Genu Valgum (Knock-Knees)

Knock-knees are normal in young children and most resolve by 6 years of age.

Between the ages of 2 and 4 years, a gap of 6 to 7 cm between the medial malleoli (the bone prominences at the ankles) is regarded as normal. 

Referral is necessary if:

• There is asymmetry.
• There is an ankle gap larger than 6-7 cm.
• Changes are associated with pain or functional impairment.
• Changes persist beyond 5 years of age.

Conditions to consider include Rickets, Skeletal Dysplasias or Chronic (untreated) Inflammatory Arthritis (picture below).