Lower Limb Development

Question 1

When is a deformity significant?

Answer 1

If it is likely to persist or cause physical or mental problems later in life

Question 2

Bones start as what?

Answer 2

Cartilage

Question 3

Bones grow longitudinally from where? How?

Answer 3

From the growth plate (physis) by endochondral ossification

Question 4

Bones grow circumferentially from where?

Answer 4

Periosteum

Question 5

What are some factors influencing the growth plate?

Answer 5

Diet/nutrition, sunshine and vitamin D, injury/illness, hormones

Question 6

If a child has a short stature, what other factor may increase suspicion of an endocrine or genetic disorder?

Answer 6

Dysmorphic features

Question 7

When is it normal for a child to sit alone, crawl?

Answer 7

6-9 months

Question 8

When is it normal for a child to stand?

Answer 8

8-12 months

Question 9

When is it normal for a child to walk?

Answer 9

14-17 months

Question 10

Children at birth usually have what kind of knees? When does this correct?

Answer 10

Usually varus, aligns at 14 months

Question 11

After the genu varum from birth has aligned at 14 months, what happens?

Answer 11

Progress to 10-15 degrees valgus at age 3

Question 12

What is the normal physiological position of the knees? At what age will this be settled?

Answer 12

6 degrees of valgus, 7-9 years

Question 13

What is genu varum?

Answer 13

Bowing of the knees

Question 14

What is genu valgum?

Answer 14

Knock knees

Question 15

What defines pathological varus/valgus?

Answer 15

+/- 6 degrees from the mean value for the age

Question 16

Some people develop minor varus/valgus which can be what?

Answer 16

Familial

Question 17

Genu varum is normally below what age?

Answer 17

< 2

Question 18

What are some indicators of underlying pathology in a child with genu varum?

Answer 18

Unilateral, > 2SDs from mean, painful, very short stature

Question 19

Genu varum will result in a large gap between where?

Answer 19

The knees

Question 20

What are some pathological causes of genu varum?

Answer 20

Skeletal dysplasia, rickets, tumour, Blount’s disease, trauma causing physical injury

Question 21

What is Blount’s disease?

Answer 21

The growth arrest of the medial tibial physis with unknown aetiology

Question 22

What tumour is most likely to cause genu varum?

Answer 22

Osteochondroma

Question 23

If a case of genu varum/valgum is still present by what age, they may require surgery?

Answer 23

10

Question 24

Genu valgum will cause a large gap between where?

Answer 24

The ankles (inter-malleolar distance)

Question 25

What are some pathological causes of genu valgum?

Answer 25

Tumours, rickets, neurofibromatosis, idiopathic

Question 26

What tumour is most likely to cause genu valgum?

Answer 26

Enchondroma

Question 27

When should you refer a child with genu valgum?

Answer 27

If it is asymmetrical, painful or inter-malleolar distance is > 8cm

Question 28

Parents may notice what about children with intoeing?

Answer 28

They may be clumsy and wear through shoes very quickly

Question 29

When is intoeing accentuated?

Answer 29

When the child runs

Question 30

What conditions may intoning be associated with?

Answer 30

Femoral neck anteversion, internal tibial torsion, metatarsus adductus

Question 31

The femoral neck normally points slightly anterior, but in femoral neck ante version there is increased what?

Answer 31

Internal rotation of the hip

Question 32

Femoral neck anteversion can give the appearance of what?

Answer 32

Genu valgum and intoeing

Question 33

Femoral neck anteversion is normally of no consequence, but can predispose to what?

Answer 33

Patella-femoral problems

Question 34

What happens in internal tibial torsions? This is seen in who? It should resolve by what age?

Answer 34

The tibia is inwardly rotated, seen in toddlers, should resolve by age 6

Question 35

Metatarsus adductus usually resolves with age, but if not by age 6-12 months what may help?

Answer 35

Casting

Question 36

We are born with flat feet, what usually develops and when?

Answer 36

We develop a medial arch once we start walking as the tibialis posterior stretches

Question 37

What are flexible flat feet?

Answer 37

A medial arch will form with dorsiflexion of the great toe, flat footedness may only be present on weight bearing

Question 38

What may flexible flat feet be related to?

Answer 38

Ligamentous laxity (though can be familial or idiopathic)

Question 39

What is rigid flat feet?

Answer 39

The arch remain flat regardless of load or great toe dorsiflexion

Question 40

What does rigid flat feet imply?

Answer 40

Underlying bony abnormality e.g. tarsal coalition which may need surgery

Question 41

Curly toes normally resolves by what age? If they persist what can they cause?

Answer 41

6 years, can cause flexor tenotomy

Question 42

Which sex is more knock kneed?

Answer 42

Females

Question 43

Anterior knee pain occurs in who?

Answer 43

Adolescents, especially female

Question 44

Where is the pain in anterior knee pain? When is it worst?

Answer 44

Localised patellar tenderness, worse on stairs or squatting

Question 45

What should you always check for if a child presents with knee pain?

Answer 45

Check the hips for SUFE

Question 46

Anterior knee pain is a type of what? What therapy may help?

Answer 46

Growing pain, can give physiotherapy but will go away