Orthopedics

Children and orthopaedic problems, when to see a specialist?

As time passes, you may notice that your child's growth isn't completely on the straight and narrow. Many young kids have flatfeet, toe walking, pigeon toes, bowlegs, and knock-knees. As kids grow, some of these conditions correct themselves without treatment. Others don't or become more severe because of other medical conditions. But many orthopedic (bone) conditions, just like dimples or cleft chins, are just normal variations of human anatomy that don't need to be treated.

Flatfeet

Most babies are born with flatfeet and develop arches as they grow. But in some kids the arch never fully develops. Parents often first notice this because their child has what they describe as "weak ankles" (which appear to turn inward because of the way the feet are planted). Flatfeet usually don't cause problems. Doctors only consider treatment if it becomes painful. Parents sometimes worry that flatfeet will make their kids clumsier than other kids, but doctors say that being flatfooted isn't a cause for concern and shouldn't interfere with playing sports. Sometimes, doctors will recommend inserting arch supports into shoes to reduce foot pain.

Toe Walking

Toe walking is common among toddlers as they learn to walk, especially during the second year of life. The tendency often goes away by age 3, although it lasts in some kids.

Occasional toe walking should not be cause for concern, but kids who walk on their toes almost all the time and continue to do so after age 3 should see a doctor. Persistent toe walking in older kids or toe walking only on one leg might be linked to other conditions, such as cerebral palsy, muscle weakness disorders, autism, or other nervous system problems.

If an otherwise healthy child has persistent toe walking, the doctor might recommend a few visits with a physical therapists to learn stretching exercises. Once a child is around age 4 or 5, casting the foot and ankle for about 6 weeks may be needed to help stretch the calf muscles.

In-Toeing (Pigeon Toes)

Babies may have a natural turning in of the legs at about 8 to 15 months of age, when they begin standing. As they get older, parents may notice their children walking with feet turn inward, also called in-toeing, or walking pigeon-toed. Intoeing can have a few different causes that are normal variations in the way the legs and feet line up.

Children who intoe and trip often may have internal tibial torsion, in which the lower part of the leg is rotated inward. Children over the age of 3 or 4 with intoeing may have femoral anteversion, in which there is a greater-than-normal bend in the upper part of the leg, which causes the upper leg to rotate inward. In some children, intoeing can be related to existing medical problems such as cerebral palsy.

Doctors rarely have to treat pigeon-toed feet. In-toeing usually doesn't interfere with walking, running, or sports, and ends on its own as kids grow into teens and develop better muscle control and coordination.

Bowlegs

Bowleggedness (also called genu varum) is an exaggerated bending outward of the legs from the knees down that can be inherited. It's common in infants and, in many cases, corrects itself as a child grows.

Bowleggedness beyond the age of 2 or bowleggedness that only affects one leg can be the sign of a larger problem, such as rickets or Blount disease:

Rickets, a bone growth problem usually caused by lack of vitamin D or calcium in the body, causes severe bowing of the legs and also can cause muscle pain and enlargement of the spleen and liver. Rickets is much less common today than in the past.

Rickets and the resulting bowlegs are almost always corrected by adding vitamin D and calcium to the diet. Some types of rickets, however, are due to a genetic condition and may need more specialized treatment by an endocrinologist.

Blount disease is a condition that affects the tibia bone in the lower leg. Leg bowing from Blount disease is seen when a child is about 2 years old, and can appear suddenly and quickly become worse.

The cause of Blount disease is unknown, but it causes abnormal growth at the top of the tibia bone by the knee joint. To correct it, kids may need bracing or surgery when they're between 3 and 4 years old.

You should also take your child to the doctor if bowleggedness is only on one side or gets progressively worse.

Knock-Knees

Most kids show a moderate tendency toward knock-knees (also called genu valgum) between the ages of 3 and 6, as the body goes through a natural alignment shift. Treatment is almost never needed because the legs usually straighten on their own.

Severe knock-knees or knock-knees that are more pronounced on one side sometimes do need treatment. In rare cases where children have symptoms such as pain or difficulty running, surgery might be considered after age 10.

Orthopedic Problems in Adolescents

Physical health problems encountered during adolescence can affect the development of the body, if not treated. There are few anatomic regions, such as spine, knee and ankle, in adolescents which can get orthopedic problems such as Osgood-Schlatter disease, and Slipped Capital Femoral Epiphysis.
Osgood-Schlatter disease is caused due to injury or overuse of the knee which causes swelling and pain in the area below the knee, above the shin bone. The patellar tendon and the soft tissues surrounding it gets inflamed, because of the constant pulling of the area where the tendon joins the below knee. Usually, adolescents who participate in sports actively and are athletic, such as football, basketball, soccer, ballet and gymnastics, tend to get the Osgood- Schlatter disease. Boys of age eleven to fifteen and girls of age eight to thirteen are at greater risk. The reason why adolescents get this problem is that their bones grow faster when compared to the tendons and muscles in this age and because of this the muscles and tendons stretch and become tight.
Slipped capital femoral epiphysis is a problem which affects the hip joint. The ball or head of the thigh bone, also known as femoral head slips from the thigh bone’s neck. Because of this the hip joint becomes stiff and painful. Slipped capital femoral epiphysis is the most common disorder of the hip which can happen in both the hips or one and it is more common in boys when compared to girls. Basically, adolescents of the age ten to eighteen years and who are overweight can be affected by this condition. The condition can arise over a time interval of few weeks or years. The condition, if resulted because of trauma and is also called acute slip and if results after a period of time is called chronic slip. Slipped capital femoral epiphysis is caused because of medications, radiation treatment, thyroid problems, and chemotherapy.

Scoliosis in Adolescents

Normally, a spine when viewed from rear should appear straight but if the spine is lateral or curved or sideways or rotated then it is affected by scoliosis. It gives an appearance as if the person has leaned to a side. According to Scoliosis Research Society the definition of scoliosis is the curving of the spine at an angle greater than 10 degrees on an x-ray. Scoliosis is a kind of spinal deformity and shouldn’t be confused to poor posture

There are numerous symptoms attributed to scoliosis which can vary from individual to individual. The symptoms are: Difference in heights of the shoulders, off-centered head, difference in the height or position of the hip, difference in the position or height of shoulder blade, different arm lengths in straight standing position and lastly different height back sides when the body is bent forward.

Sprains and Strains in Adolescents

Sprains and strains are among the majority of the injuries caused while playing sports. Sports injuries can be caused by small trauma which involves ligaments, muscles and tendons including bruises, sprains and strains. The body part which is most commonly involved in spraining or straining is the ankle

An injury caused to the soft tissue as a result of a direct force like fall, kick and blow is called a contusion or a bruise. A sprain is nothing but a ligament injury which is wrenched or twisted. Sprains usually affect knees, wrists and ankles. On the other hand a strain is an injury caused to a tendon or muscle which usually results from force, stretching and overuse.

Sprains/Strains are usually diagnosed by a physician after a physical examination. The physician asks for thorough medical history of the adolescent and asks various questions that lead to the cause of the injury. Various diagnostic procedures are also available which also helps in evaluating the problem.

Various options available for treatment include things like restriction of the activity after the injury, application of cast/splint on the injured spot, crutches or wheelchair, physical therapy which involves stretching exercises to give strength to the muscles, tendons and ligaments that are injured and last but not the least is the surgery which is opted for in worst case scenario.