Review Article: Genu Valgum in the Developing Child: Etiology, Evaluation, and Evidence-Based Management

Abstract: Genu valgum is a condition where an individual's knees bend inward, touching each other and creating a "knockkneed" look, which may lead to discomfort and difficulties with walking. Commonly known as knock knees, genu valgum is a coronal plane deformity of the lower limb that is often seen in pediatric orthopedic settings. This review focuses on distinguishing between physiological and pathological genu valgum, highlighting the significance of a thorough clinical history, physical examination, and radiographic assessment for accurate diagnosis. Although it is usually a normal variation of growth that appears between ages 2 and 5 and typically resolves on its own by age 7, it is essential to differentiate between physiological and pathological genu valgum to ensure proper treatment. Physiological genu valgum is usually symmetrical, associated with typical height, and seldom leads to functional issues. Conversely, pathological genu valgum can arise from injuries, metabolic conditions (like rickets), skeletal abnormalities, tumors, or systemic illnesses, and is marked by asymmetry, progress that exceeds the anticipated age for correction, or notable functional limitations. The evaluation starts with a thorough clinical history that emphasizes growth, development, family patterns, and dietary habits. A comprehensive physical assessment involves measuring the tibiofemoral angle or the intermalleolar distance, analyzing limb alignment and gait, and checking for rotational deformities or ligament laxity. Imaging is generally utilized only for cases with unusual characteristics, such as asymmetry, abnormal height, or suspected underlying conditions. X-rays, especially long-leg standing images, are useful for determining mechanical axis deviations and assist in planning for surgery. Management typically follows a conservative approach in physiological cases, where observation is the key strategy. Bracing and orthotic devices are generally discouraged due to their limited effectiveness and low adherence rates. For growing children, guided growth techniques like hemi-epiphysiodesis using staples, plates, or screws are preferred, while osteotomy is typically reserved for patients with fully developed skeletons or when rapid correction is essential. In certain cases that necessitate concurrent limb lengthening, external fixators may be used. This review emphasizes the clinical presentation, evaluation, and treatment alternatives for genu valgum in children, with the goal of assisting clinicians in distinguishing benign growth variations from significant underlying problemsand guiding appropriate care to prevent long-term consequences.