pediatric lower extremities development

Question 1

lower extremity position at birth

Answer 1

hip is flexed and laterally rotated, knees are in varum and tibia is internally rotated, and feet are flat, flexible, mobile, and the forefoot is often adducted

Question 2

when do children’s arches start developing

Answer 2

when they start standing and walking, really around ages 2-3

Question 3

hip flexion contracture for babies

Answer 3

is present at birth and masks the high degree of femoral anterversion

Question 4

what does the typical arch of a foot start to develop?

Answer 4

around 8 years

Question 5

do children with flat feet need treatment?

Answer 5

most often no, most will outgrow them without treatment and even as an adult this is normal

Question 6

genu varum meaning

Answer 6

tibia angles medially and knees point outwards

Question 7

genu valgum meaning

Answer 7

tibia angles laterally and knees point in

Question 8

when is genu varum present?

Answer 8

at birth

Question 9

when are tibia neural?

Answer 9

2 years and again as adolescents and adults

Question 10

when is genu valgum present?

Answer 10

3-4 years

Question 11

another name for in-toeing

Answer 11

pigeon toeing

Question 12

in-toeing

Answer 12

is common in children and can point towards neurological factors but often not

Question 13

three main causes of in-toeing

Answer 13

metatarsus adductus, internal tibial torsion, and femoral anteversion

Question 14

metatarsus adductus

Answer 14

is the medial deviation of the forefoot at the tarsometatarsal joints and causes a C-shaped or bean shaped foot

Question 15

is metatarsus bilateral and unilateral

Answer 15

about an even mix of both

Question 16

hindfoot in metatarsus adductus

Answer 16

is neutral

Question 17

heel bisector line in normal feet

Answer 17

through the 2nd webspace

Question 18

mild metatarsus adductus heel bisector line

Answer 18

through the 3rd toe

Question 19

moderate metatarsus adductus heel bisector line

Answer 19

through the 3-4th webspace

Question 20

severe metatarsus adductus heel bisector line

Answer 20

through the 4th or 5th toe

Question 21

flexible metatarsus adductus

Answer 21

the foot passively abducts past normal

Question 22

semi-flexible metatarsus adductus

Answer 22

passible abducts to neutral

Question 23

rigid metatarsus adductus

Answer 23

foot cannot reach neutral

Question 24

metatarsus adductus treatment

Answer 24

most resolve spontaneously within 6-12 months, but other options are at home stretching, serial casting if rigid, or surgery if servere

Question 25

tibial torsion

Answer 25

is intraosseous twisting of the tibial on its long axis

Question 26

tibial torsion at birth

Answer 26

is internal and gradually decreases with age; becomes more noticeable when toddlers start walking

Question 27

tibial torsion at age 8

Answer 27

is external followed by very little change after this point

Question 28

how do you notice tibial torsion

Answer 28

the feet point inwards and the patellae face forward

Question 29

how to measure internal tibial torsion?

Answer 29

the thigh-foot angle which is between the longitudinal axes of the thigh and foot (this reflects the tibial torsion and hindfoot position); measured in prone with knee flexed at 90 degrees and foot in 90 degree dorsiflexion

Question 30

management of internal tibial torsion

Answer 30

education, reassurance, twister cables, orthotics, shoe modifications, gait drills, and in severe cases surgery

Question 31

when does internal tibial torsion usually improve by?

Answer 31

ages 4-8

Question 32

angle of femoral anteversion at birth

Answer 32

35-40 degrees

Question 33

femoral anteversion at age of skeletal maturity

Answer 33

10-15 degrees

Question 34

what is femoral anteversion?

Answer 34

is an inward twisting of the hip due to the larger angle formed between the femur neck and the femur condyle

Question 35

what does femoral anteversion present as?

Answer 35

in toeing gait with patellae and feet pointing inward

Question 36

signs of femoral anteversion

Answer 36

increased tripping, windmill running, and W-sitting

Question 37

what population is femoral anteversion seen more often in?

Answer 37

females

Question 38

how to measure femoral anteversion?

Answer 38

craig's or trochanteric prominence test, which measures in prone with knees at 90 degrees and palpates the greater trochanter at most lateral position, then measures the tibia to vertical angle to approximate femoral anteversion

Question 39

what does femoral anteversion look like in prone?

Answer 39

increased hip internal rotation and decreased hip external rotation

Question 40

management of femoral anteversion

Answer 40

usually improves throughout late childhood and surgery in severe cases

Question 41

when would surgery be used for femoral anteversion?

Answer 41

after ages 8-12 and if rotation is less than 50 degrees

Question 42

when does femoral anteversion usually normalize?

Answer 42

around 10-12

Question 43

W-sitting

Answer 43

is often associated with in-toeing and should resolve over time; not associated with developmental dysplasia of the hip

Question 44

most common causes of in-toeing during birth to first year

Answer 44

metatarsus adductus and tibial torsion

Question 45

most common cause of in toeing during walking to three years

Answer 45

internal tibial torsion

Question 46

most common cause of in toeing during >3 years age

Answer 46

femoral anteversion

Question 47

childrens muscles with neuromuscular conditions

Answer 47

have less strength and coordination compared to typically developing children

Question 48

out-toeing

Answer 48

is less common and due to either femoral retroversion (quite rare), external tibial torsion, or flat feet; this is more likely to be pathological

Question 49

external tibial torsion

Answer 49

can cause out-toeing and does not improve with development

Question 50

what would you look for in a child with out-toeing

Answer 50

pain or asymmetry