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Chapter 3 - Normal Lower Limb Variants in Children

from Section 1 - General Introduction

Published online by Cambridge University Press:  30 January 2024

Sattar Alshryda
Affiliation:
Al Jalila Children’s Specialty Hospital, Dubai Academic Health Corporation, Dubai UAE
Stan Jones
Affiliation:
Al Ahli Hospital, Qatar
Paul A. Banaszkiewicz
Affiliation:
Queen Elizabeth Hospital, Gateshead
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Summary

A substantial proportion of referrals to paediatric orthopaedic clinics consist of normal physiological variants in growing children. Careful history and examination, and knowledge of the clinical course of rotational and angular deformities allow accurate assessment of children to exclude pathology and provide reassurance to parents. The aim of this chapter is to highlight areas of normal variation in paediatric orthopaedic practice and to identify abnormal features that require further investigation.

Type
Chapter
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Postgraduate Paediatric Orthopaedics
The Candidate's Guide to the FRCS(Tr&Orth) Examination
, pp. 24 - 36
Publisher: Cambridge University Press
Print publication year: 2024

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References

Gunz, AC, Canizares, M, MacKay, C, Badley, EM. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: a population-based study. BMC Musculoskelet Disord. 2012;13:98.Google Scholar
Carli, A, Saran, N, Kruijt, J, Alam, N, Hamdy, R. Physiological referrals for paediatric musculoskeletal complaints: a costly problem that needs to be addressed. Paediatr Child Health. 2012;17(9):e93–7.Google Scholar
Blackmur, JP, Murray, AW. Do children who in-toe need to be referred to an orthopaedic clinic? J Pediatr Orthop B. 2010;19(5):415–17.Google Scholar
Salenius, P, Vankka, E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. 1975;57(2):259–61.Google Scholar
Sabharwal, S, Zhao, C, Edgar, M. Lower limb alignment in children. J Pediatr Orthop. 2008;28(7):740–6.CrossRefGoogle ScholarPubMed
Heath, CH, Staheli, LT. Normal limits of knee angle in white children – genu varum and genu valgum. J Pediatr Orthop. 1993;13(2):259–62.Google ScholarPubMed
Witvrouw, E, Danneels, L, Thijs, Y, Cambier, D, Bellemans, J. Does soccer participation lead to genu varum? Knee Surg Sports Traumatol Arthrosc. 2009;17(4):422–7.Google Scholar
Thijs, Y, Bellemans, J, Rombaut, L, Witvrouw, E. Is high-impact sports participation associated with bowlegs in adolescent boys? Med Sci Sports Exerc. 2012;44(6):993–8.Google Scholar
Jafarnezhadgero, AA, Shad, MM, Majlesi, M, Granacher, U. A comparison of running kinetics in children with and without genu varus: a cross sectional study. PLoS One. 2017;12(9):e0185057.Google Scholar
Ciaccia, MCC, Pinto, CN, da Costa Golfieri, F, et al. Prevalence of genu valgum in public elementary schools in the city of Santos (SP), Brazil. Rev Paul Pediatr. 2017;35(4):443–7.Google Scholar
Woo, K, Lee, YS, Lee, W-Y, Shim, JS. The efficacy of percutaneous lateral hemiepiphysiodesis on angular correction in idiopathic adolescent genu varum. Clin Orthop Surg. 2016;8(1):92.Google Scholar
Farr, S, Alrabai, HM, Meizer, E, Ganger, R, Radler, C. Rebound of frontal plane malalignment after tension band plating. J Pediatr Orthop. 2018;38(7):365–9.CrossRefGoogle ScholarPubMed
Park, SS, Kang, S, Kim, JY. Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity. Bone Joint J. 2016;98-B(9):1270–5.Google Scholar
Bleck, EE. Metatarsus adductus: classification and relationship to outcomes of treatment. J Pediatr Orthop. 1983;3(1):29.Google Scholar
Ponseti, IV, Becker, JR. Congenital metatarsus adductus: the results of treatment. J Bone Joint Surg Am. 1966;48(4):702–11.Google Scholar
Eamsobhana, P, Rojjananukulpong, K, Ariyawatkul, T, Chotigavanichaya, C, Kaewpornsawan, K. Does the parental stretching programs improve metatarsus adductus in newborns? J Orthop Surg. 2017;25(1):230949901769032.Google Scholar
Herzenberg, JE, Burghardt, RD. Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis. J Orthop Sci. 2013;19(2):250–6.Google Scholar
