Q. What is a Pediatric Orthopedic Surgeon? A. Pediatric orthopaedic surgeons are specialists who treat musculoskeletal (bone, joint, back, or muscle) problems in children. Their specialty training is particularly valuable when treating bones that are still growing.
Q.What training is required for a Pediatric Orthopaedic Surgeon? A. All orthopaedic surgeons must graduate from medical college(MBBS) and then do post graduation in orthopedics (MS ortho).
After graduation, most pediatric orthopedic surgeons complete 1 or 2 additional years of subspecialty training, in which they focus on the special needs of growing children.
Q. Why does child need a specialist?
Children are not just small adults. Their growing bones pose different challenges than those of adults.
Sometimes, what looks like a problem in a child is just a variation that the child will outgrow over time.
Some common pediatric problems don’t even occur in adults.
Pediatric orthopedic surgeons, their clinic, and supporting staff are all equipped to deal with kids and families to create a comfortable, patient-focused and family-friendly environment.
Q. When should I take my child to a Pediatric Orthopaedic Surgeon? A. Pediatric orthopaedic surgeons diagnose and treat a variety of problems with the arms, legs and spine. Problems walking, crooked limbs, legs of different lengths, curves in the spine, broken bones, bone/joint infections or tumors, and birth defects of the hands or feet are just some examples of the conditions that may require a pediatric orthopaedic surgeon.
Children with complex pediatric problems such as developmental delay, skeletal dysplasias, or other syndromes are usually best managed by a multidisciplinary, medical-surgical team.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is Clubfoot’? A. ‘Clubfoot’ is a condition in which a baby’s foot is twisted inwards and downwards.
Q. Why does clubfoot happen? A. In most cases, clubfoot is ‘idiopathic’, which means, the cause is unknown. In some children, clubfoot can be due to disorders of the spine or due to weakness of the nerves and muscles in the legs. Such children are said to have ‘syndromic’ clubfoot.
Q. How common is clubfoot? A. Clubfoot is one of the commonest birth anomalies. It occurs in about 1 to 2 babies per 1000 births. It is 2.5 times more common in boys. In more than half the children affected, both feet are involved.
Q. Will it get better on its own? A. No. Without treatment, the foot will remain in the abnormal position, and the child will have trouble in walking.
Q. How is clubfoot treated? A. Clubfoot is treated with ‘Ponseti Method’ which is essentially non-surgical method. The first part of treatment consists of a series of plasters applied by your doctor to the child’s foot and leg. This is called ‘Ponseti casting’. These plasters or casts are applied once a week. With each cast, the position of the foot is slowly corrected to near normal. In most children, after 4 to 5 casts, a minor surgical procedure is required, to stretch out a tight tendon called the ‘Achilles tendon’ which lies behind the ankle. After this procedure, the final cast is applied, which is only removed after 3weeks. The second, and equally important part of the treatment, consists of maintaining the correction achieved by wearing a brace.
Q. How long does this treatment take? A. The initial treatment with casts usually takes 5 to 6 weeks, followed by the final cast for 3weeks. The brace must initially be worn for 23 hours a day for first three months, and then eventually just at night and nap times for 4 to 5 years.
Q. Will major surgery be required? A. Children with ‘idiopathic’ clubfeet usually do not require any major surgery, as long as they are treated early, within the first few months after birth.
Sometimes, surgery may be required as a part of the initial treatment itself. This is usually for children with ‘syndromic’ clubfeet, or for children who receive treatment when they are older and have started walking on the deformed feet. Sometimes, a child who’s feet have been corrected well with Ponseti casting may develop some minor issues after some years, such as the feet turning inwards only while walking. In such cases, a surgery is sometimes need to re-direct certain tendons or to release tight soft tissues in the foot.
Q. Will my child be able to walk, run and play? A. Yes. Most children with clubfoot are able to perform all activities, just as well as their peers.
Q. Will the foot look normal? A. The foot with clubfoot is usually slightly smaller than the normal side. The calf of the affected side is also usually smaller than the other side. However, after treatment, the shape of the foot will be like normal.
Q. Is the treatment painful? A. In general, the treatment does not cause any pain to the child. They may have some discomfort initially due to the cast, but they soon become used to it.
Q. What if my child doesn’t wear the brace afterwards? A. It is very important that your child uses the brace properly, so as to maintain the feet in the corrected position. If the brace is not worn regularly, there is a high chance of recurrence of the clubfoot, which may then require further treatment, including surgery.
