When it comes to orthopaedic disorders in children, it is natural for parents to become concerned when it affects the way their child walks. However, understanding the more common orthopaedic conditions -— and knowing that many conditions are just variations of normal — can help parents recognize when the condition is a natural part of childhood and when it is necessary to enlist the help of a medical provider.
In toeing is one of the most common musculoskeletal problems brought to the attention of primary care providers. Estimated to occur in 10 percent of children between the ages of 2 and 5, in toeing, also known as pigeon toeing, is a very common pediatric orthopaedic condition. In toeing may first be noticed when a child starts walking by the appearance of the feet being turned in or because of repeated falling while running. In most cases, the condition resolves itself without treatment. Special shoes or braces are not needed or recommended in most cases.
In toeing is caused by several conditions. If the foot causes the in toeing, it is due to a condition called metatarsus adductus. If the in toeing is caused by the lower leg between the knee and ankle, it is known as tibial torsion. If the area of the leg between the hip and knee causes the in toeing it is known as medial femoral torsion or femoral anteversion.
Majority of cases will spontaneously resolve by late childhood. There are few indications for surgery and if persistent, it is usually only a cosmetic problem. Moreover, there is some evidence that persistent in toeing may be beneficial in sports where quick directional shifts are necessary, like basketball, tennis, and soccer.
Bowlegs and knock-knees
Most cases of bowlegs and knock-knees are physiologic variations of normal. All infants are born slightly bowlegged, and the curvature gradually decreases by about 2-3 years of age. By about age 7, most children reach a typical adult stance, which is slightly knock-kneed, meaning that when standing, the knees angle slightly inward. If the problem occurs on one side or becomes severe, further investigation is warranted. In these cases, a referral to a pediatric orthopaedist may be needed.
A relatively common congenital foot disorder is clubfoot, which occurs in approximately one in 1,000 children. It can be unilateral or can occur on both sides. It is a congenital deformity that develops during the early stages of fetal development. Los Angeles Orthopaedic Hospital uses the highly effective and less invasive Ponseti method to correct clubfoot. This technique involves a series of manipulations and corrective cast applications. At the end of the period, a small surgical procedure is done to lengthen the heel cord.
A high arched foot or cavus foot is a hereditary condition and usually requires no intervention. However, any new onset, unilateral, painful, or worsening condition may indicate a neurologic problem so that further evaluation is necessary. Flat feet, or pes planus, also tends to run in families. The condition is associated with lax ligaments that cause the foot to sag during weight bearing activities. If the flat feet cause pain or affects walking, further evaluation is warranted to differentiate if the condition is flexible or rigid, since the treatment is different for the two.
Toe walking may occur as a natural phase of gait development and generally self-corrects in children around age 3. If a child older than 4 continues to toe-walk, further evaluation is necessary to evaluate if the child toe walks out of habit or if he or she has tight heel cords or a possible underlying neurologic condition.
Growing pains typically occur at night and may be described as an “ache” or “throb” usually in front of the thighs, calves or behind the knees. The pain usually subsides by the morning. The term “growing pains” is a misnomer since there is no actual evidence that growth is painful. The musculoskeletal pain experienced at night is likely caused by overuse during the day. Treatment consists of the use of analgesics, heat, massage and stretching.
If the pain is persistent or severe enough to interfere with normal activities, located in the joint area, associated with an injury or accompanied by swelling, redness, fever or loss of appetite, it is a good idea to be evaluated by a physician to rule out other serious conditions.
By staying aware of common orthopaedic disorders, their symptoms and treatment options, parents can be prepared and help ensure that their children continue to grow and thrive — happy, healthy and active.
Dr. Balucan practices general pediatrics at Los Angeles Orthopaedic Hospital. Los Angeles Orthopaedic Hospital recently opened the Renee and Meyer Luskin Children’s Clinic in Santa Monica for the treatment of all forms of pediatric orthopaedic injuries and illnesses. For more information go to www.orthohospital.org/smclinic.