Commonly Encountered Orthopaedic Conditions in Children

All of us love to see children running around, laughing and playing – their happiness is infectious and uplifting. However, certain orthopaedic conditions can prevent children from being their active selves. The good news is that with early treatment these conditions can be treated and children can have a happy and lively childhood.
Given below are some of the commonly encountered orthopaedic conditions in children.

Flat Foot

• If you observe the soles of your feet, you will notice an arch in each one.
• Children however are rarely born with the arch and it develops over time – usually by around 6 years of age.
• In some cases, the arch never forms. This condition is called flat foot.
• In some youngsters with flat feet, pain might be felt on the sole of the foot, while others might be completely asymptomatic.
• When symptoms do manifest, they can take the form of the following:
  • Cramping in the legs
  • Pain in various parts of the foot
  • Pain felt while walking
  • Pain in the muscles of the foot and leg
  • Problems with balance and stability

• A physical examination along with x-rays are used to diagnose flat feet.

Treatment is most often non-surgical – rest, medication to handle pain, exercises for strengthening and using orthotics which will effectively help in managing the condition.

In very rare cases, surgery might be suggested.

In-Toeing

• This is a condition in which the child’s feet are rotated inwards and the toes of both feet point towards each other instead of forward.
• There are 3 reasons due to which in-toeing may manifest:
  • Due to the confined space of the uterus, the baby might develop with its feet turned inwards.
  • In some cases, toddlers who did not have in-toeing when they were born developing it later on. This is due to the shinbone being twisted.
  • Children aged 3 years or more can have the thigh bone twisted resulting in in-toeing.

• In-toeing is usually genetic and is diagnosed with a physical examination, X-ray and CT scan.
• If the child does not outgrow the problem, a consult with an orthopaedic specialist is recommended.
• Treatment includes casts to set the bone properly. The doctor might also suggest massaging techniques to help with the condition.
• It is only for very serious cases that surgery will be suggested.

Bow Legs

• This is a commonly encountered condition in children. The legs are moved outward at the knees coming back together at the feet.
• This gap in between the lower part of the legs might be due to one leg or both legs bending outwards.
• When walking, the bow legs seem even more obvious.
• Doctors will usually wait for the condition to resolve on its own, which it often does.
• But if the child exceeds 3 years of age without outgrowing it, then further probe into the cause of bow legs is warranted. The doctor will rule out conditions like rickets and Blount’s disease.
• However, parents need not worry that a child’s ability to walk will be affected by bow legs as these children do not lag behind their peers when it comes to starting to walk.
• Sometimes, bow legs and in toeing both will be present.
• While children are unaffected by bow legs and do not complain of pain, when the condition persists in adolescence, some joints like the hip, knee and ankle can be subjected to stress because of it.
• When one leg is bowed more than the other, diagnosis involves physical examination and X-rays.

Treatment options, if the child does not outgrow bow legs on his own, include determining the underlying cause and treating it. Braces for children with Blount’s disease and medication for rickets are usually prescribed if those conditions are present.

When the condition does not respond to the above non-invasive treatment options, surgery will be suggested.

Knock Knees

• This is a reversal of the bow legs condition listed above. Knock knees, as the name implies, are when the knees point towards each other and as a result, the feet don’t come together.
• Girls are more prone to knock knees than boys.
• The condition often resolves on its own.
• Children under a year rarely exhibit knock knees which usually manifests only on toddlers.
• By 7 years, knock knees will, in most cases, resolve itself.
• Knock knees can have various causes:
  • In small children who are learning to walk, knock knees might actually help them balance better.
  • Sometimes there are other underlying reasons like rickets, being overweight or sustaining a leg injury.

• In rare cases where the condition does not resolve itself but actually worsens exhibiting symptoms like pain or a pronounced limp, the doctor will suggest treatment options that will aim at treating the cause of the condition.
• In extremely rare cases, surgery will be advised. Two possible surgical procedures can be performed:
  • Guided Growth Surgery: This involves inhibiting the growth of the bent bone to give time for the other side to grow and resolve the condition. It is performed on adolescents before they experience their growth spurt.
  • Osteotomy: Done only for severe cases, here a part of the bone is shaved off to resolve the condition.

Toe Walking

• Here, the child starts to walk on only the toes of his feet without resting the heel on the ground.
• Like all the aforementioned conditions, toe walking too will eventually resolve in most cases – typically by around 5 years of age.
• If it persists beyond that, an orthopaedic doctor should be consulted.
• The doctor will check for other conditions that might result in the child’s toe walking. These conditions include cerebral palsy, autism, a contracted Achilles tendon or an underlying genetic disorder.

Treatment options include the following:

• Physiotherapy to stretch and strengthen the muscles
• Braces or casts to induce the child to walk normally
• Administering certain injections which will help with the condition
• Surgery as always is the last option – it involves increasing the length of the muscle/tendon to aid in overcoming toe walking.