Tips for successful brace use
There are various types of braces used to maintain correction of the foot after casting. All types have a shoe for each foot, connected to each other by a rod. Even if only one foot was affected, it is necessary to keep both the feet in the brace in order to maintain correction.
Care of feet in the brace
Place a soft cotton sock on each foot prior to applying the brace. Cut of the end of the sock so that you can observe your child’s toes while in the brace.
Remove the brace completely and check your child’s feet all around for any redness or skin irritation. This must be done at least 3 to 4 times a day.
The brace should be applied firm enough so that the heel rests on the base of the shoe, but not so tight that the toes turn white or the skin is injured.
The bar in between the legs is an essential component of the brace. Without it, the brace will not serve its purpose. Remember, applying the shoes only, without the bar is as good as not applying the brace at all.
Check the brace regularly for fitting and breakage. If your child’s toes are curling over the front edge of the brace, the brace is too small and needs to be changed.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘Congenital Dislocation of the Hip’? A. Congenital Dislocation of the Hip (CDH) means a condition in which a child’s hip joint is dislocated from the time of birth. This is an old term and has now been replaced by the term ‘Developmental Dysplasia of the Hip’ (DDH). This is a broad term that describes any condition in which the hip joint is not developed normally and is unstable.
Q. What exactly happens in DDH? A. The hip joint is formed by ball like head of the femur that connects with the cup like socket of the pelvic bone. The ball and socket normally fit very closely together and the joint remains stable. In DDH, the hip joint is unstable, that is, the ball is loose in the socket. This instability may be of varying severity.
Q. What causes DDH? A. In DDH, the shape of the acetabulum is abnormal. The cup is shallow instead of deep and so the femoral head does not fit tightly into it. The soft tissues around the hip joint may also be loose. One or more of these factors may act simultaneously to cause the hip joint to dislocate.
There are a number of risk factors for DDH i.e. factors that increase the likelihood of a child having DDH. These include:
Breech position – When the baby is delivered legs first instead of head first
Family history – When either one of the baby’s parents had suffered from DDH during childhood, their baby is 12 times more likely have DDH.
Tight swaddling of newborns – It increases the risk of DDH.
DDH is much more common is girls, eight out of every ten cases of DDH is seen in baby girls.
Q. How often does DDH occur? A. Approximately 1 or 2 babies out of every 1000 babies born suffer from DDH.
Q. They say that swaddling causes DDH. But swaddling is the only way my child falls asleep. What should I do? A. Swaddling is safe as long as it is done correctly. ‘Hip-safe swaddling’ is where you bundle your baby is such a way as to leave his legs free and able to move. As long as you allow the legs to remain in this position when swaddled, it will not harm the hips.
Q. What are the symptoms of DDH? A. DDH is painless. Hence it very often goes undiagnosed in infancy unless a child is specifically examined for it. Suspicion of an abnormality is usually raised only when the child starts to walk. The child walks with a limp. One of his/her legs appears to be shorter than the other.
Q. How is DDH diagnosed? A. A pediatric orthopaedic surgeon can usually make a diagnosis of DDH after examining the child’s hip joints. The diagnosis is confirmed in children smaller than 4 months by using a sonography. In older children, an x-ray is used to confirm the diagnosis.
Q. If DDH is painless, why does it need to be treated? A. DDH is painless during childhood. However, if it remains untreated, as the child grows older, the abnormal walking puts a strain on other parts of the body. Eventually, they develop pain in the back and knees.
Further, treatment for DDH is simpler the earlier it is done. Older children require more complicated surgeries and have poorer results.
Q. How is DDH treated? A. Treatment of DDH depends on the age at which it is diagnosed. Up to 6 months:
In infants this small, treatment consists of a brace known as a Pavlik harness. This is a soft brace made of fabric, that is fastened into position with Velcro straps. It acts by gently keeping your baby’s legs in a position that allows the hip to get back into the joint.
If treatment with the Pavlik harness is unsuccessful, your baby may need to be treated as for slightly older children (see below)
6 months to 18 months:
Children seen at this stage are usually treated by something called ‘arthrogram and closed reduction’. This is done under anaesthesia in the operation theatre. If this is successful, a body cast known as ‘hip spica’ is applied. This cast will remain for two months, changed once in between.
Closed reduction means that the joint has been reduced without actually opening it. This is not always possible however, especially in older children. When closed reduction fails, or if your doctor feels it is unlikely to be successful, he/she will advise ‘open reduction’ (see below).
Older than 18 months:
In children older than 18 months, open reduction is usually necessary. This surgery might also include femoral and pelvic osteotomies.