Hossain, M, Davis, N. Evidence-based treatment for metatarsus adductus. In: Alshryda, S, Huntley, JS, Banaszkiewicz, PA, eds. Paediatric Orthopaedics: An Evidence-Based Approach to Clinical Questions. Cham: Springer; 2016. pp. 5175.Google Scholar
Pentz, AS, Weiner, DS. Management of metatarsus adductovarus. Foot Ankle. 1993;14(5):241–6.Google Scholar
Feng, L, Sussman, M. Combined medial cuneiform osteotomy and multiple metatarsal osteotomies for correction of persistent metatarsus adductus in children. J Pediatr Orthop. 2016;36(7):730–5.Google Scholar
Cahuzac, JP, Laville, JM, de Gauzy, JS, Lebarbier, P. Surgical correction of metatarsus adductus. J Pediatr Orthop. 1993;2(2):176–81.Google Scholar
Knorr, J, Soldado, F, Pham, TT, Torres, A, Cahuzac, JP, de Gauzy, JS. Percutaneous correction of persistent severe metatarsus adductus in children. J Pediatr Orthop. 2013;34(4):447–52.Google Scholar
Napiontek, M, Kotwicki, T, Tomaszewski, M. Opening wedge osteotomy of the medial cuneiform before age 4 years in the treatment of forefoot adduction. J Pediatr Orthop. 2003;23(1):65–9.Google Scholar
Staheli, LT, Corbett, M, Wyss, C, King, H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg. 1985;67(1):3947.CrossRefGoogle ScholarPubMed
Fabry, G, MacEwen, GD, Shands, AR, Jr. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am. 1973;55(8):1726–38.Google Scholar
Kong, M, Jo, H, Lee, CH, Chun, S-W, Yoon, C, Shin, H. Change of femoral anteversion angle in children with intoeing gait measured by three-dimensional computed tomography reconstruction: one-year follow-up study. Ann Rehabil Med. 2018;42(1):137.CrossRefGoogle ScholarPubMed
Karol, LA. Rotational deformities in the lower extremities. Curr Opin Pediatr. 1997;9(1):7780.Google Scholar
Eckhoff, DG, Kramer, RC, Alongi, CA, VanGerven, DP. Femoral anteversion and arthritis of the knee. J Pediatr Orthop. 1994;14(5):608–10.Google Scholar
Staheli, LT, Clawson, DK, Hubbard, DD. Medial femoral torsion. Clin Orthop Relat Res. 1980;Jan–Feb(146):222–5.Google Scholar
Nelitz, M. Femoral derotational osteotomies. Curr Rev Musculoskelet Med. 2018;11(2):272–9.Google Scholar
Yang, JS, Dobbs, MB. Treatment of congenital vertical talus: comparison of minimally invasive and extensive soft-tissue release procedures at minimum five-year follow-up. J Bone Joint Surg Am. 2015;97(16):1354–65.Google Scholar
Rome, K, Ashford, RL, Evans, A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;7:CD006311.Google Scholar
Evans, AM, Rome, K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med. 2011;47(1):6989.Google Scholar
Kothari, A, Bhuva, S, Stebbins, J, Zavatsky, AB, Theologis, T. An investigation into the aetiology of flexible flat feet. Bone Joint J. 2016;98-B(4):564–8.Google Scholar
Carr, JB, Yang, S, Lather, LA. Pediatric pes planus: a state-of-the-art review. Pediatrics. 2016;137(3):e20151230.Google Scholar
Kanatlı, U, Aktas, E, Yetkin, H. Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet? J Orthop Sci. 2016;21(5):662–6.Google Scholar
Wenger, DR, Mauldin, D, Speck, G, Morgan, D, Lieber, RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. 1989;71(6):800–10.Google Scholar
Dars, S, Uden, H, Banwell, HA, Kumar, S. The effectiveness of non-surgical intervention (foot orthoses) for paediatric flexible pes planus: a systematic review: update. PLoS One. 2018;13(2):e0193060.Google Scholar
Mosca, VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4(2):107–21.Google Scholar
Metcalfe, SA, Bowling, FL, Reeves, ND. Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot Ankle Int. 2011;32(12):1127–39.CrossRefGoogle ScholarPubMed
Ford, SE, Scannell, BP. Pediatric flatfoot. Foot Ankle Clin. 2017;22(3):643–56.Google Scholar
Suh, DH, Park, JH, Lee, SH, et al. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. Int Orthop. 2019;43(5):1179–92.Google Scholar
Indino, C, Villafañe, JH, D’Ambrosi, R, et al. Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot: a retrospective cross-sectional study with final follow up at skeletal maturity. Foot Ankle Surg. 2020;26(1):98104.Google Scholar

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