http://blog.naver.com/drsangwonlee에 글을 올리면서 인사드립니다.위 글은 www.koreapediatrics.com 부모도 반의사가 되어야 한다
제16권 소아청소년(0~18세)
정형외과 질환 및 스포츠 의학
Orthopedics and Sports medicine of Children and Adolescents
에서 퍼온 글입니다.
다음은 이상원의 저작 및 저서
1. http://www.koreapediatrics.com/부모도 반의사가 되어야 한다–약 20,000 여 쪽. 13412 제목, 2013년 출시 소아과 웹사이트 이상원 운영
2.소아가정의학 백과-618쪽, 1988년 출간
3.소아가정간호백과–부모도 반의사가 되어야 한다-1076쪽, 1998년 청문각 출간
4.신생아 영유아 학령기아 사춘기아 성장발육 육아-623쪽 2014년 좋은땅 출간
5.신생아 성장 발육 양호 질병, 610쪽 2014년 좋은땅 출간
6.모유 모유수유 이유 308쪽, 2014년 좋은땅 출간
7.소아청소년 뇌전증(간질)+뇌전증 백문 백답, 240쪽 2015년 좋은땅 출간
8.임신에서 신생아 돌보기까지, 약 300쪽 1998년 청문각 출간
9.아들 딸 이렇게 사랑해서 키우세요, 210쪽 역저 전 세계 명작 Ross Campbell 의학박사 저 1988년 서문당 출간
11.마약과 아이들 약 200쪽 , 1988년 출간
12.아들 딸 조건 없는 진정한 사랑으로 키우세요 그리고 인성교육은 이렇게 2016년 양서각 출간 647쪽
13.”https://www.flickr.com/people/drleesangwon
14.http://blog.naver.com/drsangwonlee
15,https://www.facebook.com/drleesangwon
16.Ｎｅｗｙｏｒｋｋｏｒｅａ．ｎｅｔｄ의 Ｐｅｄｉａｔｒｉｃ ｃｏlｕｍｎｉｓｔ
17.그 외
위 포스팅 내용의 대부분은 www.koreapediatrics.com에 있는 내용들입니다. 전문적인 면도 있지만 소아청소년 자녀 양육에 많은 도움이 되리라고 믿습니다. 그러나 여기에 있는 정보는 여러분의 의사로부터 얻는 정보 진단 치료를 대신할 수 없습니다. www.koreapediatrics.com 부모도 반의사가 되어야 한다
저자의 양력–연세대학교 의과대학 졸업, 무의촌 2년간 의료봉사 및 대한민국 군의관 3년 근무
미국 커네티컷 UCONN 의과대학, 예일대학교 의과대학 소아과 수련, 미국 소아과 전문의, 한국 소아청소년과 전문의
American Top pediatrician 2002~2005, 미국 커네티컷 주 의사면허증 #016370, 한국 의사면허증 #7794
Copyrightⓒ 2017 John Sangwon Lee, MD.FAAP
■ 검색 창에서 찾고자하시는 정보를 찾아보세요.
Copyright drleepediatrics.com 2/23/2026
Intoeing (Intoeing)
For more information, please visit drleepediatrics.com. Search
For more information, visit drleepediatrics.com and search. A condition in which the big toe (the big toe) points inward is called pigeon toe (metatarsus varus/metatarsus adductus/in-toe gait/intoeing/in-toeing or false clubfoot).
▴ Photo 106. Congenital Metatarsus Varus
Congenital metatarsus varus, a condition in which the lower part of both feet bends inward, and the resulting clubfoot.
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
▴ Photo 107. The tibia and fibula of the foot and lower leg are normal, but the femoral head is physiologically slightly rotated inward, a phenomenon called femoral head anteversion.
Physiological femoral head anteversion results in a physiological varus foot in both feet. This results in a varus foot in both feet.
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
▴ Photo 108. a○-Hip joint and femoral head,
b○-Tibia and fibula, c-○Ankle bone
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
● A varus foot can occur when the foot, tibia, and fibula of the lower leg are normal, but the femoral head is anteversion.
● A varus foot can occur when the femoral head and foot are normal, but the tibia of the lower leg is twisted inward.
