2025 – PAGE 414 – ORTHOPEDICS AND SPORTS MEDICINE

2025 – Core Study Guide 24 – Orthopedics and Sports Medicine 2025 – PAGE 414 – ORTHOPEDICS AND SPORTS MEDICINE

GENU VALGUM (AKA KNOCK-KNEES)

Genu valgum (AKA knock-knees) is normal for children 2-5 years of age. Refer to ortho if genu valgum is noted outside of that age range, if the tibiofemoral angle is >15 degrees, if the valgus deformity is unilateral/asymmetric, or if it is worsening after the child turns 4 (instead of improving).

GENU VARUM (AKA BOWED LEGS)

Genu varum (AKA bowed legs) is not the same thing as intoeing. Most babies are born this way. This is usually physiologic, so you can reassure parents that it will resolve by 2 years of age. In physiologic varus, both legs are bowed at a tibiofemoral angle within two standard deviations of the mean for age. Usually both the femurs and the tibias are bowed, the bowing is symmetric, and the stature is normal. It is pathologic if it is unilateral, WORSE after 1 year of age, or presents after age 2.

IMAGE: www.pbrlinks.com/GENUVARUM1

RICKETS

Please see the endocrine section for extensive discussion of Rickets.

BLOUNT DISEASE

Children with Blount disease have abnormal growth of the medial epiphysis of the proximal tibia. This is much more common in African Americans.

  • PEARL: Especially consider this diagnosis if you see a patient with bowed legs and a fracture. Look at the X-ray to see if the proximal, medial aspect of the tibia looks odd, and if that leg is bowed.
  • PEARL: Blount disease gets worse, not better.
  • IMAGE: www.pbrlinks.com/BLOUNT1
  • INFANTILE BLOUNT DISEASE: Usually symmetric. You’ll need to differentiate from genu varum and treat early. This is usually diagnosed by 4 years of age. The patient can use BRACES first by about 3 years of age, but if that doesn’t work then do SURGERY by 4 years of age to prevent recurrence.
  • ADOLESCENT BLOUNT DISEASE: Usually in kids over 10 years of age. Look for an overweight African American patient. Treat with surgery.

INTOEING

The causes of intoeing include tibial torsion, femoral anteversion, and metatarsus adductus. All are discussed below.

  • PEARL: PICK REASSURANCE FOR A CHILD WITH INTOEING!
  • TIBIAL TORSION: Noted in Toddlers around Two years of age. Most common reason for intoeing. Usually benign and resolves by 5–6 years of age. Treat with reassurance!
  • FEMORAL ANTEVERSION:Newborns can be born with this because of their positioning in the womb. This is caused by too much internal rotation of the femur and not enough external rotation at the hip. Patients can sit in a W style. It’s about 30–40 degrees at birth but decreases to about 15 degrees by 8–10 years of age (# of degrees is low-yield). If it persists beyond 8–10 years of age, it’s considered pathologic.
  • METATARSUS ADDUCTUS(AKA HOOKED FOOT): Noted in infancy because of an anatomic bend in the foot. In most cases, the problem corrects without intervention. A cast or surgery is sometimes required.
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