Paediatric orthopaedics

Paediatric orthopaedics

Club Foot

Club foot is a congenital condition in which the baby’s foot will be turned towards the inside and will also possibly face downwards. It mostly affects both the feet, but the new-born will be otherwise healthy. In club foot, the tendons of the foot will be shorter than usual. For severe club foot, surgery is done to correct it, and doctors recommend early surgery so that the baby’s walk is not affected. Parents however need not feel concerned that the baby will find club foot painful. Though it looks painful, club foot does not hurt the baby.

Club foot can be treated with casts and braces. A small surgery to the Achilles tendon might also be carried out. Wearing the brace properly according to the doctor’s instructions plays a very important role in recovery.

Alternatively, for severe club feet, surgery might be done to stretch the tendons and ligaments to position the foot properly. Here again, the use of casts and braces will be needed for best results.

Perthes Disease

Perthes disease is a rare condition that affects certain children. Here, the blood supply to the top of the thigh bone is impaired. When the bone does not get enough blood, the bone cells die (necrosis).

The thigh bone, or the femur, ends in a ball that fits into the socket of the pelvis. As a result of the reduction in blood supply to the bone, the top of the thigh bone (the ball) may weaken and ultimately collapse. The exact cause for this condition is unknown, though there is a probability that the condition might be genetic. Children in the age group of 4-10 years are the ones usually affected.

When the child is affected with Perthes disease, there will be a noticeable change in the way he/she walks and runs. Hip pain that increases with activity and a limp may be the other symptoms. Diagnosed with a physical examination (in which the doctor will check the child’s ability to move the legs) and an x-ray, the doctor may suggest treatment options depending on the individual child’s condition.

Non-surgical options include not stressing the legs too much with sporting activities, physiotherapy and using casts.

Surgery is recommended if the damage to the top of the thigh bone is bad. An osteotomy is usually performed wherein the bones are cut and realigned. They are made to fit well within the socket and held in position with metals screws, plates, etc. Post-operative care involves the use of crutches, casts, and rehabilitation exercises.

Slipped Capital Femoral Epiphysis

This is a condition that can manifest in adolescents. In adults, the thigh bone ends in a ball that fits into the socket of the acetabulum, thus forming the ball and socket joint. In children who are still growing, the head of the femur is called as the epiphysis. This epiphysis and the rest of the thigh bone are connected by a growth plate. In a slipped capital femoral epiphysis, this interconnecting growth plate is injured and the Epiphysis is displaced. Reasons for this may vary from obesity and hypothyroidism to endocrine problems. Boys are more susceptible to the condition compared to girls. Leg pain, reduced range of movement in the leg, change in walking style, etc. are the possible symptoms. It is usually diagnosed with a physical examination and an x-ray; in some cases an MRI may be required.

The condition is treated with surgery. A metal screw is used to join the femur head to the femoral bone. If the bones have been badly damaged, the surgeon may have to reposition the bones. After surgery, the use of crutches will be necessary to protect the leg till it heals.

Cubitus Varus/ Genu Valgus Deformities

Cubitus varus, also known as gunstock deformity, is a condition in which when the arm is extended; the palm is facing front, and the arm is turned towards the body. Fracture malunions may result in this condition. Very rarely, it is present as a congenital defect. Sometimes, infections, tumours and bone cell death might also cause this condition. If the deformity does not cause any trouble, doctors may just decide to observe the condition. If the ulnar nerve is compressed, then surgery might be needed. The surgeon will perform an osteotomy to realign the elbow and treat the condition.

A genu valgum deformity is the opposite of a varus deformity i.e., the limb is turned away from the body at the knee. Knee pain may be a result of this deformity, and the uneven pressure distribution might result in arthritic changes in the knee. It can be corrected with surgery during which the bones are repositioned.

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