● When the femoral head, tibia, and fibula in the lower leg are all normal, but the lower back of the foot turns inward, a clubfoot condition can occur. This is called metatarsal varus.
● When the femur, tibia, and foot all turn inward, a clubfoot condition can occur.
● A clubfoot condition can cause a duck-toed gait.
■ Causes of Clubfoot
● In most adults, the toes of the feet point straight forward or slightly outward.
● However, in rare cases, the toes of the feet can turn inward.
● In infants and school-aged children, a clubfoot condition occurs when the toes of one or both feet, or only the big toe, turn inward when lying down, walking, or standing. ● It’s normal for newborns and infants under two years of age to develop a clubfoot, with one or both of their big toes turning inward.
● This type of clubfoot that develops normally is called a physiological clubfoot.
● Most cases of physiological clubfoot gradually disappear on their own as they grow.
● In rare cases, a clubfoot can develop due to a pathological condition. Such a condition is called a pathological clubfoot.
■ Let’s take a closer look at the causes of clubfoot (see Arms and Legs, p. 00).
① Within the narrow uterus, the fetus grows while occupying a minimal volume.
During this process, the front part of one or both feet may turn inward.
This is called a fetal clubfoot.
A fetal clubfoot can occur only on the hallux, or sometimes on both hallux and metatarsal clubfoot. Sometimes, only the big toe (hallux) may bend inward, like a hook, resulting in a hallux valgus. ② When the entire foot, the midfoot, the forefoot, and the big toe are all normal, but one or both tibias of the leg below the knee are twisted inward, the toes also turn inward, resulting in a clubfoot. It is normal for the uterine position to remain in place for some time after birth. This can cause a physiological “O-shaped” lower leg to develop for up to 18 to 24 months after birth. When the lower leg bends inward in this physiological “O-shaped” shape, the normal toe of the foot may turn inward, causing a clubfoot on that side.
When infants and toddlers with clubfoot are put to sleep face down, the tibia of the lower leg, which is already bent inward, can bend even further inward.
This causes the already existing clubfoot to turn even further inward. ③ When the trochanter is normal, and the tibia and fibula of the lower leg are normally straight, but one or both femoral heads are anteverted (femoral anteversion), the upper leg, lower leg, trochanter, and big toe on that side turn inward, resulting in a clubfoot (see Photo 107).
④ When there is metatarsal varus, and the tibia of the lower leg on that side is twisted inward, a clubfoot can also occur, as shown in Photo 106.
Clubfoot can also occur if there is a simultaneous abnormality that causes the femur, tibia, and the tip of the foot to turn inward.
Table 1. Differential Diagnosis of Metatarsal Clubfoot, Internal Tibial Torsion, and Femoral Anteversion
Metatarsal Clubfoot
Internal Tibial Torsion
Femur
Anteversion
Characteristics
Metatarsal Clubfoot
Metatarsus varus
Internal Tibial Torsion
Femoral Anteversion
Age of Presentation
4-14 months
1-2 years
3-6 years
Natural Course
85% return to normal spontaneously
99% return to normal spontaneously
Almost all return to normal spontaneously
Symptoms
Cosmetic concerns, foot pain, and shoe problems
None
Sometimes cosmetic concerns, sometimes knee pain
Early Treatment
Manual physical therapy and cast treatment
In rare cases, immediate treatment is provided by Dennis Brown.
None
If natural healing does not occur and the deformity persists,
Foot Bone Surgery
Foot Bone Surgery
Femoral Surgery
■ Treatment of Clubfoot
● Most infants and young children may develop both physiological O-shaped legs and clubfoot for some time after birth.
▴ Figure 109.
a – Normal foot,
b – Mild metatarsal clubfoot,
c – Moderate metatarsal clubfoot,
d – Severe metatarsal clubfoot
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
● Most clubfoot cases, whether physiological or caused by mild congenital metatarsal clubfoot, resolve spontaneously by 12 to 18 months of age without treatment. ● However, clubfoot caused by severe metatarsal clubfoot requires treatment under the doctor’s direction, including manual physical therapy, plaster cast therapy, or special shoes.
● Most clubfoot cases, which are caused by the tibia of both legs below the knee bending inward despite the foot being straight and normal, will improve on their own between the ages of 3 and 5 without any treatment.
