Normal lower limb development and common variations

Question 1

Genu varus

Answer 1

Bow legged

Question 2

Genu valgum

Answer 2

Knock kneed.

Question 3

At birth, children are born with..

Answer 3

Generally varus knees (bow legged).

Question 4

At what point to childrens legs become neutrally aligned

Answer 4

14 months

Question 5

After childrens legs become aligned- they do..

Answer 5

They become slightly valgum at the age of three.

Question 6

What age to childrens legs become alligned

Answer 6

By the age of 7-9

Question 7

When is genu valgum or varus considered pathological?

Answer 7

When it is outside 2 standard deviations of the mean.

Question 8

Treatment of genu valgum and genu varus

Answer 8

Generally corrects itself by the age of 10, if not/excessive, surgery may be indicated.

Question 9

Blounts disease

Answer 9

Due to a growth defect of the medial proximal tibial physis.

Question 10

Treatment of Blounts disease

Answer 10

May require surgery

Question 11

Causes of pathological genu varus

Answer 11

Rickets, tumours (osteochondromas), traumatic physeal injury, skeletal dysplasia.

Question 12

Causes of pathological genu valgum?

Answer 12

Rickets, tumours (endochondromas), trauma, neurofibromatosis

Question 13

In-toeing

Answer 13

Also known as pigeon toed.

Feet point toward the midline

Question 14

Causes of in-toeing

Answer 14

Femoral neck anteversion
Internal tibial torsion
Forefoot adduction

Question 15

Femoral neck anteversion

Answer 15

Normal anatomy means the femoral neck points slightly anteverted (pointing forwards). Excess anteversion can give the appearance of intoeing.

Question 16

Internal tibial torsion

Answer 16

The bone can be rotated inwards about its vertical axis. This is a normal variation and therefore should be ignored.

Question 17

Forefoot adduction

Answer 17

Surgery is debatable in this case.

Question 18

When are flat feet a normal finding?

Answer 18

At birth- all feet are flat. Arches only come about when you have been walking a lot because the muscle strengthens

Question 19

Key to determining flat feet pathology?

Answer 19

Whether the arch is fixed or unfixed.

Question 20

Mobile/flexible flat feet

Answer 20

The flattened medial arch comes about in dorsiflexion of the great toe (jacks test).
May be related to ligamentous laxity.

Question 21

Fixed flat feet

Answer 21

The medial arch remains flattened even with dorsiflexion of the big toe and weight bearing.

Question 22

Causes of fixed flat feet

Answer 22

Tarsal coalition- the bones in the heel have a bony or cartilaginous connection to one another.
May require surgery.

Question 23

Curly toes

Answer 23

Minor overlapping and curling of the toes. Common in the 5th toe.
Most often corrects without intervention.