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Variations of normal posture

most resolve w/o Rx
1. but if severe, progressive, painful or asymmetrical, refer
bow legs (genu varum)
1. many kids evolve leg alignment w/ initial degree of tibiae bowing-> knees being wide apart
  1. best seen when child is standing w/ feet together
  2. diamond shape
2. pathological differentials w/ bow legs
  1. rickets osteogenesis imperfecta
  2. Blount disease
    1. severe progressive & unilat bow legs
    2. uncommon
    3. seen mostly in Afro-Caribbean kids
3. characteristic x-ray
  1. beaking of prox medial tibial epiphysis
4. normal age range
  1. 1-3 years
normal toddler has broad base gait
knock-knees (genu valgum)
1. feet are wide apart when standing w/ knees held together
2. common
3. usually resolves spontaneously
4. normal age range
  1. 2-7 years
5. pathological differentials
  1. juvenile idiopathic arthritis (JIA)
flat feet (pes planus)
1. toddlers learning to walk usually have flat feet
  1. cos of flatness of medial longitudinal arch & fat pad which disappears w/ age
2. how to demo an arch
  1. stand on tiptoe
  2. passively extend big toe
3. pathological differentials
  1. hypermobility
    1. marked flat feet common
  2. congenital tarsal fusion
4. fixed flat foot, often painful in older kids
  1. may suggest a congenital tarsal condition
    1. refer to orthopaeds
5. Mx of symptomatic flat feet
  1. footwear advice
  2. arch
6. normal age range
  1. 1-2 years
toe walking
1. normal age range
  1. 1-3 years
2. pathological differentials
  1. spastic diplegia (of CP)
  2. muscular dystrophy
    1. Duchenne's
  3. JIA
    1. foot
    2. ankle
3. common in young kids
4. may become persistent from habit
5. can walk normally on request
in-toeing
1. causes
  1. metatarsus varus
    1. adduction deformity of a highly mobile forefoot
      1. big toes point towards each other
    2. occurs in infants
    3. passively correctable
    4. heel held in normal position
    5. no Rx needed unless persisting > 5 years old & symptomatic
  2. medial tibial torsion
    1. at lower leg, when tibia less laterally rotated than normal in relation to femur
      1. knees brought closer together (but not touching) w/ calf and ankles internally rotated
    2. occurs in toddlers
    3. may be assoc w/ bowing of tibiae
    4. self corrects within about 5 years
  3. persistent anteversion of femoral neck
    1. at hip, when femoral neck is twisted more forward than normal
      1. kids sit btw their feet w/ hips fully internally rotated (W sitting)
    2. presents in childhood
    3. usually self-corrects by 8 years old
    4. most don't need Rx
      1. but femoral osteotomy for persistent anteversion
2. normal age range
  1. 1-2 years
out-toeing
1. uncommon
2. normal age range
  1. 6-12 months
3. cause
  1. lateral rotation of hips
    1. bilat out-toeing
    2. resolves spontaneously

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Variations of normal posture

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	Created by v.djabatey about 10 years ago