● However, clubfoot can become more severe when tired or wearing heavy shoes.
● If clubfoot is mild, severe, does not improve on its own, or becomes increasingly severe, you should immediately see your primary pediatrician for a referral to an orthopedic specialist for treatment.
▴ Figure 110. 85% of metatarsal clubfoot cases resolve spontaneously. However, if this does not resolve spontaneously, treatment may include:
a) manual physical therapy for metatarsal clubfoot,
b) plaster cast treatment,
c) shoe treatment, or d) Dennis Brown bar treatment.
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
▴ Figure 111. Dennis Brown bar treatment.
Denis Brown bar treatment is also used to treat pronated metatarsal clubfoot.
Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP
● When metatarsal clubfoot is caused by congenital metatarsal clubfoot, treatment involves turning the big toe of the affected foot outward.
● Mild clubfoot cases can be treated by placing the right shoe on the left foot and the left shoe on the right foot, as directed by a doctor.
● Alternatively, the patient can be treated by tying the heels of both shoes together with a string while sleeping.
● Alternatively, the heels of the shoes attached to the pajamas can be stitched together and the patient can be put to sleep wearing the pajamas. If the shinbone is severely bent inward, resulting in severe clubfoot, splinting is recommended.
● Most physiological clubfoot cases resulting from normal growth and development will heal on their own without treatment.
● Before resorting to long-term treatment with special shoes or braces, you should seek a referral from your regular pediatrician and receive a diagnosis and treatment from an orthopedic specialist.
The following is an example of an online pediatric health consultation Q&A regarding the question, “My gait is a bit strange.”
Q&A. My gait is a bit strange
Q.
Hello.
I am the mother of a 39-month-old boy.
My child has an unusual gait. When he walks, only his right foot points inward. Perhaps because of this, he walks with a slight limp. What should I do? When I look at them standing up or lying down, their legs don’t appear to be bent or anything.
I sometimes masturbate face down, so I wonder if that’s the effect. I’m wondering if I should get tested or just wait and see. If I do get tested, should I go to the surgeon?
A.
Misun
● Hello. Thank you for your question. More detailed information, such as your child’s age, gender, past medical history, family medical history, physical findings, and clinical tests, would be more helpful for a better answer, but I’ll answer based on the information you’ve provided.
● Walking with your toes turned inward can occur when there’s an abnormality in any or all of the toes, forefoot, midfoot (lumbar), back of the foot, tibia, femur, or hip joint.
● If the midfoot and other parts of the foot are normal, but only the front of the foot (where the big toe is) turns inward, that foot will turn inward.
● Even if the toes and legs are normal, walking with your toes turned inward can occur when the front of the foot turns inward.
● If the toes, forefoot, and leg are normal, but the lower back of the foot is bent inward or the back of the foot is turned backward, the toes may turn inward as you walk.
● If the foot, toes, and back of the foot are normal, but the tibia is bent inward, the toes may turn inward as you walk.
● If the foot and tibia are normal, but the femur is bent inward, the toes may turn inward as you walk.
● If the foot, tibia, and femur are normal, but the femoral head is turned inward at the hip joint, the toes may turn inward as you walk.
● The phenomenon of the toes turning inward can be caused by congenital causes, acquired causes, or various other diseases or physiological phenomena.
● While this may be a bit complicated, there are two types of clubfoot: physiological, which occurs normally when the feet turn inward, and pathological, which can occur due to a variety of conditions.
● If your regular pediatrician can’t resolve the problem, seek a referral from your regular pediatrician for help from a pediatric orthopedic specialist or general orthopedic specialist.
● Masturbation is normal and doesn’t cause this condition in your feet.
● Please refer to p. 00, “Clubfoot.” If you have any further questions, please contact us again.
● Thank you.
The following is an example of a Q&A session for the online pediatric and adolescent health consultation regarding “Clubfoot and Falls Frequently.”
Q&A. Clubfoot and Falls Frequently
Q.
Hello, doctor.
My son is now 17 months old. He’s starting to walk and run around the house. However, he falls frequently. I noticed that his big toe is curled inward, so it seems like he trips on it. (It’s pointing inward toward the floor. ^ㅡ^) Is there something wrong with his big toe? Or is it just because he’s still young and clumsy? Would it be okay to wear socks?
