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Understanding Normal and Abnormal Growth in Paediatric Orthopaedics

Learn about normal growth patterns, flat feet variations, intoeing conditions, bow legs, and their differentials, examinations, and management in paediatric orthopaedics.

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Understanding Normal and Abnormal Growth in Paediatric Orthopaedics

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  1. Normal and abnormal in Paediatric Orthopaedics; what should we do James Hunter Nottingham

  2. Clinics and Team • Kathryn Price Monday KRP1B • James Hunter Tuesday JBH2B • DominikLawniczak Tuesday DL22B • Julian Chell Thursday JC34B • Hip instability Tuesday • Mark Batt Friday MEB5P • Physio Clinic Friday JBH5P

  3. Normal Growth • Growth is predictable • Boys half adult height aged 2 • Tanner and Whitehouse • Legs half adult length age • 3 for girls • 4 for boys (Paley)

  4. Leg growth cm/yr 0.6 1.2 0.7 0.7 • Proximal femur 15% • Distal femur 37% • Proximal tibia 28% • Distal tibia 20%

  5. Normal Variation

  6. Flat feet • Flexible flat feet are normal • 90 % at age 1 • 20 % of adults • Associated with generalised laxity • Doesn’t all “get better”

  7. Flat feet

  8. Flexible

  9. Flat feet: Jack’s test

  10. Flat feet ; red flags • Pain • Stiffness • Peroneal spasm

  11. Stiff

  12. Flat feet; differential • Infection • Inflammation eg arthritis • Tarsal coalition • Tumours

  13. Flat feet: tarsal coalition

  14. Stiff

  15. Flat feet: management • Flexible flat feet are normal • Orthotic if painful retain if effective • First orthotic from shop or internet • Treat other conditions on merit

  16. Intoeing • Persistent femoral anteversion • aka femoral torsion • Tibial torsion • Metatarsus adductus

  17. Intoeing: examination • Foot progression angle • Range of hip movement • Thigh-foot angle • Inter-malleolar angle • Foot curvature (from below)

  18. Intoeing: examination

  19. Intoeing: examination

  20. Intoeing

  21. Intoeing: W position

  22. Intoeing: management • Advice • Torsional differences do not • Reduce athletic performance • Lead to degenerative changes • Metatarsus adductus mostly resolves if flexible • The only definitive management is osteotomy • Bracing stresses joints

  23. Metatarsus adductus

  24. Bow legs

  25. Bow legs

  26. Salenius and Vankka

  27. Bow legs

  28. Bow legs • Red flags • Unilateral • Progressive after age 3 • Blount’s is physiological varus gone wrong • Common in • Overweight • Early walkers • US black population

  29. Bow legs: Blount’s

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