7 Common Normal

Variations
IN CHILDREN (caused by
Hypermobility of Joint/joint laxity)
Results from lax ligaments and extremely
common in infancy, less common in
childhood, and relatively uncommon in
adult life
Flexible Flat Feet
(Hypermobile Pes Planus)
As a result, the feet, being flexible, look
flat, but only with weightbearing. It
becomes obvious that the mild and
moderate degrees of this condition
require no treatment aart from reassuring
the arents. !or severe degree , the aim
of treatment is simly to revent further
stretching of the already lax ligaments of
the feet until such time as the
generali"ed ligamentous laxity imroves
sontaneously.
Knock Knees (Genu Valgum)
#y far the most common cause of knock
knees in young children is hypermobility
of the knee joints which, in turn, is simly
another manifestasion of generali"ed
$oint laxity. %onsequently this tye of
knock knee correct it self spontaneously in
more than 90% of children.
&he aims of treatment should be
simly to revent further stretching of
the already lax medial collateral
ligament. &he habitual osition of sitting
on the floor'television osition should be
avoided because it stretches these
ligaments further
&his common tye of knock knees, or
genu valgum, must be differentiated
from the much less common but more
serious tye of genu valgum that occurs
through bone secondary to an eihyseal
late disturbance from congenital
abnormalities, metabolic, in$ury.
Caused by Torsional Deformities
of Bones
&he affected long bone becomes twisted
in its long axis(that is, it develos either
an internal or an external torsional
deformity.(before birth, the hips always
flexed and externally rotated, whereas the
knees are usually flexed and the feet
turned in ward)
Toeing Out
Eternal !emoral Torsion
("ateral !emoral Torsion)
)xamination reveals that when the
extended lower limbs are rotated
outward(externally), the knees turn out
to about *+,, whereas when they are
rotated inward(internally), the knees can
be brought only to neutral osition
Rarely, in the older child, it may be
necessary to use a simle night slint in
which the feet are turned inward to
correct the residual external femoral
torsion.
Eternal Tibial Torsion ("ateral
Tibial Torsion#
Is rare, may aggravated the toeing out
caused by external femoral torsion, as
already mentioned- it may also
comensate to some extent for internal
femoral torsion
Toeing $n
$nternal !emoral Torsion (%edial
!emoral Torsion)
If the child subsequently acquires the
habit of sitting on the floor with the
knees in front, the femore internally
rotated, and the feet out to the side(the
W, television position), &he associated
.
torsional force on the growing femur
gradually roduces an internal femoral
torsion by the time the child is about /
years of age
&he aim of treatment is simly to
revent further internal torsional from
being exerted on the femora by sto
sitting 0 osition, training the child to
sit in the tailor or cross(legged osition-
for more severe and ersistent internal
femoral torsion in children older than 1
years of age, to use a specially designed
night splint
$nternal Tibial Torsion (%edial
Tibial Torsion#
0hen the knee is facing forward, the
foot is turned inward. 2ormally corrects
itself sontaneously with subsequent
growth, but if adots the habitual
osition slee on the knees or of sitting
on to of inturned feet, not only fail to
correct but also may increase over the
years.
&he aim of treatment is to revent
internal torsional forces from being
alied to the tibiae by training the child
to avoid the aforementioned harmful
osition of sleeing and sitting(mild
with night slint.
Bo& "egs (Genu Varum#
&he most common cause in children is
internal torsion and varus of the tibia along
with external torsion of the femur,
common tye is not simly the oosite
deformity of knock knees. 3abitual
osition of sleeing and sitting may be
increased.
4ore severe bow legs needs secially
designed corrective night splint to
influence eihyseal late growth and
threby correct the genu varum.
5ay braces for the bow legs are
ineffectual, and osteotomy of the tibial is
not necessary for this hysiological tye
of bow legs in young children.
NORMAL ARIA!ION" IN
AD#L!"
&he more severe degree of residual flat
feet, knock knees, and bow legs,
although relatively rare in adults, may
roduce symtoms because of remature
degenerative changes in the associated
$oints.
Normal 'ging (rocess in t)e
%usculoskeletal *ystem
%hanges of normal aging in the
musculoskeletal system include a
gradual decrease in $oint motion.
6ynovial $oint normally7last a lifetime7
in site of gradual thinning of articular
cartilage. %hondromalacia (softenig of
cartilage), however, is seen to some
extent in the atella of almost all adults
older than 8+ years of age. &here is
gradual decrease in the water content of
the intervertebra disc sace and in turn,
gradual decrease in body height during
the later decades of adult life
6enile osteoorosis (sine, femoral
neck, distal radius esecially suscetible
to fracture from minor in$ury- dorsal
kyhosis(round back)
It is imortant that you learn to
distinguish the normal (hysiological)
from the abnormal (athological) for
each age of human develoment so that
you may deal with them intelligently.
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Thurman.H.Silalahi/Residen Orthopaedic/FKUI
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