Genu Valgum (Knock Knees): How Knee Alignment Affects the Hips, Feet and Lower Back

What Is Genu Valgum?

Genu valgum, commonly known as knock knees, occurs when the knees angle inwards towards the body’s midline.

Dynamic knee valgus describes excessive inward knee movement during activities such as walking, running and squatting. This can affect lower-limb biomechanics, altering how forces travel through the hips, knees, ankles and feet [1].

Femoral Adduction and Hip Biomechanics

Femoral adduction occurs when the thigh moves towards the body’s midline, often accompanied by internal rotation of the femur during dynamic knee valgus. Weakness or reduced control of the gluteal muscles, particularly the gluteus medius and maximus, may contribute to altered hip positioning, reduced pelvic stability and increased mechanical demands on the knee joint [1,2].

Pes Planus (Flat Feet) and Foot Pronation

Pes planus describes a reduced medial longitudinal arch of the foot. Excessive foot pronation may involve heel eversion, lowering of the foot arch and increased internal rotation of the tibia. These changes can influence knee alignment and hip mechanics during walking and running, potentially increasing stress on the lower-limb joints [3].

However, foot pronation is a normal part of walking, and flat feet do not necessarily cause knee problems.

Knee Pain and Swelling

Excessive dynamic knee valgus may increase stress on the patellofemoral joint and surrounding soft tissues, contributing to anterior knee pain during walking, running, squatting or stair climbing [1,2].

Associated joint irritation or conditions such as synovitis and cartilage damage may result in swelling, stiffness and discomfort. Persistent or unexplained knee swelling should be clinically assessed to establish its underlying cause.

How Can This Contribute to Lower Back Pain?

Altered hip, knee and foot biomechanics may influence pelvic stability, walking patterns and lumbar spine movement.

Compensatory movement patterns, muscular fatigue and changes in weight distribution can increase mechanical demands on the lower back, potentially contributing to lumbar discomfort [4].

However, lower back pain has multiple possible causes, and altered lower-limb alignment is not necessarily the direct cause.

How Osteopathy and Sports Massage Can Help

Your practitioner will carry out a postural and gait assessment to identify potential biomechanical factors contributing to your symptoms.

A gait assessment examines walking mechanics, including foot pronation, knee tracking, femoral rotation, pelvic stability and weight distribution throughout the walking cycle.

A postural assessment evaluates spinal alignment, pelvic positioning, lower-limb symmetry and potential muscular imbalances.

Depending on the findings, treatment may include:

• Osteopathy: Joint mobilisation and soft tissue techniques to improve mobility and reduce discomfort.
• Sports massage: Addressing muscular tension around the hips, thighs, calves and lower back.
• Strengthening exercises: Targeting the gluteal muscles, hip stabilisers and lower-limb musculature.
• Gait and movement retraining: Improving knee tracking, foot stability and movement control during weight-bearing activities.

Your practitioner will also provide a personalised home exercise programme based on the assessment findings, helping to improve muscular strength, joint stability and functional movement patterns [2,5].