After this surgery also, a hip spica cast is applied, usually for two months.
The above is only an outline to the approach to treatment of a child with DDH. Actual treatment depends on many factors and not just the age of the child.
Q. My child’s treatment is completed. Do I still need to take her to the Orthopaedician for check-ups? A. Yes, it is important that you keep a regular follow up with your surgeon. As your child grows, the bones around the hip change, and sometimes, some part is not able to keep up. Some instability of the hip may occur again as the child grows. This must be detected soon so that it can be treated. Ideally, you must continue follow up with your doctor, at least once a year, until your child’s growth is complete.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘Cerebral Palsy’ A. ‘Cerebral Palsy’ (CP) is a disorder that affects a child’s ability to control his/her muscles. It is caused by damage to the parts of the brain that control movement and co-ordination.
‘Cerebral Palsy’ is a general term to describe a very wide spectrum of disorders. There are three important things to understand in a child who has CP
How the affected parts behave
Which parts are affected
In terms of how the affected parts behave:
Spastic CP – This is the most common form. In this, the affected muscles are in spasm i.e. the are very tight and do not relax easily. Dystonic CP – In this form, the child’s arms or legs repetitively move in abnormal twisting movements. This may occur whenever the child attempts to use the arm/leg, or may even occur continuously when the child is at rest. Hypotonic – In this type, the affected parts are limp and floppy. It is like how the limbs are in a person who is paralyzed.
In terms of the parts of the child’s body that are affected the most:
CP Hemiplegia – When one half of the body i.e., the arm and leg on one side are affected. CP Diplegia – Both legs are affected maximally. Usually, there are some problems in both arms as well, but this is very mild. CP Quadriplegia – Both arms and both legs are equally affected. Very often, the trunk is also weak.
Q. What causes cerebral palsy? A. CP occurs due to some damage to a small child’s growing brain. This damage may occur while the child is in the womb or may occur around the time of birth – children who are born prematurely or who have a very low birth weight, babies who do not breathe immediately after birth and need to be resuscitated. Finally, the damage may occur soon after birth as well – babies who have trouble breathing and need to be kept on a ventilator, those who suffer from jaundice, or have bleeds in their brain.
All these are the known risk factors for CP, however the exact cause may not be known in many cases.
Q. What are the symptoms of cerebral palsy? A. The initial symptom of CP is usually a child who is slow to meet his/her developmental targets. CP also affects other body systems besides the movement problems:
Learning disabilities
Speech, vision and hearing problems
Epilepsy (seizures or fits)
Curvature of the spine and poor posture
Joint and gait problems
Q. Which are the specialists that will be needed to treat my child? A. The diagnosis of CP is usually made by your paediatrician or a neurologist. You may also need to consult a number of other specialists:
Paediatric Orthopaedic surgeons – to treat the problems with muscles, joints and gait
Eye specialists – For visual problems
ENT specialists – For problems in hearing
Physiotherapists – To help improve movement and strength
Occupational therapists – To help your child learn daily living skills such as eating, dressing
Speech therapists – To help with communication problems
Nutritionists – To help give your child type of diet he/she needs
Orthotists – To provide braces and aids to help your child walk and do other activities
Q. How is cerebral palsy treated? A. The treatment of a child with CP consists of a combination of medications, physical therapy, bracing and surgery.
Q. Does cerebral palsy get worse over time? A. The injury in the brain which results in CP remains the same and does not change over time. However, as the child grows, the problems with movement and other impairments do change and worsen.
Q. What is ‘Botox’? Will Botox injections help? A. ‘Botox’ or ‘Botuminum toxin’ is a chemical that relaxes tight muscles when injected into them. The effect of botox lasts for only a few months. However, if you regularly do physiotherapy and use the necessary braces, the beneficial effects of botox can be prolonged by several months.
Q. Will my child need special shoes or braces? A. Yes, braces and splints are very important in the treatment of CP.
Q. Will my child need surgery? A. The need for surgery will depend on many factors. Regular exercise and use of braces can help in delaying the need for surgery, however, most children with severe CP need surgery eventually.
Q. Can stem cell injections help? A. NO. Stem cell injections have NOT been proven to be effective in cerebral palsy.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. My child has flat feet. Why does this happen? A. Flat feet is a condition where the arches of the feet are flattened. When walking, it appears as if the entire foot is resting flat on the ground, instead of the normal tripod shaped area of contact.
Flat feet are normal in the majority of small children and in more than 20% of adults as well. This is called flexible flat foot, because the arch can be seen when the person is sitting on standing on tip-toes, and disappears only when they are standing. This type of flatfeet is painless.
