Lower Limb Development Flashcards
When is a deformity significant?
If it is likely to persist or cause physical or mental problems later in life
Bones start as what?
Cartilage
Bones grow longitudinally from where? How?
From the growth plate (physis) by endochondral ossification
Bones grow circumferentially from where?
Periosteum
What are some factors influencing the growth plate?
Diet/nutrition, sunshine and vitamin D, injury/illness, hormones
If a child has a short stature, what other factor may increase suspicion of an endocrine or genetic disorder?
Dysmorphic features
When is it normal for a child to sit alone, crawl?
6-9 months
When is it normal for a child to stand?
8-12 months
When is it normal for a child to walk?
14-17 months
Children at birth usually have what kind of knees? When does this correct?
Usually varus, aligns at 14 months
After the genu varum from birth has aligned at 14 months, what happens?
Progress to 10-15 degrees valgus at age 3
What is the normal physiological position of the knees? At what age will this be settled?
6 degrees of valgus, 7-9 years
What is genu varum?
Bowing of the knees
What is genu valgum?
Knock knees
What defines pathological varus/valgus?
+/- 6 degrees from the mean value for the age
Some people develop minor varus/valgus which can be what?
Familial
Genu varum is normally below what age?
< 2
What are some indicators of underlying pathology in a child with genu varum?
Unilateral, > 2SDs from mean, painful, very short stature
Genu varum will result in a large gap between where?
The knees
What are some pathological causes of genu varum?
Skeletal dysplasia, rickets, tumour, Blount’s disease, trauma causing physical injury
What is Blount’s disease?
The growth arrest of the medial tibial physis with unknown aetiology
What tumour is most likely to cause genu varum?
Osteochondroma
If a case of genu varum/valgum is still present by what age, they may require surgery?
10
Genu valgum will cause a large gap between where?
The ankles (inter-malleolar distance)
What are some pathological causes of genu valgum?
Tumours, rickets, neurofibromatosis, idiopathic
What tumour is most likely to cause genu valgum?
Enchondroma
When should you refer a child with genu valgum?
If it is asymmetrical, painful or inter-malleolar distance is > 8cm
Parents may notice what about children with intoeing?
They may be clumsy and wear through shoes very quickly
When is intoeing accentuated?
When the child runs
What conditions may intoning be associated with?
Femoral neck anteversion, internal tibial torsion, metatarsus adductus
The femoral neck normally points slightly anterior, but in femoral neck ante version there is increased what?
Internal rotation of the hip
Femoral neck anteversion can give the appearance of what?
Genu valgum and intoeing
Femoral neck anteversion is normally of no consequence, but can predispose to what?
Patella-femoral problems
What happens in internal tibial torsions? This is seen in who? It should resolve by what age?
The tibia is inwardly rotated, seen in toddlers, should resolve by age 6
Metatarsus adductus usually resolves with age, but if not by age 6-12 months what may help?
Casting
We are born with flat feet, what usually develops and when?
We develop a medial arch once we start walking as the tibialis posterior stretches
What are flexible flat feet?
A medial arch will form with dorsiflexion of the great toe, flat footedness may only be present on weight bearing
What may flexible flat feet be related to?
Ligamentous laxity (though can be familial or idiopathic)
What is rigid flat feet?
The arch remain flat regardless of load or great toe dorsiflexion
What does rigid flat feet imply?
Underlying bony abnormality e.g. tarsal coalition which may need surgery
Curly toes normally resolves by what age? If they persist what can they cause?
6 years, can cause flexor tenotomy
Which sex is more knock kneed?
Females
Anterior knee pain occurs in who?
Adolescents, especially female
Where is the pain in anterior knee pain? When is it worst?
Localised patellar tenderness, worse on stairs or squatting
What should you always check for if a child presents with knee pain?
Check the hips for SUFE
Anterior knee pain is a type of what? What therapy may help?
Growing pain, can give physiotherapy but will go away
