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Boston Children's Hospital's Orthopedic Center specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.
Doctors treat most children who have knock knees with close observation during those years when this condition is a natural (physiologic) part of a child's leg development (typically ages 2 to 5), since the condition usually corrects itself with time. As a child grows, her walking patterns become normal or near-normal by 7 to 8 years of age (or occasionally by the time the child becomes a teen).
In a very few cases, the valgus may be severe and may not self-correct. Splints and other devices aren’t usually needed for a child at a natural stage of valgus up to age 7. These devices can be useful if the child’s natural valgus doesn’t straighten out on its own by about the time she’s 7 or 8 years old—or if the valgus has an underlying systemic or metabolic condition causing it.
For children with severe, unresolved knock knees, doctors may recommend:
• a night brace, particularly if a family history of knock knees exists; the brace attaches to a shoe and works by
pulling the knee up into a straight position
• orthopedic shoes, usually equipped with a heel wedge and occasionally an arch pad
In the rare event that natural growth, braces or shoes don't correct your child's knock knees, her doctor may recommend surgery. The surgery may involve either influencing bone growth (called a “guided growth” procedure) or cutting and straightening the thigh bone or shin bone (osteotomy of the femur or tibia).
Guided growth surgery means stopping the growth on the bent side of the bone (for knock knees, the inside of the knee).This is often done by implanting small metal devices that tether the medial/inside part of the growth centers around the knee, allowing the lateral/outer part to grow and straighten the knee.
Children usually have guided growth surgery when they're approaching puberty (approximately age 11 in girls and 13 in boys). This allows time for the child's bones to continue to straighten on their own during the remaining growing years. This is a minimal day-surgery procedure, with immediate weight bearing and a rapid return to sports allowed.
Osteotomy surgery is needed for more severe deformities or after growth is finished. After surgery, your child will probably stay in the hospital for a couple of days, and be given pain medication. When she goes home, she'll need to limit her weight-bearing activities, and she may use crutches or a walker for a six to eight weeks. Physical therapy will help restore her muscle strength. She'll probably be able to resume full activities, including sports, after six months.
• Since knock knees are self-correcting in up to 99 percent of cases, the long-term outlook is very positive for most
children with the condition.
• For children who need surgery for severe forms of the condition, the outlook is also excellent. The procedures are
quite safe—and children's bones usually heal faster and more reliably than adults'.
• For children with surgically repaired knock knees caused by an underlying condition (pathologic valgus), adulthood
can bring can risks of arthritis, meniscal tears, pain or dislocation.
Severe knock knees may restrict a child's physical activities. She may not be able to run easily, putting some sports or other physical activities out of reach. If her knock knees persist into adolescence, she may become self-conscious about her appearance.
At Children's, we understand that a hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit the Hale Family Center for Families for all you need to know about:
• getting to Children's
• navigating the hospital experience
• resources that are available for your family
In particular, we understand that you may have a lot of questions when your child is diagnosed with knock knees. Will my child need surgery? When will her knees look normal? Will it affect her long term? Children's can help you connect with extensive resources to help you and your family through this stressful time, including:
• patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists
will be on hand to walk you through your child's diagnosis, treatment (if any) and recovery. And once your child
is home, we'll help you coordinate and continue the care and support she received at Children's.
• parent-to-parent: Want to talk with someone whose child has been treated for knock knees? Our
Orthopedic Center can often put you in touch with other families who've been through the same experience
that you and your child are facing.
• faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy.
Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith
traditions—who will listen to you, pray with you and help you observe your own faith practices during your
• social work: Our social workers and mental health clinicians have helped many other families in your situation.
We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to
coping with illness and dealing with financial issues.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”