{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:48:58Z","timestamp":1785854938113,"version":"3.56.0"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Angular and rotational lower limb alignment concerns are a frequent reason for paediatric consultations. In most children, these findings reflect physiological developmental patterns that resolve spontaneously, but unilateral, progressive, or symptomatic cases may indicate pathology and require specialist assessment. Materials and Methods: This narrative review summarizes clinically relevant developmental norms, key elements of history and physical examination, common differential diagnoses, and practical indications for imaging and referral, with the objective of offering a structured clinical guidance framework for primary care and paediatric practitioners. Results: Physiological coronal plane lower limb alignment typically progresses from infant genu varum to neutral alignment by around 2 years, followed by transient genu valgum between 3 and 6 years, and stabilizes by approximately 7\u20138 years. Rotational alignment changes predictably with growth and most commonly presents as in-toeing due to femoral anteversion, internal tibial torsion, or metatarsus adductus. Out-toeing is less often physiological and should prompt careful evaluation for underlying disorders, including slipped capital femoral epiphysis. Clinical assessment should prioritize gait observation, foot progression angle, hip rotation, and thigh\u2013foot angle, while imaging should be reserved for atypical presentations, asymmetry, progression, pain, or suspected systemic or neuromuscular disease. Conclusions: Most paediatric lower limb alignment \u201cabnormalities\u201d represent normal variants and require reassurance and observation. Recognizing age-appropriate patterns and red flags enables paediatricians to limit unnecessary interventions while ensuring timely referral and treatment for pathological conditions.<\/jats:p>","DOI":"10.3390\/medicina62081499","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:42:36Z","timestamp":1785850956000},"page":"1499","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Angular and Rotational Lower Limb Alignment Variations in Children: Practical Guidance for Paediatricians"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6381-8684","authenticated-orcid":false,"given":"Josip","family":"Vlaic","sequence":"first","affiliation":[{"name":"Division of Paediatric Orthopaedic Surgery, Children\u2019s Hospital Zagreb, Ulica Vjekoslava Klaica 16, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7511-334X","authenticated-orcid":false,"given":"Amelia","family":"Kruk","sequence":"additional","affiliation":[{"name":"Academy of Current Orthopaedics, 76-200 Slupsk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5475-1999","authenticated-orcid":false,"given":"Marcin K.","family":"Wasko","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Centre of Postgraduate Medical Education, Marymoncka 99\/103, 01-813 Warsaw, Poland"},{"name":"Health Sciences Department, Ignacy Mo\u015bcicki University of Applied Sciences in Ciechan\u00f3w, Wojska Polskiego 51, 06-400 Ciechanow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.31128\/AJGP-08-20-5561","article-title":"Paediatric Rotational Abnormalities: A Primer","volume":"50","author":"Loh","year":"2021","journal-title":"Aust. 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