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Angular ‘Deformities’ of Lower limbs


Physiological Genu Valgum

  • Normal development of tibiofemoral angle with age

Presentation - Usually at 'cruising’age

Symptoms - Parents notice bowlegs, intoeing

 History

Ask about dietary deficiency, Family history, rate of progression

Examination:

  • Look generally for obvious signs of rickets, (Short stature, rickety rosary etc)

  •  

    Measure distance between medial femoral condyles with medial malleoli touching, and patellae facing forwards

  • Where does mechanical axis fall from ASIC?

Investigation:

  • No Xray necessary till at least 18mnths of age, unnecessary worrying

  •  

    Transverse planes of knee and ankle joint tilted medially

  • Bilateral

    epiphyses, physis and metaphysis normal

Pathological conditions causing varus deformity of the legs:

1.

Metabolic bone disease      

  • Vit D deficiency

  • Vit D refractory rickets

  • Hypophosphatasia

2.

Assymmetrical growth arrest or retardation

3.

Bone dysplasia

  • Metaphyseal dysplasia

  • Dwarfism

  • Enchondromatosis

4.

Metal intoxication

  • Fluoride in pregnancy

5. Congenital

  • Deficient tibia with relatively long fibula



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