Bone and Joint Problems of Children Flashcards
name the common musculoskeletal problems of childhood
Flat foot
Club foot
Toe walking
CDH
Perthe’s
SUFE
Blount’s disease
Osgood-Schlatter disease
how do people with childhood musculoskeletal problems present
- usually present with a limp in the lower limb
who usually gets musculoskeletal problems of childhood
- usually boys except for CDH which effects girls more
what is childhood musculoskeletal problems linked to
Linked to development
Growth
Presence of epiphyseal growth plates
are babies born with flat feet
Most babies are born with flatfeet and develop arches as they grow and start to walk
- In some the arch never fully develops - either because the muscles are hypotonic
what does a parent described that children having when they are born with flat feet
Parents often first notice their child has what they describe as “weak ankles”
why in some babies do they have flat feet
- In some the arch never fully develops
- either because the muscles are hypotonic
- or a bony problem in the shape of the tarsal bones are not the right shape then the arch does not developed
what do the ankles look like in flat foot
Ankles appear to turn inward
- Weight on inside of sole
What is the treatment of flat foot
Orthotics
Surgery
who is toe walking normal in
Toe walking is common among toddlers as they learn to walk
- Idiopathic (habitual)
when does toe walking become a problem
- muscle imbalance in conditions such as cerebral palsy that can make dorsiflexors hypotonic compared to the plantar flexors
when does normal toe walking tend to disappear
by the age of 2
what conditions is toe walking in older children linked to
- cerebral palsy
- DMD (duchenne muscular dystrophy)
- nervous system problems
how do you treat toe walking in healthy children
Castingthe foot and ankle for about 6 weeks to help stretch calf muscles
Physiotherapy
Surgery to release tight calf muscles
describe the epidemiology of club foot
1:1000
50% bilateral
M:F ration = 2:1
name the other name for club foot
Talipes equinovarus
what can club foot develop from
- underdevelopment of the calf muscles
- in utero need to move your legs around to stretch them out to move and develop the joints and the muscles, if there is any constraint in utero this can lead to everything being constricting
describe club foot
Fixed varus and equinus deformity,
what is club foot associated with
- Breech presentation
- Connective tissue disorders (Ehlers Danlos)
- Oligohydramnios
- Genetic syndromes (Edward’s Syndrome – trisomy 18)
- Family history
what is treatment for club foot
Ponseti method – manipulative technique to correct clubfoot without invasive surgery - repetitive plasting over weeks, so you can reshape into a normal condition
- after this fixed plaster class requires abduction of the foot brace thus keeping the position of the ankle and foot in the normal positive
- in this full time for 24 hours a day for 12 weeks and then every night up to the age of 4
describe the benefits of the ponseti method
- Painless
- fast
- successful in almost 100% of cases
what is congenital hip dysplasia
- this is a dysplasia
- present at birth
- same position as an adult posterior hip dislocation
what are the risk factors of congenital hip dysplasia
- Females - everything is looser, and the pelvis is wider
- Breech delivery
- Family history
- Oligohydramnios
- 1st born
what are other skeletal disorders with congenial hip dysplasia
Clubfoot
Scoliosis
when does congenial hip dysplasia spontaneous resolve
60-80% resolve spontaneously within 2-8 weeks
How do you diagnose congenital hip dysplasia
Barlow test
Ortolani test
Galeazzi sign