Common Lower Extremity Problems in Children

Objectives

After completing this article, readers should be able to:

1. Describe the presentation of hip joint pathology in children.

2. Know how to treat most rotational and angular deformities.

3. Describe the hallmark of clubfoot that helps to differentiate it from isolated metatarsus adductus.

4. Explain why screening for developmental dysplasia of the hip should be performed.

5. Describe foot problems that can be markers for a neurologic disorder.

Overview

Growing children are susceptible to a variety of developmental lower extremity disorders of varying degrees of seriousness. Because children are growing and developing and are not simply smaller versions of adults, it can be difficult to treat some conditions, but in other cases, there is leeway in the results of treatment not available to adults. Long-term outcome is of utmost importance for pediatric patients because their bones, joints, and muscles optimally should remain functional and pain-free during childhood and throughout their lives. Treatment should disrupt daily life as little as possible to minimize the social and psychological toll of the illness.

Common lower extremity problems in children can be grouped broadly into four categories: rotational deformities, angular deformities, foot deformities, and hip disorders. This article covers the major conditions in each group. Pediatricians and other primary care clinicians can expect to encounter these disorders in their practices. A working knowledge of the basics of these disorders will help in appropriate diagnosis, treatment, counseling, and referral of patients.

Rotational Deformities

The developmental rotational deformities, intoeing and outtoeing, probably are the most common childhood musculoskeletal entities that prompt parents to consult a physician. Because intoeing is more common than outtoeing, the chief complaint generally is that the child is “pigeon-toed” or that his or her “feet turn in” when he or she stands, walks, or runs. Often, the parents express concern that the pigeon-toeing is leading to falls, and they …