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Lower limb problems in children- physiotherapy referral guide

Parents often consult GP’s regarding lower limb problems in young childre. This guide from Oxford University Hospital NHS Trust would help you manage such situations better and refer / reassure concerned parents.

Reproduced on A4Medicine for educational purposes

Flat Feet (Pes Planus)
Babies starting to stand, toddlers and young children may have flat
feet. It is a normal developmental foot posture and the medial arch of
the foot may not develop until 5-6 years. The whole of the medial side
of the foot may be in contact with the floor. There may be a degree of
heel valgus. Falling over is very common in the under 4’s and does
not require referral. Back Pain in young Children & Adolescents
It is common for children/adolescents to suffer with back pain at some
point in their development. Most symptoms are caused by postural dysfunction or musculo-skeletal ‘mechanical’ problem. (Tight hamstrings,
over-use of smart phone/tablet). Curly Toes
Congenital curly toes tend to affect the 3rd, 4th and 5th toes of one or
both feet. They tend to become more noticeable with the onset of
walking. Curly toes are often caused by intra-uterine moulding and
are usually flexible. They generally do not cause any gait problems. Tip Toe Walking
Toe walking is only normal as a transient phase in the early weeks of
walking independently. It should last no more than 3 – 6 months.
Long-term toe walking can cause the fore-foot to broaden, and the calcaneus to be under-developed, which leads to issues with finding footwear to fit and often pain/arthritis in later life.Genu Valgum
Normal variant in children from 2 – 4 years old. In this age group, in
standing, an inter-malleolar distance of 8cm is considered normal. It
should self-correct by 6 – 7 years of age.In-toeing
The child should have a well-established gait before this can be assessed, as it will often reduce with time. Out-toeing
Normal variant. May be associated with knock knees and flat feet. Genu Varum
• Ensure not Tibial bowing or internal tibial torsion.
• Normal variant (see image) & will change to valgus by 31/2 years.
• Common in certain races.
• Can be associated with obese/overweight babies/toddlers & early



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