In some instances, flat feet can be a sign of an underlying abnormality of the bones/muscles/nerves or can occur due to certain types of arthritis. In these cases, the flatfoot is usually ‘rigid’, which means that the arch of the foot may not appear eve when sitting or on tip-toes. These disorders are often painful.
Q. Will my child grow out of his flat feet? A. 80 to 90% of children with ‘flexible flatfeet’ do grow out of it. In small children, the arch of the foot is usually present but obscured because the feet are normally quite chubby at this age. The arch usually develops during the first ten years of life. In the remaining 10 to 20% of children, the flatfoot may persist into adolescence and adult life.
Q. Will my child need to have any tests? A. Flexible flatfeet can be diagnosed simply by examining your child’s feet and legs. Usually, no investigations are required. However, if the flat feet are associated with pain, or are rigid, or there are signs of some nerve/muscle problem, your doctor might ask for x-rays or other tests.
Q. Is there any treatment for flat feet? A. The vast majority of flatfeet are asymptomatic and do not require any treatment. There is no need for braces/shoe inserts/special shoes in children with flexible flat feet.
In some children with flatfeet, there is also some tightness of the calf muscles, which can be a source of pain. If this is found on examination, your doctor will advise some simple exercises to stretch out these muscles, known as heel cord stretching exercises.
Older children and teenagers with flat feet, sometimes complain of arch pain. Soft shoe inserts to support the arch can be helpful for them. Sports shoes that have in-built arch supports work just as well. There is no need for expensive custom-made braces or special shoes. Hard or rigid arch supports actually cause more pain and should be avoided.
Q. Can the flat feet cause my child pain/discomfort during athletics or regular activities? A. The majority of children and adults with flat feet do not have any pain or discomfort. They are able to do all regular activities and even participate in sports.
Q. Will my child’s flat feet prevent him/her from playing sports or joining any job? A. There are many professional athletes who have flat feet. Flat feet will not stop your child from playing any sport.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘Obstetric Brachial Plexus Palsy’? A. The ‘brachial plexus’ is a bunch of nerves starting from the neck and going towards the arm, one on the right and one on the left side. These nerves carry the signals for sensation and movement between the spine and the arm.
‘Palsy’ means weakness or paralysis.
Obstetric Brachial Plexus Palsy or OBPP is the condition when, around the time of child birth, these nerves are injured, resulting in weakness of the arm.
Q. What causes OBPP? A. OBPP occurs when the nerves of the brachial plexus get stretched and/or torn around the time of birth. Causes include:
Long, difficult labour
Big baby
Breech delivery i.e. when the baby is delivered legs first instead of head first
Complicated delivery – where some maneuver like forceps/vacuum assistance needs to be used in an emergency, to save the life of the mother/baby
Q. How common is OBPP? A. Around 1 to 2 out of every 1000 babies born have OBPP.
Q. Is OBPP painful for my child? A. No, children with OBPP do not have any pain due to it.
Q. What are the signs of OBPP? A. Typically, a baby with OBPP will have decreased movements of one upper limb as compared to the other.
There are varying severities of OBPP depending on which of the nerves in the brachial plexus have been affected and how severe the injury to the nerves is.
Q. How is OBPP treated? A. Treatment starts with diagnosing and documenting your child’s weak muscles. In most cases of OBPP, the nerves heal on their own, and the arm regains function. Until the time that the arm is weak, it is important to do certain exercises to keep the joints in the arm supple and lose. Without this, the arm becomes stiff, and even if the nerves recover later on, the arm may not function fully. Sometimes, if the joints are becoming very stiff, they may need treatment with injections of ‘Botox’, to help them relax.
Your doctor will reassess your baby at regular intervals and monitor the speed of recovery. This natural recovery of the nerves can take up to two years to be completed. Most children with OBPP will have some residual weakness in their arm, even after complete recovery of the nerves.
Q. Will my child need surgery? A. Children with OBPP may require broadly two types of surgeries:
Surgery on the nerves: If the natural recovery of the nerves is less than expected, your doctor may recommend surgery to repair and reconnect the torn nerves.
Surgery on the muscles: Older children in whom the nerves have fully recovered but still have some residual weakness may benefit from surgery to release stiff joints, or to redirect strong muscles to help weaker ones.
Q. Will my child be able to participate in sports and activities? A. Children with OBPP usually are able to participate in all sports and activities at the same level as children who do not have OBPP. Your child may have some residual weakness and may not be able to place the arm in certain positions. However, children are very adaptable, and they learn to compensate and perform activities in different ways.
