Physicians who provide primary care for children from birth through adolescence encounter a variety of positional deformities of the legs and feet. The distinction between a pathological and functional cause must be made. The former should be referred to an orthopedist for treatment. When a pathological deformity of the legs or feet is diagnosed, the physician should look for other congenital anomalies, especially those involving the skeletal system.

The lower extremity rotates medially during the 7th fetal week, bringing the great toe to midline. With growth, femoral anteversion gradually declines from 30 degrees at birth to 10 degrees at maturity, leading to lateral rotation of the lower extremity during growth (Figure 183-1). Most functional deformities of the legs and feet are self-correcting in time, through this normal developmental progression of the lower extremity, even without treatment. This characteristic must be considered in weighing the results of any treatment prescribed. Studies of functional deformities, analyzing treated versus untreated paired control patients, have demonstrated the relative ineffectiveness of various treatments for these conditions, when analyzing treated versus untreated paired control patients. Therefore most clinicians choose to observe these conditions while children grow out of them.[3] [4] [5]