Clinically reviewed by What is knock knees
Knock knees means the knees touch while the ankles stay apart when a child stands with the legs straight. Parents describe it as ghutnay andar ki taraf jhukay huye.
In most children this is a normal stage. Babies start slightly bow legged, straighten by about two, then become knock kneed, with the gap at the ankles widest around three to four years. It then corrects slowly on its own, and the legs usually look straight by about seven or eight.
So the question is not whether the knees knock. It is whether the pattern fits your child's age, whether both legs look the same, and whether your child is growing well.
Symptoms you might have
- Knees that touch while the ankles stay a few centimetres apart on standing
- A gap at the ankles your child cannot close without crossing the legs
- Feet that roll inwards, so the inner edge of the shoe wears down
- A slightly clumsy, knees-together walk, and tripping over his own feet
- Knee or inner thigh ache after a long walk, in older children
- Both legs affected roughly equally, which is the usual and reassuring pattern
Why it happens
- Normal growth between about two and six years, by far the commonest reason
- A family pattern, where a parent had the same thing and grew out of it
- Vitamin D deficiency and rickets, which is common in Pakistan and weakens growing bone
- Extra body weight, which loads the inner side of the knee
- An old fracture near the knee that affected the growth plate, usually on one side only
- Rarer bone and kidney conditions, which also slow growth and need a doctor
When you should see a physiotherapist
Between two and six years, with both knees affected equally and a child growing normally, this needs nothing more than a check and a photograph to compare against later.
Come in, or see a doctor, if the knock knees worsen after six or seven years of age, if only one leg is affected, if your child is short for his age, or if there is pain or a limp.
Nutrition and vitamin D are a doctor's area, not a physiotherapist's. If rickets is suspected, your child needs blood tests and sometimes an X-ray, and vitamin D and calcium are prescribed by a doctor. Severe or worsening deformity needs an orthopaedic surgeon, because the correction, when needed, is surgical. A child who loses a skill he already had, such as walking, or whose muscles suddenly turn stiff or floppy, needs a doctor urgently.
Al-Shama Physiotherapy Clinic
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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How it is treated
Be clear about what physiotherapy can and cannot do here. It does not straighten bones. Normal knock knees straighten on their own, and abnormal ones are corrected by an orthopaedic surgeon. What physiotherapy treats is the muscle, the walking pattern and the pain.
- Assessment and measurement, recording the gap at the ankles so change is followed rather than guessed
- Exercise therapy for the hip and buttock muscles, which control how the knee tracks
- Strengthening and stretching for the thigh, calf and outer hip, where the assessment finds imbalance
- Gait training, teaching a more efficient walking and running pattern so the knees are loaded better
- Insoles or supportive footwear where the feet roll in badly, which helps comfort and shoe wear
Braces do not correct ordinary childhood knock knees. Where correction is genuinely needed, an orthopaedic surgeon has good options, including a small operation that guides growth over a year or two. That is always a surgeon's decision.
Exercises, and what to avoid
What helps
- Side lying leg lifts and standing hip work for the outer hip and buttock muscles
- Sitting to standing from a low chair, slowly, with the knees tracking over the toes
- Walking on uneven ground and barefoot on grass, which trains the whole leg
- Swimming and cycling, which build the legs without pounding the knees
What to avoid
- Tying, binding or splinting the legs together at night. It does not work and it hurts
- Oil massage promised to straighten the legs. No massage changes bone alignment
- Heavy jumping sport if the knees ache, until the strength work has had a few weeks
- Letting a heavy child stay heavy. Weight is the one factor you can genuinely change
What you can do at home
Take a photograph every three months. Stand your child against a plain wall, feet together, legs straight, knees facing forward. Nothing beats comparing pictures a year apart.
Check the shoes. Inner edges wearing down fast tells you the feet are rolling in and insoles may help.
Keep your child active. Walking, cycling and play build the muscles that control the knee.
If there is aching after a long day, ice on the inner knee for ten minutes with a cloth in between is enough. Heat is not needed for this.
Ask your doctor about vitamin D. In Pakistan deficiency is common, and it is simple to test and simple to treat.
How long it takes
Normal childhood knock knees correct themselves over years, not weeks. The widest point is usually around three to four years, and most children look straight by seven or eight.
Where there is aching or a clumsy walk, six to ten weeks of strength and gait work usually settles the pain and tidies the walking, even though the alignment itself has not changed.
Where rickets is the cause, the bone shape often improves noticeably within six to twelve months of correct medical treatment, which is a doctor's job.
What slows things down is extra weight, untreated vitamin D deficiency, and waiting past the age when a surgeon could have guided growth.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
بچوں میں گھٹنوں کا اندر جھکنا دو سے چھ سال کی عمر میں نارمل ہوتا ہے۔ تین چار سال میں یہ سب سے زیادہ نظر آتا ہے، پھر خود ٹھیک ہونے لگتا ہے۔ سات آٹھ سال تک ٹانگیں سیدھی ہو جاتی ہیں۔
فکر کی بات یہ ہے: اگر سات سال کے بعد بھی بڑھ رہا ہو، صرف ایک ٹانگ میں ہو، بچہ قد میں چھوٹا ہو، یا درد اور لنگڑا پن ہو۔
وٹامن ڈی کی کمی اور رکٹس پاکستان میں عام ہے۔ اس کا ٹیسٹ اور دوا ڈاکٹر کرتا ہے، فزیوتھراپسٹ نہیں۔
ٹانگوں کو باندھنا یا تیل کی مالش سے ہڈی سیدھی نہیں ہوتی۔ ورزش سے پٹھے مضبوط ہوتے ہیں اور درد کم ہوتا ہے۔
Roman Urdu
Bachon mein ghutnon ka andar jhukna do se chhe saal ki umar mein normal hota hai. Teen char saal mein ye sab se ziada nazar aata hai, phir khud theek hone lagta hai. Saat aath saal tak tangen seedhi ho jati hain.
Fikr ki baat ye hai: agar saat saal ke baad bhi barh raha ho, sirf ek taang mein ho, bacha qad mein chhota ho, ya dard aur langra pan ho.
Vitamin D ki kami aur rickets Pakistan mein aam hai. Is ka test aur dawa doctor karta hai, physiotherapist nahi.
Tangon ko bandhna ya tel ki malish se haddi seedhi nahi hoti. Warzish se pathay mazboot hote hain aur dard kam hota hai.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Will my child's knock knees straighten on their own?
Can exercise straighten my child's legs?
Is this caused by a calcium or vitamin D problem?
Should my child wear special shoes?
When would surgery be considered?
Related conditions
- Cerebral palsy treatment and physiotherapy
- Torticollis in babies
- Child not walking
- Delayed developmental milestones
- Low muscle tone in babies