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Lower Limb Normal Variants

There is a wide variation in lower limb development, and minor (normal) variants, such as flat feet or knock-knees, are a common cause of parental concern. Sometimes they can be confused with indicators of underlying pathology.

Here we describe the common normal variants, indications for concern and when to refer for specialist opinion (usually to paediatric orthopaedics).

We include descriptions for flat feet, toe-walking, Genu Valgum (knock-knees), Genu Varum (bow-legs), Out-toeing and In-toeing and delayed walking. 

The photograph below shows mobile flat feet with normal arches on tip-toe (this is a normal finding in young children)

The figure below shows the normal development of leg alignment in children at different ages 

 Further information on normal variants is available

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