Please give me a good answer.
A.
Jo Won
● Hello. Thank you for your valuable question.
● The more information we have about your child’s age, gender, past medical history, family medical history, physical examination findings, and clinical tests, the more helpful it is for me to answer your question. I will answer based on the information you provided. I’m not entirely sure I understand your question. I apologize.
● Clubfoot is a condition where the big toe points inward toward the body. Please refer to p.00, Clubfoot.
● Children continue to grow and develop from birth until they reach adulthood.
● Looking at the growth and development process, among the various organs in the body, the head and upper body develop first, while the lower body and feet develop last.
● In other words, immediately after birth, the functions of the head (central nervous system) and facial organs, such as the eyes, ears, mouth, and nose, are already relatively well developed.
● The functions of each organ in the head and face are relatively well developed. However, especially before the first birthday, the development of the legs and feet, which enable standing and walking, normally occurs more slowly than the development of the upper body.
● To reiterate, infants aged 6-7 months have developed upper limbs and hands well enough to hold a bottle and feed independently, but their feet and legs are not yet fully developed enough to stand independently.
● Furthermore, infants aged 2-3 years, who are just beginning to walk, are not yet mature enough to walk with their legs and feet.
● At this time, it’s normal for most infants’ hands, feet, torso, and legs to not be fully developed enough to move in a coordinated manner. Consequently, most infants who are just beginning to walk often fall.
● Clubfoot can occur congenitally when the forefoot, middle portion of the foot, metatarsal, tibia, or femur in the hip joint points inward.
● In most cases, clubfoot is a physiological condition.
● Physiologically occurring clubfoot is called physiological clubfoot.
● Physiological clubfoot does not necessarily mean a child is prone to falls.
● However, clubfoot can be caused by congenital deformities of the hallux, foot, lower leg, or hip joint. In these cases, falls can occur easily. In these cases, the problem should be properly treated.
● Please visit a pediatrics and adolescent department for a checkup, diagnosis, treatment, and consultation.
● p.00 Clubfoot and Hallux Varus. [Parents Should Become Hallux Doctors Too – Pediatric and Family Nursing Encyclopedia] – Volume 3: Growth and Development of Newborns, Infants, School-Age Children, and Adolescents – Growth and Development for the Applicable Ages.
● Please refer to Volume 2: Prevention of Diseases and Accidents in Children and Adolescents – Regular Health Checkups, etc.
● If you have any further questions, please contact us again. Thank you.
The following is an example of a Q&A from the online pediatric and adolescent health consultation regarding “hallux.”
Q&A. Bowel Movement
Q.
My child is a 36-month-old boy.
He started walking at 15 months. When he walks, he walks in a figure-eight manner. His legs are rather thin and he stumbles often. His legs feel weak and slightly bent, so I went to the hospital for a checkup, and the results were normal. Please tell me how I can help him walk normally at home. I have him sit up straight and exercise his legs frequently.
A.
To the Beginner
● Hello. Thank you for your question. That’s a good question. Knowing more about your child’s age, gender, past medical history, family medical history, physical findings, and clinical tests will help me answer your question. I will answer based on the information you provided.
● I’m not sure whether a figure-eight gait refers to a condition where both big toes point outward from the body or a condition where both big toes point toward the midline of the trunk.
● Please get a checkup at your regular pediatric clinic and then inquire.
● Please refer to p. 00 Hallux Valgus and p. 00 Clubfoot for information. Please contact us if you have any further questions.
● It’s often beneficial to allow your child to grow and develop naturally.
● It seems like massaging infants is a huge trend these days.
● I don’t recommend it.
● Passive massage, which involves pulling, pushing, twisting, or pressing too hard on the bones, tendons, ligaments, and muscles of infants who cannot express themselves properly through words, can be harmful to them.
● Furthermore, in most cases, adults do this because they enjoy it, not the infants.
● In any case, this infant massage trend will continue until they tire of it or develop side effects.
● Physical contact and love during massage can be beneficial.
● If you still have problems, please consult a pediatrician for a diagnosis and consultation. Please refer to p. 00 Hallux Valgus, Clubfoot, etc. ● If you have any further questions, please contact us again. Thank you.
