<p>Vascular malformations often lead to orthopedic complications in children, particularly in the lower extremities where leg length discrepancies, foot deformities and joint damage occur. Regular clinical examinations are essential for early detection of abnormalities. Limb length differences result from either abnormal growth or chronic avoidance postures. Joint pathologies, such as angiodysplastic arthropathy, cause joint destruction even in childhood. Contractures arising from chronic avoidance postures or muscle remodelling, require specialized treatment, such as tendon lengthening or in severe cases amputation. Foot deformities vary depending on the syndrome and malformation. In these cases complex interventions can be necessary. The surgical treatment of vascular malformations is challenging due to the high risk of bleeding. An interdisciplinary treatment is necessary to minimize complications.</p>