Orthopedic Problems

Richard A. Feely, D.O., FAAO, FCA, FAAMA

The vast majority of orthopedic problems in childhood are seen in the lower extremities: the feet, legs, knees and hips. When one considers the vast changes that a small body must make as it grows from its cramped in utero position through crawling to walking, it is not surprising to find problems in the lower extremities.

The orthopedic condition routinely evaluated for at birth is “congenital hip,” where the head of the femur (upper leg bone) cannot seat itself in the too shallow depression present in the ilium (hip bone). Though it must be treated with bracing, osteopathic treatment helps to normalize the joint functions which were inevitably disturbed by the bracing. Osteopathic manipulative treatment, which looks to improve body function through addressing body structure, assists in the resolution of many common orthopedic conditions of childhood.

Tibial torsion, the outward bowing of the lower leg, is caused b the cramped folding of the baby's legs in utero, and often resolves spontaneously in the first year of life. However, if the torsion is accompanied by a distortion between the knee cap and the tibial bone, or between the tibia and the nearby fibula, these should be treated osteopathically, preferable before the baby begins to walk. When babies first stand, they often place their feet far apart for stability, thereby standing on the inside edges of their feet. If the stance remains wide beyond the first few months of walking, osteopathic treatment is recommended.

Falling hard on one's bottom is another normal component of learning to stand but is hard on the relationship between the sacrum (at the base of the spine) and the vertabrae of the lower back. This common insult, left untreated, is probably one of the underlying causes of low back pain suffered by adults.

Toddlers

Between 10 and 14 months of age, most children begin to walk. As more balance is gained, the distance between the feet should become the same as the distance between the hips, and the feet should point straight forward when the child stands, walks or runs.

If this normalization of postural stance is not gained spontaneously, osteopathic evaluation and treatment should be pursued. The causes may be found in disturbed relationships of the bones of the pelvis or legs or in abnormal tensions of the connective tissues or muscles. Correcting these osteopathically early in life will foster healthy structural growth throughout childhood and adolescence. Although standard medical counsel advises waiting, with an expectation that gait abnormalities will resolve themselves, we all have seen school children and adults plagued with gait problems and the frequently associated back pain.

Older Children

Sports injuries are the cause of the vast majority of structural problems in this age group. Though they may not result in “skeletal deformity” (the common definition of an orthopedic problem), they are worthy of osteopathic consideration.

Children are physically active by nature and should be both encouraged and enabled to engage in the physical activities that interest them. However, they as well as their parents must be prepared to accept the periodic injuries that accompany physical activity.

Knee injuries are common in basketball due to the necessity of rotating one's body over a foot planted on the court. Running sports, such as track and soccer, are ideally done only by children whose hip, knee and ankle line up vertically. Poor alignment fosters more frequent and more severe injuries. All activities played with balls involve the risk of impact from the ball, the most serious location being the head. The intentional “headers” of soccer are less damaging to the normal motion mechanics of skull joints than are accidental impacts. Football, gymnastics, and snow or ice-based sports are fraught with potential injury. Osteopathic treatment to release the sprains, strains and bony misalignments as they occur is good insurance toward a healthy and pain-free adulthood.

Some skeletal problems of childhood affecting the hips and/or knees, such as slipped epiphysis, Perthes' disease, Osgood Schlatter disease and synovitis, require cessation of sports activities for variable periods of time. Though they each have their appropriate orthopedic treatment, the recovery of full and pain-free joint function can be aided by osteopathic treatment, both during and after the disease process.

Scoliosis

Scoliostic curves of the spine are most commonly, though not exclusively, seen in girls between the ages of 10 and 14. The curves vary widely in their severity. The more severe fixed curves require bracing or surgical treatment. In scoliosis, the vertebrae are both sidebent and rotated. Ribs are displaced, and muscle groups are stretched or shortened. There is often a hip height discrepancy.

Although discomfort is rare during adolescence, both pain and disability are likely to be experienced later in life if left untreated. Osteopathic manipulative treatment can be beneficial for both the more mild functional curves and for curves requiring more invasive measures. Osteopathic treatment can improve both spinal mobility and degree of curve.