Page 123 - ASOP ROT Study Guide

B. ORTHOPAEDIC CONDITIONS OF CHILDHOOD

6. INTRODUCTION

Some childhood conditions of the musculoskeletal system are common and are not serious. Other
conditions, which fortunately are rare, are serious and have very major consequences for the child and
the family.

7. MINOR PROBLEMS

7 . 1 Walking and Posture Problems

Children are often sent to an orthopaedic clinic because of parental anxiety about how, or when, children
walk and stand. During normal development we expect children to reach a certain milestone at a
certain age. The average child normally sits independently by the age of nine months, stands by a
year and walks by twenty months. However, there is a lot of variation in normal development, and
parents should be reassured that if their child does not reach a certain milestone by a certain age, this
is not a sinister sign. Very occasionally failure to achieve milestones will portend a serious problem
but these are rare cases.

When children start to walk their gait takes many months to mature and so minor variations are to be
expected.

Common, but minor, abnormalities include:

♦ Knock knees and bow legs
♦ In-toeing
♦ Flat feet
♦ Curly toes

7 . 1 . 1 Knock knees

Knock knees or genu valgum and bow legs or genu varum are frequently seen. These conditions are
rarely, if ever, serious. The normal alignment of the knee is in valgus and when a child stands to attention
there is normally a gap of 4cm or so between the feet. If this gap is diminished the knees are in varus,
and if it is increased they are in valgus. By the age of seven, nearly all children with these conditions will
have developed a normal knee alignment.