Q. Will the OBPP get worse as my child grows older? A. No, the weakness in the nerves does not get worse as the child grows. However, the nerve injury does affect the growth itself, and you may find that your child’s arm is slightly smaller/shorter as compared to the normal arm. Also, as the child grows, the imbalance between strong and weak muscles may worsen, and lead to loss of movement at a joint, most commonly at the shoulder.
Exercises for OBPP (during the first few months of life):
Shoulder rotation: Bowling movement – Straight as well as reverse
Shoulder rotation: Keep the arm by the side of the body and rotate the hand outwards, as far as it can go
Elbow: Bending the elbow fully
Forearm rotation: Hold your baby’s arm, one of your hands at the elbow, one at the wrist. Keeping the elbow stationary, rotate the forearm such that your baby’s palm faces upwards fully
Wrist movement: Bending the wrist fully in both directions
Finger movements: Opening the hand by making all the fingers straight.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘in-toeing’? A. ‘In-toeing’ is when your child’s feet point inwards instead of straight ahead when he/she is walking/running.
Q. What causes in-toeing? A. In-toeing is usually a part of the normal development of your child’s lower limbs. It sometimes runs in families.
In-toeing occurs due to an inward twist in the bones of your child’s legs. This inward twist may be at any one of the three parts of your child’s lower limbs – the thighbone (femur), the shin bone (tibia) or the foot.
Thighbone – When the femur has a twist and is turned inwards, it is known as excessive femoral anteversion. Such children have a tendency to sit in the ‘W’ position, i.e. they sit with their legs bent behind and to the outside.
Shin bone – When the twist is in the tibia, it is called tibial intorsion. This also gradually untwists, over a period of several years.
Foot – When the foot is curved inwards, it is called metatarsus adductus. For this condition, your doctor may sometimes teach you some stretching exercise, which you can do yourself at home, to help straighten out the feet. Sometimes, if it does not correct on its own, your doctor may suggest applying plaster casts or braces to the feet.
Q. Is in-toeing painful? A. No, children with in-toeing usually have no pain or any functional problem.
Q. Should I take my child to a doctor for in-toeing? A. In-toeing by itself is not a cause for concern. You should see a doctor if, along with the in-toeing, your child has any other problems, such as
Pain
Limping
Delayed development
Weakness
Q. Does my child need to have any tests done? A. Your doctor will take a thorough history, particularly regarding how your child was born, and how his/her development has been. He/she will watch your child walk, run, sit and will assess the movements at the joints. He/she will also check for the function of the nerves and whether there is any muscle tightness. All this is usually sufficient to decide whether the in-toeing is consistent with normal development in your child. Rarely, if there is any doubt, an x-ray may be needed.
Q. Will my child’s walking improve? A. In most children, the twist in the bone gradually straightens out as the child grows older. This occurs over several years, hence you may not even realize it. It is helpful to take a video of your child walking once a year and compare the videos over time so that you can appreciate the improvement.
Q. Does my child need special shoes/braces? A. No, special shoes/braces have no role in in-toeing.
Q. Is there anything I can do to help my child walk better? A. Children who have a habit of sitting in the ‘W’ position should be weaned out from this habit. They should be encouraged to sit cross-legged instead. Your child should have a good diet, rich in calcium and should get regular sunlight exposure. This helps his bones grow normally and become strong.
Q. My toddler trips and falls a lot. Is it because of the in-toeing? A. It is very common for toddlers to trip and fall often. Toddlers are just learning to walk, and they have yet to master control over their muscles, balance and co-ordination. It may appear as if the in-toeing is causing the tripping to happen, however this usually is not true. As your child becomes stronger and more coordinated, the tripping will improve.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘out-toeing’? A. ‘Out-toeing’ is when your child’s feet point outwards instead of straight ahead when he/she is walking/running.
Q. What causes out-toeing? A. Some amount of out-toeing is actually normal. Most people walk with their feet pointing slightly outwards rather than straight ahead. In some children, it may appear to be excessive, however this usually corrects on its own.
Out-toeing is less common than in-toeing, and is usually noticed in older children (school age), whereas in-toeing is usually seen in toddlers. It sometimes runs in families.
Usually, out-toeing occurs due to an outward twist in the bones of your child’s legs. This outward twist may be at any one of the three parts of your child’s lower limbs – the thighbone (femur), the shin bone (tibia) or the foot.
