How often have you encountered an anxious parent with their child with bow legs or in-toeing and wondered ‘is this normal or not?’. If you don’t feel 100% confident in knowing which child needs simple reassurance and which needs referral, you’re not alone. 25-50% of all new paediatric orthopaedic outpatient referrals are due to normal variants in the growing child! To help us a recent BMJ review nicely summarises the normal variants as well as red flags that should prompt a referral (BMJ 2015;351:h3394).
Key points in assessment
- Normal variants should be symmetrical and painless.
- Normal variants tend to improve over time in a predictable age-related way whereas pathological conditions worsen.
- Consider impact of obesity and possibility of vitamin D deficiency rickets.
- Short stature (
The table below provides a summary of different lower limb conditions.