Pediatrics Lecture Notes
intoeing- feet turned in. 0-30 degrees ok. Caused by femoral anteversion. Normally 40 degrees at birth and 15 at maturity.
Also caused by excessive anteversion of knees (knee turned in when sitting on floor). Do prone torsional profile exam to see how rotated hips are.
Normal Prone hip rotation up to 110 degrees.
90% of intoeing resolves by 8 yrs old by itself. Braces do not work. instead do surgical treatment like cut femur bone and untwist and fix w plates.
Internal tibial torsion..
Metatarsus adductus is congenital caus dof intoeing. Associated w hip dysplasia. Congenital calcaneal rx w serial casting. Use straight-last shoe.
Genu varum (bow legs)
Tibia Vera (bow leg in tibia)
Newborns have 15 degrees Bow legs on average but corrects itself by 20 months — physiologic genu Vera. Physiologic genu Valgum is knocked knees (knees together).
Infantile Blount’s (ITV) – infantile and late onset types. Caused by growth retardation. Risk factors are obese children. Etiology unknown. Rx w bracing if early to keep knee from stretching out earlier. Catch early bc risk of arthritis. Worse prognosis than late onset.
Congenital clubfoot. Ankle pointed down, heal inverted, and rigid (can’t bend back). Rule out neuropathy. Foot XR not needed for dx. Rx w serial casting. Long term bracing. Clubfoot is NEVER normal, even when u fix, can’t go back to complete normal.
Flexible flat feet – 15% of population, just a variation of normal. Arch matures by 3-7 yrs. if hurts, then rx. look for ligament laxity (flexible joints, so w weight, arch flattens out). Most of the time no problem and no rx necessary.
Rigid flat feet are always pathologic. Arch does not come back and subtalar motion is absent. Hurt if have vertical talus, causes reversal of arch – rocker bottom feet.
Hip dysplasia is when hip is loose at birth. Worst. Is dislocated irreducible. But most of time, is subluxable, and easily pushes out of socket once every while. Risk factors are breech position, family history,
Hip dysplasia (DDH) Dx w physical exsm first. Allis test. Then to confirm, you can get ultrasound if after 2 wks or radiograph if after 4 months. Rx w pavilion harness for 6-12 wks, adjusted q 2 wks. No triple diapers!!
Perthes Disease – idiopathic ostenonecrosis femoral head with open hip physis. Loss of circulation to ball of hip. Limited abduction and internal rotation of hip. Femoral head looks small and dense in radiograph. Same as leg cavay disease (?).
Slipped Capital Femoral Ephesis (SCFE) – hip thigh knee pain. 65% pt is obese boy. Don’t miss this!! Bc late dx cause High morbidity. Often missed. Usually outtoeing, limping, and can’t bear weight. Classified as stable vs unstable. Get AP pelvis XR, see unusually wide growth plate of femur. Also get frog lateral view of pelvis. Stable slip rx w percutaneous screw.