Development

Question 1

What are the approximate timescales of normal MSK development?

Answer 1

Sits alone, crawls – 6‐9 months
Stands – 8‐12 months
Walks – 14‐17 months
Jumps – 24 months
Manages stairs independently – Age 3

Question 2

What are the landmarks of neurological development?

Answer 2

Loss of primitive reflexes (Moro reflex, stepping reflex, rooting, grasp reflex, fencing posture etc) by 1‐6 months.
Head control – 2 months
Speaking a few words – 9‐12 months
Eats with fingers, uses spoon – 14 months
Stacks four blocks – 18 months
Understands 200 words, learns around 10 words/day ‐ 18‐20 months
Potty trained – 2‐3 years

Question 3

At birth what knee alignment disorder do children usually have?

Answer 3

Varus knees (bow legs)

Question 4

What is the progression of childhood knee alignment from birth to physiological normal?

Answer 4

Varus > neutrally aligned around 14 months, valgus at age 3, gradually to physiological valgus by 7-9

Question 5

How is pathological varus or valgus defined?

Answer 5

+/- 6’ from mean value for age

Question 6

At what point will genu valgum or varus require surgery?

Answer 6

Possibility after age of 10

Question 7

What can be some causes of genum varus or valgus?

Answer 7

Can be idiopathic, some familial. Due to underlying skeletal disorder (skeletal dysplasia, Blount’s disease), physeal injury with growth arrest (usually unilateral) or biochemical disorder (rickets)

Question 8

What is in-toeing?

Answer 8

Refers to a child who will have feet that point toward midline when walking or standing

Question 9

What exaggerates in-toeing, and are some features that make it noticeable?

Answer 9

Exaggerated when running and children are thought of as clumsy and wear through shoes quickly.

Question 10

What is femoral neck anteversion?

Answer 10

As part of normal anatomy the femoral neck is slightly anteverted (pointing forwards).

Question 11

What can femoral neck anteversion give the appearance of?

Answer 11

In-toeing, as well knock knees

Question 12

What are mobile/flexible flat feet?

Answer 12

The flattened medial arch forms with dorsiflexion of the great toe (Jack test)

Question 13

What can flexible flat footedness be related to?

Answer 13

Ligamentous laxity, familial or idiopathic. Normal variant in children, in adults also may be related to tibialis posterior tendon dysfunction

Question 14

What are rigid/fixed flat feet?

Answer 14

The arch remains flat regardless of load or great toe dorsiflexion.

Question 15

What does having rigid/flat feet indicate?

Answer 15

Underlying bony abnormality (tarsal coalition where bones of hindfoot have an abnormal bony or cartilaginous connection) which may require surgery. Also can be inflammatory/neuro disorder

Question 16

What can OA of the facet joints result in?

Answer 16

Osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica as previously discussed