Common Orthopedic Problems in Children
To identify the common nontraumatic orthopedic conditions in childhood
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Sanjay Sarup
Learning Objectives
1. To identify the common non-traumatic orthopedic conditions in childhood 2. To identify the normal physiologic variant from the pathological one 3. To appropriately identify the child that needs an orthopedic consult
Introduction This chapter on pediatric orthopedics (the term pediatrics encompassing a child and an adolescent in this section) encompasses a number of seemingly pathological conditions, which have a favorable natural history and improve with growth. These conditions are a challenge for the primary physician who sees the child initially, both in terms of making the right diagnosis, and managing the child and the parents with the right treatment advice. This is partly because a general pediatrician has little access to the subspecialty of children’s orthopedics in his/her years of training, and the natural history is not well known outside the pediatric orthopedic circles. The purpose of this chapter is to discuss some of these nontrau-
S. Sarup, MS Orth, DNB Orth, MCH Orth, FRCS Pediatric Orthopedic & Spine Surgery, Artemis Health Sciences, Gurgaon, Haryana 122001, India e-mail: [email protected]
matic conditions that are commonly encountered in a pediatric practice. The emphasis will be on diagnosis more than management, as identification of these conditions should normally lead to a pediatric orthopedic referral.
Case Vignette
A 3-year-old male was brought to the pediatric clinic with a history of going up on toes ever since he started to walk. The child was born full term by cesarean section. There were no untoward events. The birth weight was in the 50th percentile. The child had a normal perinatal period and normal milestones. There was a history of frequent falls. Clinical examination revealed an equinus gait – the baby was running around on toes with no heel contact during any part of the gait cycle. However, on standing for a few seconds, the stance would change to plantigrade with the whole foot in contact with the floor. General examination showed a generalized hyperlaxity, normal lower limb tone, and normal reflexes. The arches of the foot had not developed. The range of motion of the ankle and knee joints was normal. At this stage, common causes for toe walking needed to be differentiated: The differential diagnosis was mild spastic cerebral palsy, early Duchenne muscular dystrophy, and idiopathic toe walking (ITW).
© Springer Science+Business Media Singapore 2017 S. Sawhney, A. Aggarwal (eds.), Pediatric Rheumatology, DOI 10.1007/978-981-10-1750-6_16
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S. Sarup
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Blood work including creatine phosphokinase (CPK) levels, and an MRI of the brain were found to be normal. Therefore, the diagnosis of idiopathic toe walker was made by exclusion. This patient represents a classical presentation of an idiopathic toe walker – a seemingly normal child who walks on his or her toes for reasons that are not clear.
Idiopathic Toe Walking Toe walking is a common cause for an orthopedic referral. It is considered a part of normal gait pattern
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