Limp

Limp without pain

Limp with pain

Clicky hip

Clicky hip is quite a common childrens' condition. In a recent survey of the Hip Screening programme, a detected incidence on neonatal screening of approximately 3% was found. The condition requires no treatment and will resolve in most cases by three months and, in nearly all cases, by a year. These children do not require to be seen in the specialist clinic unless there is some doubt that their hip is dislocatable. The cause is usually a vacuum effect as in clicking one's knuckles or due to a tendon clicking over a bony prominence on certain movements. It should only be referred if associated with other abnormal findings.

Primary treatment:

None.

Refer when:

Knock-knees

Genu valgum is a common deformity in children which rarely requires any treatment. It appears more marked in children with persistent femoral neck anteversion and an intoeing gait but generally does not require treatment.

Primary treatment:

None. (Could consider arch support if over 5 years)

Refer when:

Bandy legs

Genu varum deformities are also common in small children. They tend to be noted more often in children who are a little overweight and generally will resolve spontaneously and require no treatment. The rare condition of Blounts Disease may cause a more significant deformity but is usually asymmetrical. Even in this condition, treatment will tend to be deferred for as long as is reasonably possible.

Primary treatment:

None.

Refer when:

Intoeing gait

Intoeing is a common gait anomaly in children and is, in most cases, due to a degree of persistent femoral neck anteversion. This effectively means that there is a slight internal twist in the femur between the hip joint and the knee and it is usually the whole leg that is turned in. This is a condition that rarely needs treatment. There is occasionally an association with patellofemoral joint problems in teenage to young adult life and the most common indication for surgical intervention is psychological problems related to teasing at school. Surgery is occasionally offered for this condition and usually carried out around the age of nine or ten prior to the children moving up into middle school.

Primary treatment:

None.

Refer when:

Talipes equinovarus (club foot)

Postural

Structural

Flat feet

Young children are naturally flat footed. This is due to the oblique nature of the distal tibial epiphysis in the young child under the age of twelve. It will tend to spontaneously improve as the child gets bigger. It is more obvious in children who are also knock-kneed and even more marked in children who have a degree of intoeing gait due to persistent femoral neck anteversion.

Causes

Primary treatment:

None. 

Refer when:

Children's bunions and bunionettes

These conditions are quite common amongst adolescent children and teenagers. Often there will be a family history. Surgical correction of these deformities carries a small but significant complication rate. Bunions in adolescents may or may not be associated with hallux valgus deformity.

Primary treatment:

Advice on footwear.

Refer when:

Curly toes

Curly toes is a common deformity in children and if recognised at birth can usually be treated up to the age of six months to a year by gentle manipulation and strapping. If the deformity is severe, as is shown by either deformity of the growing nail of the toe or pressure on the adjacent toe or corn formation on the dorsum of the toe, treatment is indicated in childhood. Under the age of five this will probably take the form of a simple flexor tendon tenotomy if the toe is passively correctable. Thereafter treatment by soft tissue tendon transfer will become more frequently the operation of choice as long as the deformity is passively correctable. In adult life bony procedures are more common and only rarely in children will bony procedures be carried out.

Primary treatment:

Refer when: