Case Study: Managing Painful Knock Knees In A Young Child

MEET CHLOE

• Healthy, active 7-year-old girl
• Extremely painful partially dislocating kneecaps occurring 1-2 times per week
• High financial & emotional stress on Chloe’s parents from seeing her in pain and regularly taking time off work to look after her

CHLOE’S EXAM

When we first met Chloe in 2019, we identified she was regularly partially dislocating her kneecaps because of a knee position called genu valgum. Genu valgum leads to a muscle imbalance in the upper leg where the glutes and inner thigh muscles aren’t able to work effectively and the outer quad muscles take control, pulling the knee cap out of position. This was extremely painful for Chloe.

Her foot posture was also moderately rolled inwards (pronated), and this exacerbated the knock-knee posture.

WHAT ARE KNOCK KNEES?

Knock-knees can be a naturally occurring skeletal posture condition where the knees turn in to face each other. While it can be part of the normal development process before the age of seven, it should not cause pain. When knock-knees persist beyond 7-years-old or are severe enough to prevent normal movement, a Podiatrist should be consulted.

CHLOE’S TREATMENT

Chloe’s treatment was discussed with her and her parents and included:

• Massage for the tight muscles in the thigh
• New footwear – stable and supportive jogger
• Orthotics – by rolling the foot out with orthotics, this helps roll the knees away from one another
• Exercises – Chloe already had some from a physio she was seeing, but we added some podiatry–specific stretches to help the muscles pulling on her kneecaps

RESULTS

Chloe’s walking improved immediately after she started wearing the orthotics, and her knees could not cross over the midline of the body. Combined with her exercises and external physiotherapy, she made reasonable progress.

Her dislocations reduced to 1-2 per fortnight, but progress was unfortunately halted as she went through a growth spurt which worsened her posture, and she stopped doing her exercises.

TREATMENT – ROUND TWO

Following Chloe’s growth spurt, we:

Adjusted her orthotics to increase the arch support to reduce how far her feet roll in even more

Discussed why Chloe stopped completing her exercises – she said she her physio exercises were very timeconsuming, but mainly, she didn’t enjoy them

Referred Chloe to an excellent knee surgeon to rule out serious bone damage around her knees, who gave her the all-clear

CHILD-SPECIFIC REHAB AND EXERCISES

As Chloe wasn’t going to complete the exercises prescribed by her current physio, we referred her to our sister clinic, The Physio.

They designed an exercise program that was more realistically suited to a seven-year-old, while at the same time making it fun and effective. We introduced Chloe to reformer pilates and she has been performing this each week too.

CURRENT RESULTS

After 8 weeks of consistently wearing her orthotics, child-friendly exercises and weekly pilates, Chloe’s kneecap dislocations have reduced greatly, as has the angle of her knock-knees. Now, when the infrequent dislocations do occur, it’s when Chloe spends lots of time in bare feet over the school holidays, or when she’s very tired. In either case, they are no longer as painful.

Chloe will continue her Pilates with us and will have 6-monthly checks for her orthotics and footwear. Her prognosis is good, and we feel positive she can grow safely into a fit and active little lady.