Paediatric Orthopaedics

Lower limb alignment in the child (Bow legs, Knock knees and Intoeing feet)

Many parents worry about the shape of their child's legs and feet or the way their child walks at one time or another. Leg alignment in children changes with time, and it is not necessary to be concerned in the majority of cases.

When children begin walking, at between 10 and 18 months, they stand and walk with a wide base of support. There is usually some bowing of the legs, which are rotated outwards for stability. The feet are flat in appearance.

In the two to five year age group, the lower limbs start to become knock kneed.

By four to five years, the majority of children develop an arch in their feet and are no longer flat-footed. The knock-kneed posture corrects by the age of seven to eight years (with knees together, ankles should just touch).

If there is a significant abnormality and your child does not follow this pattern, it may be necessary to change or “guide” the growth of the limb. Guided growth involves careful assessment of the child’s initial malalignment, their potential for remaining growth and the best timing for surgical intervention if it is required. Manipulation of growth in a growth plate requires careful monitoring and follow up. It is essential that parents understand the process and consequences of the operation so that the best possible result can be achieved for their child.

Paediatric Hip

These conditions can be challenging to treat and can cause significant disability to the children affected if they are not diagnosed and managed appropriately. Certain conditions such as Hip dysplasia, Perthes Disease and Slipped Upper Femoral Epiphysis may be managed in the private sector if they are not severe, however there are certain situations where management in a tertiary paediatric facility such as the Queensland Children’s Hospital is preferable. Dr Maine is a treating consultant at the LCCH and is able to transfer care of these children to the LCCH if required.

More detailed information on these conditions to come….

Paediatric Knee

There are many knee conditions that affect children exclusively. While the phenomenon of “growing pains” may be related to growth spurts and will settle with time, other conditions can be more serious.

Particularly sporty children may be affected by conditions such as Osgood Schlatters Disease where repetitive traction to a growth plate causes pain and limits the child’s ability to participate in sport. Other conditions such as Osteochondritis Dissecans (OCD) where a fragment of cartilage and bone can separate from the surrounding bone, can require surgical intervention. If your child is experiencing knee pain, we are very happy to assess it in order to make sure it is not a serious condition that may affect your child’s long term health.

ACL and Meniscal injury in children

These are serious injuries in the young athlete with management that centres around preventing them from further significant injury that will compromise the long term health of the knee. Our priority is actually the prevention of meniscal injury as these structures protect the cartilage of the knee joint. Repetitive instability from an ACL injury increases the potential for a meniscal tear in an active child.

While it is theoretically possible to restrict a compliant child’s level of activity so they do not risk further injury, most children who are very young are non compliant and do require surgery at some stage, to keep from damaging the knee further. There are growth plate sparing options available for ACL reconstruction in very young children. Adolescents may be treated similarly to adults, depending on the amount of growth they have remaining before reaching adulthood.


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