Q. Is out-toeing painful? A. No, children with out-toeing usually have no pain or any functional problem.
Q. Should I take my child to a doctor for out-toeing? A. Out-toeing by itself is not a cause for concern. You should see a doctor if, along with the out-toeing, your child has any other problems, such as
Pain
Limping
Delayed development
Weakness
Q. Does my child need to have any tests done? A. Your doctor will take a thorough history, particularly regarding how your child was born, and how his/her development has been. He/she will watch your child walk, run, sit and will assess the movements at the joints. He/she will also check for the function of the nerves and whether there is any muscle tightness. All this is usually sufficient to decide whether the out-toeing is consistent with normal development in your child. Rarely, if there is any doubt, an x-ray may be needed.
Q. Will my child’s walking improve? A. In most children, the twist in the bone gradually straightens out as the child grows older. This occurs over several years, hence you may not even realize it. It is helpful to take a video of your child walking once a year and compare the videos over time so that you can appreciate the improvement.
Q. Does out-toeing require any treatment? A. In most cases, the child grows out of out-toeing without any treatment. Your doctor may ask you to follow up every few months to monitor your child’s progress. Rarely, of the out-toeing does not resolve on its own by the time the child is older, it can cause knee pain, limping and problems of the knee cap. In such cases, surgery may be required to untwist the bone. However, this is very rare, and is considered only in older children (adolescents).
Rarely, the out-toeing may actually be a sign of some underlying problem, such as SCFE, Perthes disease or cerebral palsy. In such cases, it is often associated with pain and is usually asymmetric (present only on one side, or more in one side than the other). Such children will require treatment depending on the disorder.
Q. Does my child need special shoes/braces? A. No, special shoes/braces have no role in out-toeing.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What Are Bow-legs? A. When a child with bowlegs stands with his or her feet together, toes pointed straight ahead, and the knees do not touch, he or she has bow-legs. The medical term is “genu varum”. It may come from the thighbone (femur), shinbone (tibia) or both.
Q. What Are Knock-Knees? A. When a child with knock-knees stands with his or her legs together, feet pointed straight ahead, and the knees touch but their ankles do not, he or she has knock-knees. The medical term is “genu valgum”. It too may come from the thighbone, shinbone or both.
Q. So, What’s Normal (Physiological) Bow-legs And Knock-knees? A. A newborn child is normally born with about 10 to 15 degrees of varus angulation. The angulation gradually decreases in the second year of life and reaches 0 degrees by 2 years age. This normal varus angle which persists till the age of 2 years is called “Physiological” bowlegs. Thereafter the knee starts growing into valgus and reaches a peak valgus angle of about 10 degrees by the age of 4 years. This normal valgus angle is called “Physiological” knock-knees. After the age of 4 years, the valgus decreases to adult angle of about 6 degrees valgus by the age of 8 years.
Q. So, What Are The Red-Flag Signs To Identify Abnormal Or Pathological Deformities Which Need Treatment? A. Any deformity which fails to follow the above normal pattern is deemed to be abnormal. · Deformity persisting beyond the above mentioned ages. E.g Bowlegs in a 7 years old Child · Deformity more severe than the above mentioned angles. E.g: Bowlegs angulation of 20 degrees in a 2 years old Children, Asymmetrical deformity, deformity in association with an underlying skeletal dysplasia, following an infection/trauma or due to underlying metabolic bone disease.
Q. What’s The Treatment Of Bow-legs And Knock-knees? A. The first step in the treatment of bowlegs and knock knees is establishing the diagnosis, which is done on the basis of clinical examination, blood investigations (blood levels of Calcium, Vitamin D,etc.) , X-rays and in special situations advanced imaging like MRI, CT-scan, etc.
In most of the cases, bowlegs/ knock-knees is normal (physiological) in which case parents need to be reassured that the deformity will automatically resolve with age. In cases where the deformity is abnormal (pathological), treatment may consist of: - Medical treatment: Supplementation with Calcium and Vitamin D is needed in cases where the deformity is secondary to a nutritional deficiency of these nutrients.
Surgical treatment: is needed in most cases of pathological (abnormal) bowlegs and knock-knees. Surgical treatment is broadly of two types:
Growth modulation (guided growth) with eight plates: The eight plate is a metallic device which is implanted in the growing bone straddling the growth plate. The eight plate functions by guiding the bone growth in such a way that the deformity corrects with growth. This technique is an ideal modality for younger children with healthy growth plates with sufficient growth remaining.
