Ch 26 - Musculoskeletal disorders

Question 1

Bow legs (genu varum) 1-2 yrs: causes (3), features (1)

Answer 1

Normal toddler has broad based gait. Pathological causes include - OI, rickets, blount disease (infantile tibia vara - severe progressive)

Question 2

Knock-knees (Genu Valgum) 2-7 yrs

Causes (2), featuure (1), rx (1)

Answer 2

Normal or JIA

F - feet wide apart when standing with knees together

Rx - spontaneous resolution

Question 3

Flat feet (pes planus) 1-2 yrs

Causes (3), features (2), Rx (2)

Answer 3

Normal, hypermobility, Tarsal coalition - fixed painful flat foot = requires ortho referral

F - fat pad & flat medial longitudinal arch

Rx - spontanaeous resolution, symp help with arched footwear

Question 4

What are the 3 causes of in-toeing?

Answer 4

Metatarsus varus (infants)

medial tibial torsion (toddlers )

Persistent anteversion of femoral neck (children)

Question 5

Metatarsus varus (infants) : define, feature, rx (1 each)

Answer 5

D - adduction deformity in highly mobile foot

F - passively correctable, heel is held in normal position

Rx - no needed unless it is > 5yrs of age (or symptomatic)

Question 6

Medial tibial torsion (toddlers): define, feature, management

Answer 6

D - tibia is less laterally rotated than normal (compared to femur)

F - tibial bowing

Rx - none (self resolves by 5)

Question 7

anterversion of femoral neck (children): define, feature, management

Answer 7

D - internal rotation of femoral neck

F - chilren sit between feet with hips fully internally rotated - W position

Rx - self resolution by 8, femoral osteostomy if persistent

Question 8

Out toeing (6-12 months): causes (3), features (1)

Answer 8

C - hypermobility, Ehlers danlos, Marfans

F - uncommon, if bilat due to lateral rotation of hips - spontaneous resolution

Question 9

Talipes Equinovarus (clubfoot): causes (3), features (3), rx (2)

Answer 9

Causes - idiopathic, oligohydramnios, neuromuscular disorder e.g. spina bifida, malformation syndrome

F -

• Whole foot is inverted and supinated
• forefoot adducted
• heel rotated inwards and plantar flexed

Rx

• Ponsetti method - plaster casting and bracing
• v severe- surgery

Question 10

Vertical talus - needs to be differentiated from talipes equinovarus. Features (2), Ix (1), Rx (1)

Answer 10

F - rocker-bottom shaped stiff foot

Ix - x ray

Rx - surgery

Question 11

Talipes Calcaneovalgus: cause, feature, management

Answer 11

C - intrauterine moulding

F - foot is everted and dorsiflexed

M - self resolution & passive foot exercises

Question 12

Tarsal coalition (abnormal connection between tarsal bones)

Define, features (2), rx (1)

Answer 12

Lack of segmentation between one or more foot bones

Also coalitions that were fibrous or cartilagenous ossify

F - progressively increasing rigidity + limited ROM

Rx - surgery

Question 13

Pes cavus - high arched foot. Causes (3), indication for treatment

Answer 13

C - neuromuscular disorders e.g. freidrich ataxia, Type 1 Hereditary motor sensory neuropathy (CMT), Marfan

Treat only if painful or stiff foot