Lower Extremity Abnormalities in Children - American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 461 diagnosis. Table 2 includes important aspects to obtain when evaluating a child with a lower extremity problem. Physical examination should include assessment of height and weight. Normal size for age makes pathologic conditions (e.g., hypophosphatemic rickets, metabolic bone disease) unlikely. The spine should be examined for scoliosis, hairy P arents often seek medical advice about lower extremity appearance in their children. In most cases, the complaint is a variation of normal growth and development, and the problem resolves without treatment as the child grows. Common variations include rotational problems (intoeing, out-toeing) and angular problems (genu varum [bowlegs], genu valgum [knock-knees]). The normal range of rotation of the foot, leg, and hip includes measurements that fall within two standard deviations of the mean. A variation becomes a deformity when the amount of deviation from normal for that particular age is more than two standard deviations. For example, normal external hip rotation for a five-year-old child is between 30 and 65 degrees. Those with hip rotation values outside this range are said to have a deformity. A careful history and physical examination are all that are necessary to determine whether a complaint requires further evaluation.