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Infant Leg Problems Often Resolve on Their Own.

NAPLES, FLA. -- Parents may be alarmed about a calcaneal valgus foot in their newborn but can be assured that it usually resolves without treatment, said Dr. Brett Shannon, an orthopedist at the Nemours Children's Clinic, Fort Myers, Fla.

Although calcaneus valgus (CV) feet look scary with the foot bent all the way back against the tibia, most are very flexible at the joint. If so, parents should have confidence.

"It has a wonderful reputation for spontaneous healing with no need for treatment. Reassure the parents that it will almost always be OK," Dr. Shannon said at a meeting of the Florida Academy of Family Physicians.

Most CV feet resolve by 9 months of age. If parents don't see progress toward a normal foot orientation by 12 weeks of age, a cast might be indicated to help with reorientation.

But a CV that is not flexible "can be trouble," he said. If the deviated foot can't be flexed easily down toward the normal position, an orthopedic consultation should be sought.

Posterior or medial bowing of the legs, often associated with CV feet, also resolves spontaneously in most infants. In some cases, limb-lengthening procedures may be needed to resolve the bowing.

But anterolateral bowing can be "an ominous sign." It's often due to pathologic fracture or diathesis and is often associated with neurofibromatosis. "If you see it in any kid, you're nervous. Consult an orthopedist," he said.

Dr. Shannon also reviewed these common pediatric orthopedic problems:

* Metatarsus Adductis. This deformity, caused by improper in utero positioning, is characterized by a medial crease and a curved lateral border of the foot. It is usually flexible and often resolves spontaneously. If no progress is seen at 12 weeks of life, corrective shoes often solve the condition.

Some cases of metatarsus adductis are stiff and should be corrected with shoes starting at 6 weeks, he said.

* Bilateral Congenital Club Feet. These deformities are usually stiff and require orthopedic intervention in the form of casting. Immediate casting is not necessary; outcomes are the same when a cast is applied immediately as when it is applied 4 days later.

"I let the parents go home and get their lives together first," he commented.

* Flat Feet. Flexible, asymptomatic flat feet can usually be left to watchful waiting. But if flat feet are stiff, "do x-rays, be aggressive in your work-up, and seek a consult," Dr. Shannon said.

Corrective shoes or inserts are generally reserved for cases in which flat feet are stiff or painful. Remind parents that arch development doesn't start until age 2 and generally doesn't get into full swing until age 5-7.

* Knock Knees. Known properly as genu valgum, this extremely common condition is often a concern to parents. Measure the angle formed by the femur and tibia. If it's less than 15 degrees, "you're safe. If not, you're in trouble," Dr. Shannon said.

In kids under 7 years of age, knock knees should be ignored unless the femorotibial angle is wider than 15 degrees or the legs are asymmetrical.

* Hip Dysplasia. This condition occurs in about 1 in every 1,000 births in North America. Firstborn, breech presentation girls with a family history are at highest risk.

A Barlow test is the best way to evaluate whether the femoral head and the socket have a proper fit. Try to provoke the hip into a posterior dislocation to see if the fit is right.

Many parents will be alarmed by hip clicks, but remind them that clicks are normal until a baby reaches 2 years of age. "Forty-seven percent of babies have them," Dr. Shannon said.
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Publication:Family Practice News
Date:Sep 1, 1999
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