Genu valgum

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Knock knees
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Genu valgum
Other namesKnock knee
A very severe case of genu valgum of the left knee following bone cancer treatment
SpecialtyMedical genetics Edit this on Wikidata

Genu valgum, commonly called "knock-knee", is a condition in which the

Latin genu, 'knee', and valgus which means "bent outwards", but is also used to describe the distal portion of the knee joint which bends outwards and thus the proximal
portion seems to be bent inwards.

Mild genu valgum is diagnosed when a person standing upright with the feet touching also shows the knees touching. It can be seen in children from ages 2 to 5, and is often corrected naturally as children grow. The condition may continue or worsen with age, particularly when it is the result of a disease, such as

congenital
or has no known cause.

Other systemic conditions may be associated, such as Schnyder crystalline corneal dystrophy, an autosomal dominant condition frequently reported with hyperlipidemia.

Causes

Genu valgum can arise from a variety of causes including nutritional, genetic, traumatic, idiopathic or physiologic and infectious.[3]

Rickets

Nutritional rickets is an important cause of childhood genu valgum or knock knees in some parts of the world. Nutritional rickets arises from unhealthy life style habits as insufficient exposure to sun light which is the main source of vitamin D. Insufficient dietary intake of calcium is another contributing factor.[4][2] Genu valgum may arise from rickets caused by genetic abnormalities, called vitamin D-resistant rickets or X-linked hypophosphatemia.

Osteochondrodysplasia

Osteochondrodysplasias. A complete bone X-ray survey is mandatory to reach a definitive diagnosis.[5]

Diagnosis

Image showing how Q-angle is measured

The degree of genu valgum can clinically be estimated by the Q angle, which is the angle formed by a line drawn from the

tibial tubercle. In women, the Q angle should be less than 22 degrees with the knee in extension and less than 9 degrees with the knee in 90 degrees of flexion. In men, the Q angle should be less than 18 degrees with the knee in extension and less than 8 degrees with the knee in 90 degrees of flexion. A typical Q angle is 12 degrees for men and 17 degrees for women.[6]

Radiography

On

ankle joint.[8] It is normally between 1.0° and 1.5° of varus in adults.[9] Normal ranges are different in children.[10]

Treatment

The treatment of genu valgum in children depends on the underlying cause. Developmental also known as idiopathic genu valgum is usually self-limiting and resolves during childhood. Genu valgum secondary to nutritional rickets is typically treated with lifestyle modifications in the form of adequate sun exposure to ensure receiving the daily requirements of vitamin D and nutrition with a rich calcium diet. Additionally, calcium and vitamin D supplementations may be used. If the deformity does not resolve despite the above conservative treatment and the deformity is severe and causing gait impairment, then surgery can be an option. Typically, guided growth surgery is used to straighten the deformed bone.[2][11] Genu valgum arising from osteochondrodysplasia[5] usually needs repeated guided growth surgical interventions.[12] Genu valgum secondary to trauma depends on the degree of physical damage. Usually, limb reconstruction procedures are needed, especially if trauma occurs in the early years of life where the anticipated remaining longitudinal bone growth is great.

The treatment of genu valgum in adults depends on the underlying cause and the degree of joint involvement namely arthritis. Bone corrective osteotomies and prosthetic joint replacement may be used depending upon the patient's age and symptomatology in terms of pain and functional impairment. Weight loss and substitution of high-impact for low-impact exercise can help slow progression of the condition. With every step, the patient's weight places a distortion on the knee toward a knocked knee position, and the effect is increased with increased angle or increased weight. Even in the normal knee position, the femurs function at an angle because they connect to the hip girdle at points much further apart than they connect at the knees.

Working with a physical medicine specialist such as a

physiotherapist may assist a patient in learning how to improve outcomes and use the leg muscles properly to support the bone structures. Alternative or complementary treatments may include certain procedures from Iyengar Yoga or the Feldenkrais Method
.

See also

References

  1. ^ "Genu Valgum". The Lecturio Medical Concept Library. Retrieved 23 July 2021.
  2. ^
    PMID 32159063
    .
  3. ^ NHS (January 2016). "Knock Knees".
  4. S2CID 6146424
    .
  5. ^
    S2CID 79825711
    .
  6. PMID 17198449
    .
  7. PMID 19995425
    .
  8. PMID 24671469
    .
  9. PMID 20950695
    .
  10. ^
    PMID 19797583
    .
  11. PMID 33422021
    .
  12. PMID 31669550
    .

External links
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