Variation of Lower Limb Development

Question 1

what is genu varum

Answer 1

bow legged (decreased Q angle)

Question 2

when will genu varum be considered pathologic

Answer 2

outwith normal range (+/-6o from mean value) or >2SD/16o from mean
also if unilateral, severe, short stature or painful

Question 3

what causes pathologic genu varum

Answer 3

skeletal dysplasia 
rickets 
tumour eg enchondroma 
blouts disease (growth arrest of medial tibial physis - break like protrusion on xray)
trauma = physeal injury

Question 4

why is genu varum considered normal most of time

Answer 4

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

Question 5

how is genu varum treated

Answer 5

normally nothing but may require surgical correction by osteotomy if largely abnormal and age >10

Question 6

what is genu valgum

Answer 6

knocked knee (increased Q angle)

Question 7

genu valgum is also usually normal but what is pathologic causes

Answer 7

tumours = enchondroma, osteochondroma
rickets
neurofibromatosis
idiopathic

Question 8

what is treatment of genu valgum

Answer 8

usually nothing
refer if asymmetric, painful or severe
again, excess deformities can be corrected by osteotomy or growth plate manipulation surgery

Question 9

what is intoeing

Answer 9

children walks with toes pointing in aka pigeon toed and this is often accentuated when running

Question 10

what is a tell tale symptom of intoeing

Answer 10

children often clumsy and go through shoes at alarming rate

Question 11

there are three things that cause intoeing, what are they

Answer 11

femoral neck anteversion
internal tibial torsion
metatarsus adducts

Question 12

what is normal values of femoral neck anteversion and what is the tell tale sign of it

Answer 12

mean 30-40o at birth, slowly unwinds and should be around 10-15o at maturity
sits in W position

Question 13

what is internal tibial torsion

Answer 13

intwisting of tibia

usually seen in toddlers and majority resolve by 6 years

Question 14

what is metatarsus adducts

Answer 14

common benign condition that usually resolves itself

if not passively correctable = serial casting may help age 6-12 months

Question 15

what is treatment of intoeing

Answer 15

nothing really

no surgery unless very severe

Question 16

we are all born with flat feet but most of us develop medial arch, how does this happen

Answer 16

as tibialis posterior strengthens

Question 17

what are mobile / flexible flat feet, how is this tested and what may it be related to

Answer 17

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

Question 18

what is rigid flat footedness and what does this suggest

Answer 18

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

Question 19

how is flat feet treated

Answer 19

flexible = medial arch support orthoses not requires
fixed = tarsal coalition may require surgery

Question 20

what are curly toes

Answer 20

minor overlapping of toes is common with 3rd, 4th and 5th toe most frequently affected

Question 21

how is curly toes treated

Answer 21

majority resolve by 6 yo
taping or splinting ineffective
v rarely - persisting cases can consider flexor tenotomy (surgical intervention)