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By 7 spontaneous correction
To the normal of adult valgus ( 8°♀ and 7°♂)
Persistent genu varum
• Worried parents
• Assessment:
- History
- etiologic factors
Examination
• Height
• Site of varus
Causes
• Lateral ligament laxity
• Blount’s disease
• Congenital pseudoarthrosis of tibia
• Coxa vara
In ligamentous laxity notelat.Widening In Blount angulation at med.tib
Of knee joints metaphysis
In cong. Pseudarthrosis of tibia,the In coxa vara ,angulation at the neck shaft
angulation is in the distal ⅓ level
• Gait: intoeing, lateral thrust-the fibular head and
upper tibia shift laterally in Blount due to laxity and
incompetence of the lat. Collat. Lig.
• Stability
• Symmetry
• Level of fibular head, normally at the level
of the upper tibial growth plate, while it is proximal
in Blount, cong.longitudinal dificiency of the tibia
and achondroplasia
X-ray
Metaphysial/diaphysial
angle ≥ 18°
Finding
• In physiologic genu
varum no intrinsic bone
disease, gentle curve, medial
cortices thickening, horizontal
joint lines of the knee & ankle are
tilted medially
Knock Knees / Genu Valgum
• Developmental
• Miscellaneous syndromes e.g Rickets (Alk Phos
raised, with x-ray changes)
• Rare Genetic disorders e.g Cohen Syndrome
• Nutritional conditions e.g Vitamin C deficiency
• Autoimmune e.g RA
• Degenerative e.g OA
When to refer
• Age > 7 with knock knee
• Unilateral problem i.e Asymmetry of legs
• Intermalleolar distance > 3.5 inches (9 cms)
• Associated symptoms e.g Pain, Limp
Treatment
• No evidence that shoe modification, splints, or
exercises affect condition
• No evidence to justify surgical intervention
under 6 inches of intermalleolar separation.
• Surgical options:
Medial epiphyseal stapling at 10 to 11
years
Corrective osteotomy at maturity.
Flat Feet / Pes Planus
• Arch of the foot is low.
Medial arch is lost.
There may be some
valgus and eversion
deformity of the foot.
Normal Development
• Flat feet are normal
when learning to walk.
• Medial arch does not
develop until 2nd / 3rd
year of life.
• Normal arch functions
as a shock absorber.
Investigation
• Ask patient to stand on
tiptoes.
• If medial arch restores
itself when standing on
tiptoe or when foot is
unloaded, no action is
needed.
Presentations
• 2 Groups: