placed on them by crouching or slouching over time.

• Physical examination: During physical examination, the doctor will usually observe the patient's posture from both standing and sitting positions. They may measure the angle at which the legs are bent to assess the severity of genu valgum, as well as check for signs of muscle wasting or swelling in the areas surrounding the knee joint. Additionally, any pain or tenderness that occurs when moving or bending knees may indicate a more serious underlying cause such as arthritis or an injury.
• X-Rays: X-rays of the lower limbs are typically taken to diagnose genu valgum, more commonly known as 'knock knees.' X-rays allow doctors to evaluate the degree of deformity and alignment of the bones.
• CT scans: Genu valgum can be diagnosed through CT scans of the lower extremities. These scans provide an inside view of the leg bones and joints, allowing doctors to spot any anomalies in alignment or congruence that may indicate genus valgum.
• Blood tests: Depending on the individual's symptoms, blood tests may also be recommended to rule out specific underlying causes such as vitamin D deficiency or an autoimmune disorder. These might include tests for calcium levels, phosphorus levels and other related tests.

• Poor balance, increased risk of falls and injuries due to weakened stabilising ankle muscles.
• Pain in the lower extremities from increased load on the inner knee joints.
• Compression of the nerves in the back of the legs leading to numbness and tingling sensation in lower legs.
• Increased risk of arthritis due to changes in joint confirmation from thigh bone bowed inward at ankle joint.
• Impaired gait leading to altered pelvic mechanics and possible chronic back pain or sciatica-like symptoms due to shifted weight distribution during ambulation.

• Massage legs with warm sesame oil to reduce inflammation and discomfort.
• Take 4-5 drops of cow’s ghee with a few drops of garlic extract every morning before breakfast.
• Drinking fresh turmeric juice mixed with amla and honey can help improve joint strength and mobility.
• Exercise regularly, taking care not to put too much pressure on knees.
• Make a paste of ginger, cumin seeds, and rock salt; rub on the knee joints for relief from pain.

• Eating healthy foods like lean meats, fruits, and vegetables can help manage genu valgum.
• Whole grains, nuts, and fish are nutrient-rich additions to a well-rounded diet.
• Calcium is essential for strong bones and joints, and dairy products are a great option to get it.
• Eating extra servings of vitamin C and other nutrients found in citrus fruits may also contribute to better joint health.
• Antioxidant-rich foods such as blueberries, spinach, and sweet potatoes can help reduce inflammation in the body associated with genu valgum as well as other joint conditions.

• Avoid deep fried and processed foods such as chips, biscuits and fries.
• Limit high-salt foods such as fast food and cured meats.
• Limit refined carbs such as white bread and spaghetti.
• Say no to sugary treats like candy, sweets, etc.

• Observe and rest: Allow time to see if the problem will correct itself with rest and proper treatment of any underlying medical conditions.
• Physical therapy: Engage in physical therapy exercises to achieve better joint stability, strengthen leg muscles, improve range of motion and reduce pain.
• Bracing: Use braces to limit knee flexibility and ensure that feet stay in proper alignment when standing or walking.
• Osteotomies: These involve cutting a piece of bone in order to realign it correctly.
• Joint replacement: Joint replacement involves replacing damaged pieces of a joint with artificial parts like metal or plastic components.

To treat this condition properly, it is recommended to visit an orthopaedic specialist. The doctor can assess the knee joint and decide on an effective treatment plan based on the severity of the misalignment.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are a type of pharmaceutical drug commonly used to treat symptoms of inflammation, such as fever, muscle pain, and arthritis. Common NSAIDs include ibuprofen, naproxen, diclofenac and celecoxib. Research has indicated that NSAIDs can be effective at relieving the pain associated with Genu Valgum when taken according to package instructions.
• Corticosteroids: Corticosteroids are hormones used to reduce inflammation and pain associated with genu valgum. These hormones can be taken orally or injected directly into the affected area by a doctor.
• Vitamin D or Calcium supplements: If the condition is due to a dietary deficiency, then vitamin D and calcium supplements may be beneficial.

The time taken to recover from Genu Valgum will vary depending on how long it has been present, the severity of the condition and the type of treatment chosen. Generally, mild cases of genu valgum relief take a few weeks or months with conservative methods like physiotherapy and orthotics. More severe cases may require surgery, which means a longer course of recovery - potentially taking several months or years.

The treatment for genu valgum (knock knees) does not provide a permanent solution. Depending on the underlying cause and severity of the condition, different treatments are used to correct it. With appropriate treatment, the results can last over months to years, however there is no guarantee of permanently correcting the condition.

• Resting: Initially, it is important to rest and avoid activities which can lead to further joint problems or injure the knee.
• Physical Therapy: Stretching and strengthening exercises of the affected leg muscles can help to realign the knee joint. Strengthening of hip abductors should also be done together with lower limb muscles.
• Mobility Aids: Walking aids are recommended for elderly patients due to reduced muscle strength and increased risk of falls in this population group.
• Knee Bracing: Using a brace designed for genu valgum can help correct alignment temporarily and distribute pressure from the inner part of the knee joint evenly across the entire joint surface area as well as provide stability for walking or activity-related movement during early stages of treatment.
• Orthoses: Customised orthoses such as ankle foot orthoses (AFOs) may be prescribed by a doctor or orthotist which act on both mechanical and neuromuscular levels providing realignment, support, improved hinging action, decreased pressures at medial structures when closed kinetic chain movements are used combined with heel wedge modifications if needed.

In India, the cost of Genu Valgum treatments is dependent on the severity of the problem and the kind of therapy chosen. Generally, treatments for mild cases may range from Rs. 1000-5000, while more complex or advanced surgical treatments may cost up to Rs 2 lakh.

The most common side effects of treatment of genu valgum (knock knees) include:

• Pain, swelling and discomfort in the affected knee joints.
• Knee joint stiffness and limited range of motion.
• Bruising and discomfort around the area where a cast or splint was applied.
• Irritation from skin contact with a cast/splint or braces used to treat genu valgum.
• Risk of developing shin splints due to altered gait during rehabilitation period post treatment of genu valgum.

A doctor should be consulted if you are having any genu valgum symptoms since they may lead to issues including 'bad balance, compression of the nerves in the back of the legs, and arthritis,' the severity of which will determine how long it will take to heal.