Corrective Osteotomy: Osteotomy is a surgical procedure in which the deformed bone is cut at the level of deformity, the deformity is corrected and the bone is fixed in the corrected position with implants to maintain correction. It is a larger surgical undertaking than a growth plate and needs to be performed in older children or in children with damaged growth plates in whom the potential for remaining growth is limited.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is rickets? A. Rickets is a disease caused by deficiency of certain nutrients (vitamin D, calcium or phosphorus) in growing children. It causes bones to become weak and over time they become crooked and deformed.
Q. What are the risk factors for rickets? A. Rickets is most commonly a nutritional disorder. Risk factors include:
Poor diet – Diets poor in Vitamin D and calcium can result in rickets. This often occurs in strict vegetarian diets, and when children are very fussy with what they eat.
Lack of sun exposure –Vitamin D is naturally produced in the body, when human skin is exposed to sunlight. Lack of exposure to sunlight can be a cause of Vitamin D.
Exclusive breast feeding – Breast milk has very small amounts of vitamin D. Children who are exclusively breast fed need to be given supplemental Vitamin D.
Q. Can rickets be hereditary? A. A small proportion of cases of rickets do not respond to supplementation with the usual doses of Vitamin D and calcium. These cases are due to genetic disorders that interfere with the metabolism of Vitamin D and calcium in the body. Such disorders are collectively called ‘resistant rickets’. This sub-group of rickets is hereditary.
Q. How can I tell if my child has rickets? A. Rickets is usually discovered when parents notice deformities of the legs. They are usually curved, known as bow-legs. Besides, the child is often weak and easily becomes tired. The child’s wrists and ankles appear disproportionately widened. The child’s growth and development are slowed down.
Q. How does a doctor diagnose rickets? A. The diagnosis of rickets is usually apparent on examination of the child. It can be confirmed by taking X-rays of the wrists and knees. To determine the severity of the disorder, your doctor will usually also ask for blood tests to check for the levels of calcium, phosphorus and Vitamin D. In cases where your doctor suspects ‘resistant rickets’, he/she might refer you to an endocrinology specialist, i.e., a doctor specializing in hormonal disorders.
Q. How is rickets treated? A. Rickets is treated with calcium and Vitamin D supplements. Vitamin D is given in the form of powder or granules, to be dissolved in water or milk, and taken once a week. Calcium, in the form of syrup or powder is taken daily. After a month of starting treatment, your doctor will take an X-ray to check for signs of improvement. Exact dosing and form of medicines will be told by your doctor.
Q. Can children with rickets recover? A. Most children with rickets do well once treatment is started. The tiredness and weakness recovers first, and the child soon becomes active and playful. The bony deformities, for example bow legs, take legs to recover, usually several months.
Q. Will my child need surgery? A. In most cases, the bony deformities due to rickets gradually recover. In some cases, especially in older children who are close to completing growth or have very sever deformities, surgery may be necessary.
Q. What are the good sources of Vitamin D and calcium? A. Good sources of calcium include:
Milk and milk products (cheese, curds)
Ragi (nachni)
Spinach
Soyabean
Eggs
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
Q. What is ‘pulled elbow’? A. ‘Pulled elbow’, also called ‘Nursemaid’s elbow’ is an injury to the elbow that occurs in young children. It occurs when a child’s hand is pulled and a part of the elbow joint dislocates.
Q. What exactly happens in pulled elbow? A. The elbow joint consists of three bones – the upper arm bone (humerus) and the two bones of the forearm (radius and ulna). The connection between the arm bone (humerus) and the bone on the outer side of the forearm (radius) is responsible for the rotatory movement occurring at the forearm, i.e. turning the palm to face up and down (Imagine how a screwdriver is used – that is the movement – screwing and unscrewing).
The bones forming this joint are held in place by a strong ligament known as the ‘annular ligament’. In small children, this ligament is a bit loose. Sometimes, when the child’s hand is pulled in a certain way, the forearm bone (radius) slips out from under the annular ligament. This is called a joint dislocation. This is what happens in pulled elbow.
Q. What causes pulled elbow? A. Pulled elbow typically occurs when a caregiver holds a child’s hand or wrist and suddenly pulls on it, for example, to prevent the child from falling or to help the child climb a step. It can even happen while playing, when an older child swings the young child around holding just his/her hands. Thus, pulled elbow almost always occurs after a ‘pulling’ injury.
Pulled elbow usually occurs in children aged one to four years, but can even occurs up to six or seven years age.
