Lower extrem abnormalities

Question 1

Classification of lower limb abnormalities

Answer 1

Rotational problems:
* in-toeing,
* out-toeing

Angular problems:
* genu varum (bowlegs),
* genu valgum (knock-knees)

Question 2

Aspects of a history in relation to lower limb abnormalities. (4 marks)

Answer 2

• Birth History:
• Full-term, premature birth as skeletal maturation is different
• Vaginal vs C-Section: Stress during birthing process
• # of pregnancies -> packaging problem?
• Age: when did it begin, previous treatment provided. If walking, when did they begin to independently.
• Family Hx: positive family history; treatment for family memembers if so?
• Sleeping/Sitting Positions: femoral anteversion etc.

Question 3

Genu varum (bowlegs) and genu valgum (knock-knees) are similar to

Answer 3

torsional conditions in that they are commonly seen in typically developing children, and a specific natural hx has been described that results in normal skeletal alignment at maturity.

Question 4

Physical examination in relation to lower limb abnormalities

Answer 4

• Anthropometry
• Spinal Examination: For scoliosis, hairy patches or sinus openings.
• Lower Extremity Examination: Trendelenburg’s Sign and LLD. Foot progression angle during walking, hip rotation ROM, the thigh-foot angle, and alignment of the foot.
• Neurological Examination: Rule out neuromuscular disorders

Question 5

Signs to look for in the foot with low limb abnormalities

Answer 5

• flat feet
• angular deformitiy
• dorsiflexion

Question 6

What is the foot progression angle?

Answer 6

Also known as gait angle, made by the foot with respect to a straight line plotted in the direction the child is walking.

Question 7

Femoral anteversion

Answer 7

IR increased
* Femoral neck axis is rotated anteriorly in
relation to the frontal plane of the femoral condyles.

Question 8

Femoral retroversion

Answer 8

(ER increased)
* Femoral neck axis is rotated posteriorly in
relation to the frontal plane of the femoral condyles.

Question 9

In children with excess femoral anteversion, what rotation typically exceeds the other?

Answer 9

Internal rotation, while the oppositie is true in femoral retroversion

Question 10

The Thigh-Foot Angle

Answer 10

• The axis of the foot and the axis of the thigh
• measured with the child prone and knees flexed to 90 degrees.
• In-toeing angles are given negative values while out-toeing
  angles are given positive values.

Question 11

Many children will appear____________ when they begin to walk and later become _____________between the ages of three to seven years.

Question 11

The thigh foot angle normal axis for out toes? What would occur if the child has internal tibial torsion?

Answer 11

• Normally, the foot axis out-toes 10 degrees relative to the
  thigh axis.
• Internal tibial torsion would have the foot turned in relative to the thigh axis.