The child is evaluated in the prone position with knees flexed to 90 degrees. Using the tibia as a lever arm the femur is rotated both internally and externally. A positive exam demonstrates internal rotation of greater than 70 degrees and external rotation reduced to less than 20 degrees. Normal values for internal rotation are between 20 and 60 degrees and normal values for external rotation are between 30 and 60 degrees. Treatment
In those less than eight years old with simple in-toeing and minor symptoms, no specific treatment is needed.Metatarsus Adductus
Nonoperative management:  Non operative treatment of metatarsus adductus is dictated by the flexibility of the forefoot. If the child can actively correct the forefoot to midline no treatment is indicated. If the adduction cannot be corrected actively but is flexible in passive correction by an examiner, at-home stretching that mimics this maneuver can be performed by parents. In the case of a rigid deformity serial casting can straighten the foot.Surgical Management:  Most cases of metatarsus adductus that does not resolve is asymptomatic in adulthood and does not require surgery. Occasionally, persistent rigid metatarsus adductus can produce difficulty and significant pain associated with inability to find accommodating footwear. Surgical options include tasometatarsal capsulotomy with tendontransfers or tarsal osteotomies. Due to the high failure rate of capsulotomy and tendon transfer it is generally avoided.
Lichen ruber moniliformis is a rare skin disease named for Fred Wise and Charles R. Rein.It is one of several diseases also known as Kaposis disease, based on its characterization in 1886 by Moritz Kaposi.It is thought to be a rare variety of lichen planus.It is also known as "Morbus moniliformis lichenoides". Presentation
The disease causes numerous whitish punctiform papules and brownish macules arranged in a necklace-like pattern. Diagnosis
Treatment
See also
Lichen planus
List of cutaneous conditions

References


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