Q. How does the doctor diagnose pulled elbow? A. Because the dislocated joint is painful, the child cries and refuses to move the entire arm. He/she holds the arm by the side and does not allow anyone to touch it. A doctor can usually diagnose a pulled elbow based on how the injury occurred and the manner in which the child holds the arm.
Q. Are X-rays required? A. An X-ray is not required to diagnose a pulled elbow itself. However, if the mechanism of injury is different, your doctor may request an X-ray to rule out broken bones.
Q. How is pulled elbow treated? A. Pulled elbow can be treated by a simple maneuver that the doctor performs to slip the bones back into the normal position. The child’s pain is immediately relieved, however small children usually cry while the maneuver is done. Your doctor will usually ask you to wait a short while and reassess your child after that. Children typically become playful again and start using the arm as normal.
Q. Can pulled elbow happen again? How can I prevent it? A. It is important to understand that pulled elbow can happen again and again. To prevent it, parents and caregivers must remember certain simple measures:
To safely lift a child, grasp him or her gently under the arms. Do not lift children by holding the hands or arms.
Do not swing a child by holding the hands or arms
Avoid tugging or pulling on a child’s hands or arms.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider/doctor with any questions you may have regarding a medical condition.
You may contact : Department of Paediatric Orthopaedics, KGMU, Lucknow, U.P.
A. A tumor is a lump or mass of tissue that forms when there is
uncontrolled multiplication of cells. A tumor may continue to grow and
replace healthy tissue. It may weaken the bone to the extent that there may
be a fracture.
Q2. What are the types of bone tumors ?
A. The bone tumors are of TWO main types:
Benign (Non cancerous)
Malignant (Cancerous)
Q3. What are the symptoms of bone tumors ?
A. The symptoms of bone tumor include:
Movement restriction
Pain, may be worse at night.
A lump/swelling
Stiffness
Aggravation of pain on pressing the involved bone (Tenderness)
Weight loss, fever
Fatigue
Bone fracture, especially after a slight trauma
CAUTION!! Some tumors may be asymptomatic and are diagnosed incidentally.
Q4. What is the difference between a benign tumor and a malignant tumor ?
A benign tumor is rarely fatal, has a slow growth, is localized and does
not spread, does not recur after proper treatment.
A malignant tumor means a cancer, it is fatal if not treated on time, grows
very fast, spreads to neighboring tissues and lungs etc, may recur.
Q5. What causes bone tumors ?
A. The exact cause is not known, but there are certain RISK FACTORS:
Previous chemotherapy or radiotherapy for some other cancer.
Infections of bone
Genetic or hereditary causes.
Trauma/injury to bone.
Q6. What to do if you suspect a bone tumor ?
A. In case you suspect a bone tumor/ patient is having the above mentioned
symptoms, immediately consult a specialist. Your doctor will ask certain
questions regarding the pain(if present), the speed of growth of the lump
etc. He/she will examine the patient and order certain investigations, like
Xray and/or MRI.
Q7. How is the diagnosis of bone tumor made?
A. The diagnosis of bone tumor is made by taking a detailed history from
the patient/parents, examination and analyzing the X ray and/or MRI. In
majority of cases the diagnosis is achieved by these tests only. However in
some cases the doctor may advise for a biopsy.
Q8. What is biopsy ?
A. Biopsy is a procedure, which is done to take a sample of the tumor
tissue and examine it under the microscope. It helps in pin pointing the
exact diagnosis. However remember not all tumors, specially the benign
tumors, need a biopsy.
Q9. How is biopsy done ?
A. The biopsy can be done by simply piercing a thick needle into the
swelling, under local anesthesia, this technique is known as NEEDLE BIOPSY.
In some cases biopsy is done by surgically cutting the skin and taking out
a piece of tumor tissue which is subjected to microscopic examination. This
is known as OPEN BIOPSY. Open biopsy is done under general/regional
anesthesia.
Q10. What is the treatment of bone tumor ?
A. The treatment of bone tumor depends whether the tumor is benign or
malignant. Your doctor may remove the tumor and use some bone from the leg
or the pelvic bone to fill up the defect. In case of a malignant tumor your
doctor may advise chemotherapy/radiotherapy before and after perfoming the
operation. The operation for malignant tumor may be done to save the limb
whereby the tumor containing bone is removed totally and the defect that is
created is filled up either by a bone graft or an artificial metallic
implant. In advance cases the tumor containing limb may be removed
(amputation).
For any further information: Visit the Pediatric musculoskeletal tumor
clinic, every MONDAY between 11:00 AM to 2:00 PM, New OPD
block, room no. 425, KGMU, Lucknow.