Variation of Lower Limb Development Flashcards
what is genu varum
bow legged (decreased Q angle)
when will genu varum be considered pathologic
outwith normal range (+/-6o from mean value) or >2SD/16o from mean
also if unilateral, severe, short stature or painful
what causes pathologic genu varum
skeletal dysplasia rickets tumour eg enchondroma blouts disease (growth arrest of medial tibial physis - break like protrusion on xray) trauma = physeal injury
why is genu varum considered normal most of time
children at birth normally have it but become neutrally aligned at 14 months, progressing to 10-15 degrees valgus age 3 then gradually regresses to physiologic values of 6 degrees by age 7-9
how is genu varum treated
normally nothing but may require surgical correction by osteotomy if largely abnormal and age >10
what is genu valgum
knocked knee (increased Q angle)
genu valgum is also usually normal but what is pathologic causes
tumours = enchondroma, osteochondroma
rickets
neurofibromatosis
idiopathic
what is treatment of genu valgum
usually nothing
refer if asymmetric, painful or severe
again, excess deformities can be corrected by osteotomy or growth plate manipulation surgery
what is intoeing
children walks with toes pointing in aka pigeon toed and this is often accentuated when running
what is a tell tale symptom of intoeing
children often clumsy and go through shoes at alarming rate
there are three things that cause intoeing, what are they
femoral neck anteversion
internal tibial torsion
metatarsus adducts
what is normal values of femoral neck anteversion and what is the tell tale sign of it
mean 30-40o at birth, slowly unwinds and should be around 10-15o at maturity
sits in W position
what is internal tibial torsion
intwisting of tibia
usually seen in toddlers and majority resolve by 6 years
what is metatarsus adducts
common benign condition that usually resolves itself
if not passively correctable = serial casting may help age 6-12 months
what is treatment of intoeing
nothing really
no surgery unless very severe
we are all born with flat feet but most of us develop medial arch, how does this happen
as tibialis posterior strengthens
what are mobile / flexible flat feet, how is this tested and what may it be related to
those where flattened medial arch forms with dorsiflexion of great toe (Jack test)
may be related to ligamentous laxity, may be familial or may be idiopathic
what is rigid flat footedness and what does this suggest
arch remains flat regardless of load or great toe dorsiflexion
implies underlying bony abnormality (tarsal coalition where bonds of hind food have abnormal connection)
may also represent neurological disorder
how is flat feet treated
flexible = medial arch support orthoses not requires fixed = tarsal coalition may require surgery
what are curly toes
minor overlapping of toes is common with 3rd, 4th and 5th toe most frequently affected
how is curly toes treated
majority resolve by 6 yo
taping or splinting ineffective
v rarely - persisting cases can consider flexor tenotomy (surgical intervention)
