Physiological knock-knee in preschool children: Prevalence, correlating factors, gait analysis, and clinical significance

Physiological knock-knee (PKK) was categorized by measuring intermalleolar distance (IMD), a clinically simple method, to evaluate the prevalence and correlating factors in 305 preschool children. The prevalence in this cross -sectional study was relatively high, and it was age related (p = 0.002; 64 , 44, and 34% for ages 3-4, 4-5, and 5-6 years, respectively). The followin g factors were correlated with PKK: use of walking chair early (p = 0.0001) , independently walked late (p = 0.0005), dependently walked longer (p = 0. 0001), concurrence with flatfoot (p = 0.001), and angular deformity (toe in /out, p = 0.03). Gait analysis, with spatiotemporal, kinematics, and kineti cs parameters, was performed to evaluate the ambulatory significance. Presc hool children with PKK have a shorter stride length (p = 0.02) and a slower walking speed (p = 0.004). Dynamic hyperextension of the knee is noted for 8 degrees during the whole gait cycle (p < 0.05). We conclude that PKK is a variable that should be considered in the development of mature gait for preschool children.