0350 ch 09-Box 10/11/04 05:31 PM Page 171 Chapter 9: Impaired Posture and Movement 171 DISPLAY 9-3 Developmental Deviations in Posture Feet • Flat arches are normal in the small child. • By age 6 or 7, expect good arch formation. Knees • Genu valgum is normal in a small child (about 2 inches between ankles is normal for an average-height child). • By age 6 or 7, genu valgum should be diminished or gone. • Postural genu varum in the school-age child is not acceptable, and corrective measures should be taken, because it is difficult to change in the young adult. • Genu varum may be compensatory for genu valgum by hyperextension of the knees. Hips • Femur medial rotation is the most common and often result from hip anteversion, foot pronation, knee hyperextension, postural genu varum, and, less often, genu valgum. Check for structural sources and treat with the appropriate corrective measures. • By adolescence, the femur should be in near-neutral alignment. • Femur lateral rotation is more common in young boys. • Persistent lateral rotation should be treated, because it can be detrimental in adulthood. Lumbopelvic Region • A protruding abdomen is normal for a child. • By the age of 10 to 12, the abdomen should no longer be protruding. • Lordosis peaks at age 9 to 10 and should gradually diminish thereafter. • Handedness patterns emerge in school-age children, most commonly with the hip high and shoulder low on the dominant side. This should be monitored if it is borderline or excessive. Shoulder Girdle • Scapular tilting is normal in school-age children. • The prominence should diminish as the child approaches adolescence. From Kendall HO, Kendall FP, Boynton DA. Posture and Pain. Huntington, NY: Robert E. Krieger Publishing, 1970. Hall & Brody: Therapeutic Exercise: Moving Toward Function, 2nd Edition © 2005, Lippincott Williams and Wilkins.