33333333333
The following is an example of a Q&A regarding “inward arch” (inward arch) in an online pediatric and adolescent health consultation.
Q&A. Inward Arch
Q.
Hello…
I am the mother of a 16-month-old daughter.
She started walking around 9-10 months old, but she keeps walking inward, and even when sitting, her feet turn inward. Her father doesn’t walk inward, but all women, including her mother-in-law, seem to walk inward. Please let me know if this genetic tendency can be corrected.
A.
To Sister-in-Law
● Hello. Thank you for your question. It’s a good question.
● The more information we have about your child’s age, gender, past medical history, family medical history, physical examination findings, and clinical tests, the more helpful it is in answering your question.
● I will answer based on the information you provided.
● You asked a good question. Since some of my parents and siblings walk with almost the same condition, I suspect there may be a genetic predisposition.
● However, I’m not sure if there’s a specific disease causing this or if it’s a physiological condition.
● If a health problem that can be cured is not treated properly in a timely manner and the right time for treatment is missed, it can sometimes become incurable and lead to lifelong disabilities.
● The femoral head in the hip joint is rotated inward, the femur is bent inward, the tibia in the lower leg is bent inward, the midfoot is bent inward, only the front part of the foot is turned inward, or one or more of the following causes can cause the feet to turn inward and walk with an in-toe gait.
● First, please consult a pediatrician for a diagnosis and consultation regarding this problem.
● Please refer to O-shaped legs, X-shaped legs, and hallux varus.
● If you have any further questions, please contact us again. Thank you.
Greetings, I’m posting this on http://blog.naver.com/drsangwonlee. The above article is from www.koreapediatrics.com: Parents Should Become Half-Doctors, Vol. 16, Pediatrics and Adolescents (0-18 Years Old)
Orthopedics and Sports Medicine of Children and Adolescents
.
The following are Lee Sang-won’s writings and books:
1. http://www.koreapediatrics.com/Parents Should Become Half-Doctors, Approx. 20,000 pages. 13412 Title, 2013, Pediatrics website operated by Lee Sang-won
2. Encyclopedia of Pediatric Family Medicine – 618 pages, published in 1988
3. Encyclopedia of Pediatric Family Nursing – Parents Should Become Half-Doctors Too – 1076 pages, published by Cheongmun-gak in 1998
4. Growth, Development, and Parenting for Newborns, Infants, Toddlers, School-Age Children, and Adolescents – 623 pages, published by Good Land in 2014
5. Growth and Development: Healthy Diseases in Newborns, 610 pages, published by Good Land in 2014
6. Breastfeeding: Reasons for Breastfeeding, 308 pages, published by Good Land in 2014
7. Epilepsy in Children and Adolescents: 100 Questions and Answers, 240 pages, published by Good Land in 2015
8. From Pregnancy to Newborn Care, approximately 300 pages, published by Cheongmun-gak in 1998
9. Raise Your Son or Daughter with Love Like This 210 pages, translated and translated by Dr. Ross Campbell, a world-renowned classic, published by Seomundang in 1988.
11. Drugs and Children, approximately 200 pages, published in 1988.
12. Raise Your Son or Daughter with Unconditional, True Love, and This is How Character Education Works, published by Yangseo-gak in 2016. Page 647
13. https://www.flickr.com/people/drleesangwon
14. http://blog.naver.com/drsangwonlee
15. https://www.facebook.com/drleesangwon
16. Pediartric of Newyorkea.netd
17. Other
Most of the content of the above posting is from www.koreapediatrics.com. Although it has a professional aspect, I believe it will be very helpful in raising children and adolescents. However, the information here cannot replace the information, diagnosis, and treatment you get from your doctor. www.koreapediatrics.com Parents should also be half-doctors. Author’s Solar Calendar: Graduated from Yonsei University College of Medicine, served two years as a medical volunteer in a village without a doctor, and served three years as a military doctor in the Republic of Korea.
Residency in Pediatrics at UCONNECTICUT School of Medicine and Yale University School of Medicine, resident in pediatrics in the US, resident in pediatrics in Korea.
American Top Pediatrician 2002–2005, Connecticut Medical License #016370, Korean Medical License #7794.
Copyright ⓒ 2017 John Sangwon Lee, MD.FAAP
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