lower limb development

Question 1

in-toeing

Answer 1

a child who when walking and standing will have feet that point toward the midline. The abnormality is often exaggerated when running and children are felt by their parents to be clumsy and wear through shoes at an alarming rate. There are a number of causes of in‐toeing.

Question 2

femoral neck anteversion

Answer 2

normal anatomy - the femoral neck is slightly anteverted (pointing forwards)
excessive femoral anteversion can give appearance of in-toeing and knock knees
the degree of apparent in-toeing isn’t enough to warrant surgery

Question 3

what are flat feet?

Answer 3

part of normal variation and usually don’t reflect underlying pathology
at birth all feet are flat

Question 4

what happens to the feet when children begin to walk?

Answer 4

muscles develop and the foot gets an arch

Question 5

what are pathological flat feet?

Answer 5

some children continue to have flat feet which persists into adulthood

Question 6

what is a mobile/flexible flat foot?

Answer 6

a flattened medial arch forms with dorsiflexion of the great toe (jack test)
may only be dinamic – present on weight bearing only
normal variant in children - medial arch support orthoses are not required
adults – mobile flat foot may be related to tibialis posterior tendon dysfunction

Question 7

what is a fixed/rigid flat foot?

Answer 7

flattened medial arch regardless of load or great toe dorsiflexion
underlying bony abnormality – tarsal coalition
may require surgery
may also represent an underlying inflammatory disorder / neurological disorder

Question 8

what are curly toes

Answer 8

a common thing
most correct without intervention
occasionally can cause discomfort in shoes - persistent cases in adolescence - surgical correction