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Child Bone Issues
CLUB FOOT Deformity
Clubfoot (also known as Congenital Talipes Equino Varus) is one of the most common congenital foot deformities in which foot is turned inwards and downwards mimicking a golf club.
It can be present in one foot or both feet (in 50% cases) and is more common in males.
It can be present as an isolated deformity (Idiopathic clubfoot) or in association with other abnormalities of musculoskeletal system, eg. Arthogryposis multiplex congenita (AMC), Developmental dysplasia of hip (DDH), Metatarsus adductus, Congenital muscular torticollis(CMT), etc.
Syndromic clubfeets are more stiffer and complex to correct in comparison to Idiopathic clubfeet.
Children with clubfeet present with painless deformities of feet which is obvious and can be appreciated by anyone. This deformity is not fully correctible in comparison to the postural clubfoot which does not need treatment.
Treatment: The goal of treatment is to give a well corrected, supple foot to the child. It is mainly divided into casting and bracing phase.
Casting Phase: The good news is that if treatment is started early (preferably within the first week of life), this grosetque looking deformity can be fully corrected with Ponsetti casting treatment within a span of few weeks without any major surgical intervention. At the final cast, a percutaneous Tendoachilles tenotomy is done to correct the equinus. This can be done under local anaesthesia. Ponsetti casting treatment (devised by Ignacio Ponsetti) is one of the most successful and popular treatment with published long term results and is considered the workhorse of clubfoot treatment. It is possible to treat clubfoot in older children, however if not treated early, it can lead to a more rigid deformity which will need soft tissue and bony surgery for correction.
Bracing Phase: After correcting the deformity, child has to wear foot abduction braces for 4 years (as per the protocol) to prevent recurrences which are as high as 50% without braces.
Outcomes: With treatment most clubfeet are correctible and have good function however their foot size and leg girth remains smaller than the normal limb.
Tips for compliance of brace wear:
- Always follow the protocol for brace wear as suggested by your doctor.
- Check for proper fitting of the brace (heel should be properly seated).
- Keep the bar padded
- Encourage your child to play and kick in the brace.
- Check the skin atleast 3-4times in a day for redness and other signs of pressure sore.
- Don’t use any oil or lotion under the shoes.
If you are looking for Club Foot Treatment, you should meet a qualified orthopedic surgeon like Dr. Gaurav Singh, the best orthopedic surgeon in Lucknow.
BOW & KNOCK Knees
Bowing of legs and knocking of knees are commonly seen developmental issues in toddlers. They can also be seen in teenagers.
In bowing, both the knees go apart and feet come close whereas in knock knees both the knees touch each other and feet go apart. These are variations of the normal biomechanics of the body. All the new born babies have some bowing at the time of birth due to posture of child in the womb. This progressively decreases and children normally grow out of this before 2 years.
However in some conditions this bowing persists or even aggravates and thus needs further investigation in form of standing x rays of both lower limbs to look for alignment and mechanical axis, x rays of both wrists to look for rachitic changes, blood parameters including calcium, phosphorous, vit d and alkaline phosphatase levels.
These investigations can help in differentiating between physiological bowing, blount’s disease (disease of proximal tibial growth plate leading to bowing of knees) and rickets.
After attaning neutral alignment, knocking of knees start developing maximum till 6 years and then decreases till 8 years to attain adult pattern of 5 -7degrees of valgus alignment. Knocking of knees appearing later in childhood warrants investigations including blood investigations for rickets or osteomalacia. Some skeletal dysplasias also can cause knocking of knees.
History and clinical examination involves inquiring about child’s nutrition, growth and development, bowel habits, any family history of skeletal dysplasias, etc. Dr Gaurav Singh will have a general physical examination and a detailed examination of the musculoskeletal system including hips, knees and ankles, any limb length discrepancy, ligament laxity, torsional alignment, walking pattern of the child, etc.
Investigations include standing alignment views of both lower limbs, blood investigations to look for changes of rickets.
Treatment depends upon the diagnosis:
- In case of rickets, vit d and calcium supplementation is sufficient. Sequential follow up x rays and blood tests are required to document recovery and improvement in mechanical axis of the lower limbs.
- Blount’s disease: It is due to abnormal physeal growth leading to progressively increasing genu varum. Depending on the classification and grade of proximal physeal involvement, treatment varies from observation to surgical intervention. In cases of adolescent genu varum and valgum, growth modulation is a very good option with predictable results.
- Those children who have completed bone growth need corrective osteotomy to rectify the alignment.
If you are looking for BOW OR KNOCK KNEE Treatment, you should meet a qualified orthopedic surgeon like Dr. Gaurav Singh, the best orthopedic surgeon in Lucknow.
Developmental Dysplasia Of HIp
Developmental dysplasia of hip is a condition in which part of the hip joint (ball and socket joint) is dysplastic or abnormal. It is usually the socket or acetabulum part of hip joint which is usually not deep or curved enough (flat) to keep the ball (head of femur/thigh bone) concentrically reduced. Depending upon the severity, the ball can be either partially or completely out of the socket. In other cases the hip joint is reduced but is unstable and can be dislocated on clinical manueveres.
Its incidence varies between 1 to 3 in every 1000 live births. It can be present at birth or during the first year of life.It can be present in isolation or in association with other musculoskeletal disorders. It is usally more common in females, first born child, breech presentation (bottom of baby is delivered first in place of head) and in oligohydramions pregnancies.
Every child should be examined thoroughly by a paediatrician to rule out ddh and in case of any doubt, the child should be timely referred to a orthopaedic surgeon.
It is sometimes difficult to detect DDH early as there are no obvious signs present. However a careful clinical examination of both the lower limbs will be able to make out a diagnosis. Apart from examination there are other studies including USG and X-rays of the hips to confirm the diagnosis of DDH.
Treatment of DDH is age dependent:
- 0 to 6months: Chidren with DDH in this age group can be managed with soft brace also known as Pavlik harness which keeps the hips in place by flexing and abducting them. This helps in better and more normal development of dysplastic acetabulum.
- 6 months to 2 years: A Pavlik harness is not appropriate for this age. A ddh diagnosed in this age needs evaluation under anaesthesia in which arthrogram is done to assess concentric close reduction of hip. If close reduction is achieved, a hip spica cast is applied in appropriate position for 2-3months. If a close reduction doesn’t work, then an open reduction is to be done to attain reduction. If the reduction is too tight, sometimes a thigh bone shortening is also done to prevent pressure on the head and subsequent vascular damage. Also sometimes, a reshaping of the socket is also required by doing an acetabular osteotomy. After the open surgery, a hip spica is applied for 3 months.
- Older kids> 2 years: Kids older than 2 years frequently need a open reduction with femoral and pelvic osteotomies.
Outcomes: Regular long term follow ups are required to ensure normal development of the hip joint. Most of children with have good functional hips after appropriate treatment. Some patients may need further surgery for residual dysplasia. However if left untreated, dysplastic hips can lead to early degeneration and pain of the affected hips.
If you are looking for DDH Treatment, you should meet a qualified orthopedic surgeon like Dr. Gaurav Singh, the best orthopedic surgeon in Lucknow.
