Normal lower limb variants in children

The bottom line

• Musculoskeletal symptoms are one of the leading reasons for visits to general practitioners, with over 10% of children presenting for medical attention each year

• Common reasons for referral include intoeing, flat feet, knock knees, and bow legs—all normal variants in growing children

• Additionally, vitamin D deficiency and obesity in children are on the increase, with well documented associations with musculoskeletal disorders ranging from chronic conditions such as rickets with resultant bow legs or knock knees, to more acute conditions such as slipped capital femoral epiphysis

• Recognising developmental norms and differentiating them from disease may help allay parental anxiety, ease referrals to primary and secondary care, and prompt appropriate timely referrals for abnormal conditions

Sources and selection criteria

We searched PubMed and Google Scholar using the terms “p(a)ediatric”, “lower limb variants”, “intoeing”, “out-toeing”, “pes planus”, “flat foot”, “genu varum”, “genu valgum”, “vitamin D deficiency”, “obesity”, and “sporting activity”. The search was conducted from inception of databases to March 2015. Wherever possible we used evidence from randomised controlled trials, systematic reviews (including Cochrane reviews), and expert review articles published in the past 10 years. Current relevant Department of Health policies were also included.