Normal Limb Development (and common variations)

Question 1

How does the alignment of a child’s knees normally change from birth onwards?

Answer 1

@ birth, increased degree of varus (bow legs)

Becomes neutrally aligned at around 14 months

@ age 3 - 10-15 degrees valgus

This then regresses to about 6-7 degrees valgus by the ages 7-9

(Considerable variation is common!)

Question 2

By how many degrees out does genu varus or genu valgus become pathological?

Does this usually require intervention?

Answer 2

If a difference of more than 6 degrees either way is noted, this is considered pathological

Most of these settle by themselves by the age of 10

Question 3

What are some of the causes of intoeing?

Answer 3

Femoral neck anteversion

Internal tibial torsion

Forefoot adduction

Question 4

What test can be done to assess a child with flat feet?

What does this determine?

Answer 4

The Jack test

Determines if the flat-footing is fixed or flexible

If flexible, upon going on tip toes the arch of the foot will reappear

If fixed, the foot will remain flat on tip toes (implies underlying bony abnormality)