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Background
Imaging of the pediatric musculoskeletal system presents many challenges to radiology trainees due to vast normal anatomic and developmental variations. A general lack of familiarity with these variants also contributes to the challenge as they may be encountered infrequently outside of dedicated pediatric hospitals. Recognizing these developmental variants can avoid the need for advance imaging which results in unnecessary sedation and interventions while at the same time save cost and time for the patient.

Educational Goals / Teaching Points
The goal of this presentation is to describe normal musculoskeletal variants that are both common and uncommonly seen in pediatric knee, ankle and foot radiographs. Correlation with MR and CT will also be provided, if available. We will also review typical appearance and locations of uncommon accessory ossicles of the pediatric foot.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this educational exhibit, we will review imaging findings of several normal variants that can be seen in outpatient or emergency department settings through a case-based review. We will present cases that could mimic fractures or suspicious bony lesions such as multiple primary ossification centers of the calcaneus, dorsal defect of patella, irregular ossification of the lower patella, pes anseri spur, cortical desmoid of the distal femur, and cases of uncommon accessory ossicles of the foot including os vesalianum pedis, os sustenaculum, and os intermetatarsuem.

Conclusion
Radiologists should be familiarized with normal variants of pediatric lower extremity to prevent unnecessary imaging, intervention, or biopsies.