Pediatric Genu Valgum Clinical Presentation

Updated: Aug 22, 2016
  • Author: Peter M Stevens, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Presentation

History

It is important to identify and document the natural history of genu valgum. On rare occasions, genu valgum may be noted in the nursery, indicating the presence of some type of localized or generalized skeletal malformation or dysplasia. Congenital lateral dislocation of the patella has been described. The extensor mechanism of the knee is displaced laterally so that every time the child contracts the quadriceps, the knee is flexed (rather than extended) and rotates outward, accentuating the valgus deformity. Another example is postaxial hypoplasia of the limb, sometimes first manifested by the absence of a lateral ray (or two rays) of the foot. [5]

More commonly, genu valgum does not become apparent until after the child reaches walking age. A normal variant of the disorder in toddlers (physiologic valgus) typically is symmetrical and pain-free, but it should resolve spontaneously by the time the child is aged 6 years. If the valgus is unilateral or symptomatic, referral to an orthopedist and radiographic evaluation are warranted.

Family history may be important because certain heritable conditions, such as hereditary multiple exostoses, Marfan syndromeosteogenesis imperfecta, or vitamin D–resistant rickets may predispose a patient to this condition.

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Physical Examination

The physical examination should include assessment of the gait pattern, including the propensity for circumduction, and evaluation of lower extremity lengths. Stature, craniofacial features, the spine, and the upper extremities should be evaluated. Various genetic conditions and skeletal dysplasias may be documented in this manner; consultation with a geneticist may be warranted.

With the child standing, compare the relative limb lengths by leveling the pelvis with blocks and measuring and recording the intermalleolar distance (IMD). Torsional deformities of the femur, tibia, or both should be documented. Often, genu valgum is observed in association with outward torsion of the femur, tibia, or both. Look for retropatellar crepitus and tenderness and note patellar tilt, tracking, and stability. For situations other than the aforementioned physiologic genu valgum, medical imaging is warranted.

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