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
Dominik Lawniczak 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 Proximal femur 15% Distal femur 37% Proximal tibia 28%
cm/yr
0.6
1.2
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

11. Flat feet: Jack’s test

12. Flat feet ; red flags
Pain
Stiffness
Peroneal spasm

13. Stiff

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

15. Flat feet: tarsal coalition

16. Stiff

18. 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

19. Intoeing Persistent femoral anteversion Tibial torsion
aka femoral torsion
Tibial torsion
Metatarsus adductus

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

21. Intoeing: examination

22. Intoeing: examination

24. Intoeing

25. Intoeing: W position

26. 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

29. Metatarsus adductus

30. Bow legs

32. Bow legs

33. Salenius and Vankka

34. Bow legs

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

38. Bow legs: Blount’s