Normal Variants in Musculoskeletal Development
Normal variants refer to normal development of the musculoskeletal system, in particular the lower limbs. It is important to know about them as they are a common cause for concern for parents and a frequent reason for consultation.
It is important to understand normal gait and motor milestones and know about normal lower limb development in order to appreciate when observations may be considered abnormal, what conditions to consider and when to refer for a specialist opinion. Often, explanation and reassurance for parents may suffice, but practitioners should be confident in knowing when this is appropriate, and when referral for further specialist assessment may be necessary.
It is noteworthy that pGALS, V-pGALS and pGALSplus tools are assessment aids to prompt further investigations or referrals. Other tools are there to support collection of consistent and important information to aid clinical decision making, such as pREMS or the GALLOP Proforma (Gait and Lower Limb Observation of Paediatrics).
pGALSplus builds on pGALS and aims to help clinicians to determine if a child with a musculoskeletal problem has a normal variant (or not), if they need specialist referral (or not) and if so, whether to rheumatology, orthopaedics or neurology/neurodisability.