BIOLOGY 2F03 Lecture Notes - Lecture 23: Genu Valgum, Genu Varum, Flat Feet
19 May 2018
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Variations of normal posture
• Bow legs (genu varum)
o Bowing of the tibiae causing knee to be wide apart
o Common in 0-3yrs, no need for Rx
• Knock-knees (genu valgum)
o Feet are wide apart when knees held together. Seen in 2-7yrs, usually resolves.
• Flat feet (pes planus)
o Toddlers learning to walk have flat feet, due to flat medial longitudinal arch + fat pad
o Marked flat feet can be a presentation of a collagen disorder e.g. Ehlers-Danlos syn
o Rx with exercises, arch support in shoes, surgery for symptomatic adolescent
• In-toeing
o 3 main causes:
▪ Metatarsus varus: an adduction deformity of a highly mobile forefoot
▪ Medial tibial torsion: at lower leg when tibia is laterally rotated less than normal
▪ Persitent anteversion of the femoral neck: at the hip when femoral neck is twisted forward
more than normal
• Out-toeing
o Uncommon, but may occur in infants between 6-12 months
o When bilateral it is due to lateral rotation of the hips and resolves spontaneously
• Toe walking
o Common in 1-3yrs. If persisting: CP, tight Achilles tendons, Duchees Muscular Dstroph
DDH (Developmental Dysplasia of the Hip)
• At risk babies:
o Breech
o Caesarean for breech
o BW
o Older mother
o +ve FHx
o Postmaturity
o Other malformations
o Oligohydramnios
• Diagnosis: examine hips at day 1 and at 6 wks.
o click test of Ortolani:
o Barlow manoeuvre
• US: image of choice.
• Rx:
o Positioning device in abduction (Craig splint)
o Restraining device (Pavlik harness)
Club foot (talipes equinovarus)
• Positional talipes from intrauterine compression is common. Foot is normal size, deformity is mild and
can be corrected to the neutral position with manipulation.
• Talipes equinovarus is a complex abnormality.
1. Inversion
2. Adduction of forefoot relative to hindfoot
3. Equinus (plantar flexion)
o 2x more common in males
o Rx: start in 1st wk with foot manipulation, strapping and splinting. If Rx not worked after 3 months
operative reduction is carried out.
Juvenile chronic arthritis
• Now called Juvenile idiopathic arthritis = a group of conditions where arthritis for > 6wks in kids under
16yrs.
find more resources at oneclass.com
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Document Summary
Bow legs (genu varum: bowing of the tibiae causing knee to be wide apart, common in 0-3yrs, no need for rx. Knock-knees (genu valgum: feet are wide apart when knees held together. If persisting: cp, tight achilles tendons, duche(cid:374)(cid:374)e(cid:859)s muscular d(cid:455)stroph(cid:455) At risk babies: breech, caesarean for breech, bw, older mother, +ve fhx, postmaturity, other malformations, oligohydramnios, diagnosis: examine hips at day 1 and at 6 wks, click test of ortolani, barlow manoeuvre, us: image of choice. Rx: positioning device in abduction (craig splint, restraining device (pavlik harness) Foot is normal size, deformity is mild and can be corrected to the neutral position with manipulation. Talipes equinovarus is a complex abnormality: inversion, adduction of forefoot relative to hindfoot, equinus (plantar flexion, 2x more common in males, rx: start in 1st wk with foot manipulation, strapping and splinting. If rx not worked after 3 months operative reduction is carried out.
