normal_lower_limb_variants_flashcards

Question 1

What is a common reason for presentation to primary care regarding lower limbs in children?

Answer 1

Apparent abnormalities in the lower limbs of developing children causing parental concern

Question 2

Describe flat feet (pes planus).

Answer 2

Absent medial arch on standing

Question 3

What is the typical age of presentation for flat feet?

Answer 3

All ages

Question 4

What is the management approach for flat feet in children?

Answer 4

Typically resolves between the ages of 4-8 years; orthotics are not recommended; parental reassurance is appropriate

Question 5

Describe in-toeing.

Answer 5

Common in the first year; possible causes include metatarsus adductus, internal tibial torsion, and femoral anteversion

Question 6

What are some possible causes of in-toeing in the first year?

Answer 6

Metatarsus adductus, internal tibial torsion, femoral anteversion

Question 7

What is metatarsus adductus?

Answer 7

Abnormal heel bisector line; 90% of cases resolve spontaneously, severe/persistent cases may require serial casting

Question 8

What is internal tibial torsion?

Answer 8

Difference between the thigh and foot angle; resolves in the vast majority

Question 9

What is femoral anteversion?

Answer 9

‘W’ sign; resolves in around 80% by adolescence, surgical intervention in the remaining not usually advised

Question 10

Describe out-toeing.

Answer 10

Common in all ages, especially early infancy

Question 11

What is the typical age of presentation for out-toeing?

Answer 11

Usually resolves by the age of 2 years

Question 12

What is a common cause of out-toeing in early infancy?

Answer 12

External tibial torsion

Question 13

What is the management approach if out-toeing doesn’t resolve?

Answer 13

Intervention may be appropriate as it increases the risk of patellofemoral pain

Question 14

Describe bow legs (genu varum).

Answer 14

Increased intercondylar distance

Question 15

What is the typical age of presentation for bow legs?

Answer 15

1st-2nd year; typically resolves by the age of 4-5 years

Question 16

Describe knock knees (genu valgum).

Answer 16

Increased intermalleolar distance

Question 17

What is the typical age of presentation for knock knees?

Answer 17

3rd-4th year; typically resolves spontaneously

Question 18

summarise normal lower limb variants

Answer 18

Question 19

A 13-month-old boy is taken to see his general practitioner by his mother. She reports that he recently started walking, but she has noticed that his legs appear strangely shaped, curving outward at the knees. He is otherwise well in himself and has no medical history of note. Both the pregnancy and delivery were straightforward.

On examination, the boy appears well in himself. The legs curve noticeably outward at the knees. The ankles touch and the toes point slightly outward.

What is the most appropriate next step?

Reassure the mother that it usually resolves by the age of 4
Reassure the mother that it usually resolves by the age of 8
Refer for a blood test to check vitamin D levels
Routine referral to paediatrics
Urgent referral to paediatrics

Answer 19

Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years

The description in this scenario is suggestive of genu varum, or bow legs. This is a normal variant in children and can often become more noticeable when the child starts walking. It is often accompanied by out-toeing. In almost all cases, the only step needed is reassurance as the condition usually resolves by the age of 4.

Reassuring the mother that it usually resolves by the age of 8 is therefore incorrect. If it has not resolved by the age of 4, a referral for further investigation will be needed.

Referral for a blood test to check vitamin D levels is unwarranted here. Although bow legs may be caused by rickets, this is extremely rare in the developed world. In the absence of any other signs or symptoms, the most likely cause is simply normal variant bow legs.

Routine referral to paediatrics is unwarranted at this stage. If the bow legs do not resolve by the age of 4 or 5, this would be an appropriate step.

Urgent referral to paediatrics is incorrect. Bow legs are a normal variant in children of this age.