Version May 2024
| Condition | Possible clues to the diagnosis |
| Physiologic valgus | Age two to five years; symmetric deformities; normal stature; lack of symptoms. |
| Pathologic valgus | Short stature; intermalleolar distance of >8 cm with the patellas facing forward and the femoral condyles touching. |
| Posttraumatic | |
| Proximal tibial metaphyseal fracture (Cozen fracture) | History of proximal tibial fracture at age <10 years. |
| Proximal tibial physeal fracture | History of proximal tibial fracture. |
| Distal femoral physeal fracture | History of fracture. |
| Systemic/metabolic conditions | |
| Mucopolysaccharidosis type IV (Morquio syndrome) (OMIM #25300 and 253010) | Coarse facies; short stature; stiff joints; corneal opacities; lumbar kyphosis. |
| Renal osteodystrophy | Short stature; pallor; polydipsia; polyuria; abnormal BUN/creatinine |
| Rickets (with onset during physiologic valgus: two to four years of age) | Decreased serum calcium or phosphorus; increased alkaline phosphatase; widened physes and flared metaphyses. |
| Skeletal dysplasia | Characteristic clinical and radiographic features vary according to the dysplasia. Some examples are provided below. |
| Chondroectodermal dysplasia (Ellis-van Creveld syndrome) (OMIM #225500) | Autosomal recessive inheritance; short stature; short limbs; dysplastic nails and teeth; cardiac defects; polydactyly. |
| Spondyloepiphyseal dysplasia tarda (OMIM #313400) | X-linked recessive inheritance; short stature with onset between 5 and 10 years; short trunk; corneal opacities. |
| Pseudoachondroplasia (OMIM #177170); associated with bow-legs in some patients | Autosomal dominant inheritance; short-limb dwarfism with onset by two years; joint laxity; vertebral anomalies. |
| Multiple epiphyseal dysplasia syndrome (OMIM #132400) | Autosomal dominant inheritance; mild short-limb dwarfism; brachydactyly; small irregular epiphyses on radiographs. |
| Neoplasms | |
| Multiple hereditary exostoses (OMIM #133700 and 133701) | Autosomal dominant inheritance; protuberances at ends of long bones; exostoses in juxtaepiphyseal regions of long bones. |
| Focal fibrocartilaginous dysplasia of distal femoral metaphysis | Progressive, unilateral deformity; radiolucent, well-circumscribed lesion, often with rim of reactive bone. |
| Other conditions | |
| Iliotibial band tightness (due to paralytic conditions, such as myelodysplasia, spastic diplegia, or spinal cord injury) | Abnormal Ober test (refer to UpToDate content on the child with knock-knees). |
| Arthritis of the knee (rheumatoid, hemophilia) | History of joint swelling, warmth. |
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