ABSTRACT
Limb bud embryogenesis starts very early (around week 4) and is complete by week 8 (all within the first trimester). This is the same time as some internal organs, such as the heart, are forming. This means that certain limb bud abnormalities are associated with specific
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cardiac abnormalities because both are the result of the same insult to the embryo at that critical time. Children start with bowlegs and become knock-kneed by 2 to 3 years of age, and then stabilise at 7o valgus by 7 years old. Pathological causes for persistent deformity are rickets, skeletal dysplasia, or trauma. Children under the age of 3 years commonly have flat feet until the development of the medial longitudinal arch. Flat feet are associated with a valgus heel, i.e., planovalgus foot. There are two types of persistent flat feet – flexible (tiptoe arch = restores, heel corrects into varus) and rigid (does not correct on tiptoe). Flexible flat feet do not routinely require intervention. Rigid flat feet are associated with inflammatory conditions or tarsal coalition and are likely to require intervention.
