Paediatric normal lower limb

Question 1

what leg alignment is normal for newborns

Answer 1

varum

Question 2

what leg alignment is normal for 2.5 year olds

Answer 2

valgus

Question 3

where is longitudinal bone growth at

by what process

Answer 3

growth plate

enchondral ossification

Question 4

where is circumflexual bone growth

by what process

Answer 4

periosteum

appositional growth

Question 5

at what degree does knock kneed/bow legged kids need referral

Answer 5

> 16 degrees (more than 2SDs from mean)

Question 6

reasons for referral of knock kneed/bow legged kids (4)

Answer 6

> 16 degrees (more than 2SDs)
asymmetrical
painful
short stature in bow legged

Question 7

pathological aetiology of knock kneed (4)

Answer 7

tumours
rickets
trauma
neurofibromatosis

Question 8

pathological aetiology of bow legged

Answer 8

tumour 
rickets
trauma 
skeletal dysplasia (refer if short stature) 
blounts disease

Question 9

presentation of blouts disease on xray

Answer 9

beak like protrusion

Question 10

another name for intoeing

Answer 10

pigeon toed

Question 11

presentation of intoeing

when is it worse

Answer 11

child walks with feet pointed inwards

worse when running

Question 12

aetiology of intoeing (3)

Answer 12

femoral neck anteversion
internal tibial torsion
metatarsal adductus

Question 13

what is femoral neck antervsion

Answer 13

when child sits in a ‘w’ position

Question 14

treatment of femoral neck anteversion

Answer 14

nothing, will resolve itself

Question 15

what is internal tibial torsion

Answer 15

tibia rotates inward = inverted feet

Question 16

treatment of internal tibial torsion

Answer 16

nothing, will resolve itself <6 years
braces - distressing for patient
surgery if severe

Question 17

what is metatarsal adductus

Answer 17

when the bones distal to the metatarsals are internally rotated

Question 18

treatment of metatarsal adductus

Answer 18

casting if <1 year

surgery if >8 years

Question 19

which toes are usually affected by ‘curly toes’

Answer 19

3rd, 4th, 5th

Question 20

treatment of curly toes if persistent in adolescence

Answer 20

surgery

Question 21

are we born with or without an arch in our foot

Answer 21

without

Question 22

what happens in people with flexible (not painful) flat feet

Answer 22

not arch develops (1 in 5 people)

Question 23

how do you tell if flat feet are fixed or flexible (2)

Answer 23

painful = fixed, not painful = flexible

get patient to go onto tip toes, if arch forms = flexible flat foot, if no arch forms = fixed flat foot

Question 24

aetiology of fixed flat feet in kids

Answer 24

tarsal coalition (look at paeds foot and ankle conditions for more info)

Question 25

what conditions in kids lower legs should we generally not worry about (just need to reassure parents)

Answer 25

varum (bow legged)
valgum (knock kneed)
intoeing 
curly toes 
flexible flat feet