Medical Mystery of the Week

      Because of the COVID19 pandemic, you are practicing telemedicine. You are shown the shoes of a patient (see picture below) but given no history.
      What is your diagnosis, what lab test(s) would you order to confirm you suspicions, and what treatment, if any, do you recommend? What symptoms may this patient have?

DIAGNOSIS: Varus deformity of the knee leading to lateral wearing of the patient's heels.
      Infants and children are vulnerable to hip and lower extremity disorders which can lead to degenerative disease (paricularly osteroarthritis) in later life. These disorders include developmental dysplasia of the hip (˜1% of newborns), slipped capital femoral epiphysis (˜0.01% of young teenagers),  femoroacetabular impingement, and limb length discrepancy (> 2 cm difference in paired lower extremities).
      The presented patient had developmental bowing, a physiologic condition involving varus angulation of the knee. Differential diagnosis includes Blount disease, a progressive pathologic genu varus centered at the tibia.  In most persons, valgus deformity of the knee ("knocked knees") is also developmental.
      In-and-out toeing disorders are caused by abnormal tibial and femoral torsion that usually self-corrects during lower limb growth.
      Examination of patients' shoes can often provide useful information about their axial skeleton, their knees, their legs, and their feet. Good diagnosticians often take advantage of this fact.
      Examples of valgus and varus knee deformities are shown below

    Answer provided by Sarah Anne King, ETSU medical student