A PATHOLOGY OF THE CHILD AND THE ADOLESCENT THE GENU VALGUM SECONDARY
1. GENERAL :
The biometric studies that we have been carrying out for a few years in the young child, allow us to observe certain disorders during the growth. Then over time, or the doctor, can become really pathological and then cause the child a handicap sometimes irreversible. The genu valgum, in this respect, constitutes a banal affection of childhood and adolescence, whose importance must not escape the practitioner. Indeed, mothers often draw attention to a set of apparently minor disorders such as: adduction walking, frequent falls, walking fatigue, joint and muscular pains, poor general attitude. These signs should cause a simple examination to be made of the perturbations of the static of the lower limbs and of the feet which may lead to a genu valgum. It can be defined very schematically as a diminution of the external angle formed by the axes of the femur and the tibia below 170 °. It is characterized by a greater or less magnification of the internal condyles of the femur which repels the corresponding tibial plateau. The axis of the leg then becomes oblique from top to bottom and from inside out.
– Forms of the genu valgum: “G.V. essential” and “G.V. secondary”.
It is essential during the examination of the child to distinguish the genu valgum “essential”, that is to say linked to a proper deformation of the knee, with significant modification of the condyles, of the “secondary” genu valgum due to the Mid-tarsal eversion, the most frequently encountered. In the first case, the vicious attitude leads to a valgus of the tarsus and, secondarily, to a weakening of the longidudinal internal vaults. The treatment of such a form belongs to the specialist practitioner and no correction of the foot can modify the genu valgum “essential” in a favorable way. The genu valgum “secondary” we are interested in here represents about 80% of the cases and comes essentially from a posterior and mid-tarsal eversion of the foot valgus whose mechanism we will recall.
– Causes of genu valum
General causes: The general causes of genu valgum are many, often ill-defined, but two main factors must be retained: musculo-ligament hyperlaxity, calcium assimilation disorders.
– Hyperlaxity is very common in young children. The hypotonic muscles and the ligament hyperlaxity allow exaggerated passive movements in the joints. This laxity will then have direct consequences on the static base.
– Calcium absorption disorders are linked to a wide variety of causes, including infantile diseases, chronic rhinopharyngeal infections, rickets that does not allow the bone to acquire sufficient rigidity to support the child’s weight.
Mechanical Causes: Favored by the general causes that we have just mentioned, the static disorders will appear and lead to a genu valgum. The architecture of the foot will be modified by the lack of rigidity of the various elements of articular joints. The bone structures will present eversions which will either be the cause of the “secondary” genu valgum or the consequence of the “essential” genu valgum.
2 – THE GENU VALGUM SECONDARY
– Differential diagnosis between G.V. Essential and G.V. secondary.
The first stage of the examination should make it possible to differentiate the essential genu of the secondary genu valgum from an eversion of the foot, as we know the importance this represents in the subsequent orientation of the treatment.
Let us recall that the child examined standing has a contact of the knees by the internal condyles whereas the internal malleoli are separated by a variance according to the importance of the genus valgum.
For a more thorough investigation, we found the following proportions of 180 children aged 3 to 7 years and presenting an intercellular deviation of at least 5 cm:
Intermediatelevel gap (cm)%
– 5 cm ……………….. 23
– 6 to 7 cm …………… 55
– 8 to 9 cm …………… 16
– 10 cm and more …….. 6
This gap, independent of the age or stature of the child, therefore represents a good element of appreciation of the importance of the genus valgum. It is not always easy to differentiate a pathological genu valgum from a physiological genu valgum. One can, however, admit that a genu valgum is pathological in a child, if it is accentuated in a unipodal station.
Differentiation between secondary and essential genu valgum is done by a simple examination.
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