Children’s Bone Disease Q&A

1. Flatfoot
Many parents often worried that their children have flat feet (Figure 1) and take them to the doctor. In fact, most are flexible flat foot which are soft cause no pain in the feet and do not affect walking, running and exercise. Only a small number of flat feet are pathological, namely the Rigid flat foot. It is simple to distinguish the softness and the stiffness. Standing behind the children and tell them to lift the body with their toes and look at their heels. If they are turned from the outside to the inside (Figure 2), it is the soft flat foot. Morbid flat feet are rare, including vertical talus and tarsal coalition. Since the soft flat feet generally do not cause any symptoms nor affect the development of the lower extremities, parents need not to worry too much, but kindly consult orthopaedic surgeons if necessary.

2. Intoeing
Many parents complain their children often fall at schools while the teachers have the same complaint,which is quite common among children in development. Intoeing occurs mainly in the foot, cheekbones or large femur. The most common is the congenital metatarsal adductus (Metatarsal adductus), but majority can correct themselves gradually without any treatment before the age of three.

Internal tibial torsion is the most important cause of intoeing. When children first learn to walk, parents or teachers often find that they are prone to fall. Most children significantly improved before the age of two without any treatment.
Another type of internal circumflex is the internal rotation of the femur. Normally, children have a 40-degree internal rotation of the femur at birth. When they first start to learn how to walk, there is an internal rotation of about 20 to 30 degrees. When walking, there may be a phenomenon of internal characters. Frequent falls, while sitting on the ground, the sitting posture looks like W (Fig. 3). By the time they reach eight to nine years old, the internal rotation of the femur will be reduced to about 15 degrees, and the frequency of fall will be reduced or the situation may even disappear.」