Orthopedic assessment of young children: developmental variations

Parents often seek orthopedic evaluation of their young children because of apparent abnormalities. However, many of these are simply developmental variations that are part of normal growth and development. Pes planus, or flat foot, is one of the earliest and most common concerns. Torsional variations are also often seen; the presenting complaint may be intoeing (metatarsus adductus, tibial torsion and increased femoral anteversion) or out-toeing (pes calcaneovalgus and external rotation contractures of the hips). Angular variations (genu varum and genu valgum) are also seen frequently in young children. In assessing each finding, consideration must be given to the age at which the finding may be considered within normal limits, methods of examination and documentation, the expected course, findings that may signify abnormality, and appropriate follow-up and referral. An understanding of these common developmental variations in the orthopedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling.