Knock knees

Emergency

If fracture is present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar

When public outpatient services are not routinely provided

None.

Note: typically children aged 3-4 years have knock knee alignment that improves over time. Reassurance at this age is recommended

Criteria to access public outpatient services

CategoryCriteria

Category 2
Recommended to be seen within 90 calendar days.

  • Progressive knock knees following a fracture or infection
  • Asymmetrical or progressive deformity

Category 3
Recommended to be seen within 365 calendar days.

  • Persistent knock knees in a child aged ≥ 8 years (intermalleolar standing distance > 8 cm)
  • Knock knees with functional impairment in a child aged ≥ 8 years
  • Knock knees associated with other skeletal deformities
  • Stature below the 3rd percentile and has already seen another specialist to exclude metabolic disease

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition including evolution and duration of symptoms
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • treatment prescribed (for example physiotherapy)
    • relevant family history
    • x-ray: weight bearing long leg (if unilateral, severe, or progressive deformity and > 8 years of age)

If available

  • Photograph of the legs.
    Note: clinical photographs can be very helpful at monitoring progress and review after 6-12 months. Photographs alone can avoid the need for specialist referral​

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing