Orthopedic Disorders in Children | Orthopedic Surgeons

Most private and government hospital have resident orthopedic surgeons. If you suspect that your child has got one of the following orthopedic conditions, do get a referral from your GP, family doctor or your pediatrician.

What are some common orthopedic conditions in children?
Bowlegs
This happens when your child stands with his feet and ankles together but his knees remain far apart. Bowlegs are usually physiological, meaning that they will straighten when your child starts to walk and by age three, most children grow out of this condition.However, if bowlegs persist beyond the age of three years, further assessment is needed to exclude underlying pathological causes.

Knock-knees
This is a condition where the legs curve in at the knees so much that the ankles are separated when your child tries to stand with his feet together. Many children become knock-kneed between the ages of three and five. When they are about six years old, the body straightens naturally and most children can then stand with their knees and ankles touching at the same time. Sometimes pathological knock-knees occurs and the distance between the ankles usually exceeds 15cm.

Flatfeet
This refers to the absence of an arch on the bottom of your child's feet between his toes and heel. Flatfeet happen when most of the foot surface is in contact with the ground. Most babies are born with almost no arch in their feet but this develops after they start walking.
Clubfoot
This is a deformity of the foot, present at birth, which can occur by itself or be associated with other disorders (spina bifida). The foot is curved in toward the midline and the toes point down. If both your baby's feet are involved, the soles of the feet face each other.

Congenital dislocation of the hip (CDH)
This happens when there is an abnormality of the hip joint. The hip joint is a ball and socket joint. The end of the leg bone forms a ball shape which rolls around in a cup-shaped socket in the pelvic bones. In CDH, the cup shape of the socket is shallow and allows the ball of the leg to slip in and out of the cup. This is usually detected by the doctor who examines your baby soon after birth.

Other than the structural abnormalities can these disorders give rise to other problems?
  • Pathological bowlegs and knock-knees may lead to
    • discrepancy between length of both legs
    • abnormal gait
    • early arthritis
  • Clubfeet may remain a permanent deformity if uncorrected
  • Congenital dislocation of the hip is associated
    • delayed walking
    • abnormal waddling gait
    • asymmetrical thigh creases
    • restricted movement of the affected hip
    • arthritis in later life
How should these conditions be treated?
  • Bow legs
    1. physiological bow legs do not need treatment as they will resolve spontaneously
    2. pathological bow legs :
      • determine underlying cause
      • close observation
      • surgery may be required
  • Knock-knees
    1. physiological - no treatment necessary
    2. pathological - treat according to cause
  • Flatfeet
    Flexible flatfeet cannot be fixed but they usually do not cause any pain or problems. Your child may need to wear arched inserts in the shoes if they have foot pain.
  • Clubfeet
    Treatment is urgent and should start at birth. Your child may need a series of casts, manipulation and strapping. Surgery is sometimes required.
  • Congenital dislocation of the hip
    Treatment consists of :
    1. Double nappies
    2. splint or plaster cast
    3. surgery in complicated cases
Close follow-up with the orthopaedic surgeon and physical therapist is important.

Reference:  http://www.myhealth.gov.my

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