Extended Abstract
Introduction
GGenu Valgum, commonly known as knock-knees, is a prevalent lower limb deformity in developing countries. While numerous factors contribute to this condition, including genetic disorders and metabolic bone diseases, there is hope. In individuals with this condition, the knees turn inward, causing the distance between the ankle bones to increase depending on the severity of the deformity. The prevalence of knock-knees can lead to uneven force distribution in the knee joint, subsequently causing anterior cruciate ligament (ACL) injuries. However, the potential of corrective exercises or supportive devices to mitigate the severity of this deformity is a promising area of research, offering hope for improved outcomes and a brighter future for individuals with Genu Valgum.
Methods
This review article evaluates original research, review articles, and clinical trials published in Persian and English during January 2008 to March 2023. The sources include WOS, SID, ISC, Magiran, Scopus, PubMed, and Google Scholar. We used specific keywords to extract articles related to Genu Valgum and its treatments. Inclusion criteria encompassed studies on the application of various training protocols and supportive devices in individuals with grade 4 knock-knees. Exclusion criteria involved studies with subjects suffering from other body deformities or those with a history of knee joint surgery (post-surgical rehabilitation). Article validation was assessed by evaluating indexed articles in Scopus, WOS, and ISC, ensuring that the selected articles were indexed in at least one of these databases. Initially, 76 articles were identified, with 22 articles ultimately selected based on the inclusion and exclusion criteria. The selected articles were critically reviewed, and their findings were synthesized to provide a comprehensive overview of the effects of exercise regimens and supportive devices on individuals with Genu Valgum.
Discussion
An increased Q-angle beyond the normal range is recognized as Genu Valgum and is considered a misalignment of the extensor mechanism. It manifests with excessive knee joint movement, patellar instability, and patellofemoral pain syndrome. Aerobic exercises significantly impact factors such as BMI, body weight, body fat mass, and lean body mass, thereby reducing pressure on the lower limbs.
Exercise interventions, including appropriate resistance training with elastic bands, have been positively reported for improving lower limb strength and balance maintenance. These exercises, particularly those with TheraBand, have been shown to reduce excessive pressure on the medial knee and the risk of structural damage progression. TheraBand exercises are recognized as a safe and effective tool for enhancing neuromuscular function, muscle strength, and the ability to perform functional tasks. Performing corrective resistance exercises with TheraBand can increase muscle electrical activity, enhance joint co-contraction, improve proprioception, support muscle function and efficiency, stabilize knee joints, improve range of motion, balance, and ankle joint stability, providing reassurance of their effectiveness and instill confidence in their potential benefits.
Foot orthoses and insoles are effective in treating lower limb deformities. Insoles designed to support the longitudinal arch and strengthen muscles, combined with balance training providing lower limb feedback, should be considered interventions to reduce dynamic knee valgus during stair descent. Non-surgical treatments for knock-knees also include various braces. Using knee braces significantly increases the activity of the semitendinosus muscle, a crucial muscle for walking and maintaining posture. Therefore, rehabilitative knee braces can reduce joint forces, and some knee joint risk factors, such as adduction torque, play an essential role in supporting joint health. Adjustable knee braces can immediately reduce the injury rate in individuals with knock-knees by affecting mid-frequency during descent movements. Adequate flexion in the ankle, knee, and hip can reduce joint forces by approximately 50%. Additionally, using these braces decreases hip joint vibration and instability during descent. Some studies highlight the positive effects of orthoses, wedges, and braces on knock-knees. However, one study reported negative effects due to reduced angle limitation by the knee brace, increased joint forces, and injury.
Kinesio taping is another tool used for knock-knees. Taping a limb or body part, similar to applying a flexible splint, helps reduce pressure on the injured area and prevent further damage. Kinesio taping (hamstring and vastus lateralis muscles) has been reported to increase negative power in the ankle and knee joints during the loading response phase of gait. Kinesio tape reduces pain, enhances athlete performance and functionality, and prevents the worsening of the deformity. Importantly, Kinesio taping has the potential to significantly improve dynamic balance and proprioception, as well as reduce dynamic knee valgus, providing encouragement and motivation for its use in individuals with knock-knees and instilling a sense of optimism about its potential benefits.
Conclusion
The findings of this review have significant implications for the practice of sports physiology, nephrology, and vascular access for hemodialysis. Aerobic exercises, for instance, have been shown to significantly reduce pressure on the lower limbs, which could be beneficial for athletes and individuals undergoing hemodialysis. Similarly, non-surgical treatments for knock-knees, including various knee braces, can play a crucial role in maintaining joint health, potentially reducing the risk of ACL injuries in athletes and improving the quality of life for hemodialysis patients. These findings could influence the development of exercise regimens and supportive devices for individuals with Genu Valgum undergoing hemodialysis, thereby improving their long-term catheter performance.
Conflicts of Interest
The authors have no conflicts of interest.
Acknowledgement
We sincerely thank the authors who provided full access to their articles and facilitated our research.

Key Message
Performing corrective exercises, especially resistance training with TheraBand, and using supportive tools such as insoles for internal arch support and Kinesio tape can be beneficial in reducing knee valgus degrees in affected individuals.