બાળ ઓર્થોપેડિક્સ: બાળક માટે પરીક્ષા ક્યારે જરૂરી છે?

By ક્રિસ્ટિયાનો એન્ટોનિનો On જાન્યુ 5, 2023

પીડિયાટ્રિક ઓર્થોપેડિક્સ એ એક સુપર-સ્પેશિયાલિસ્ટ શાખા છે જે મસ્ક્યુલોસ્કેલેટલ સિસ્ટમના રોગો અને વિકૃતિઓના નિદાન અને સારવાર સાથે કામ કરે છે જે બાળકો અને યુવાનોને અસર કરે છે જેઓ હજુ પણ વૃદ્ધિ પામી રહ્યા છે.

What does the paediatric orthopaedist do?

The paediatric orthopaedist is responsible for diagnosing and treating (conservatively or surgically) all congenital, acquired and developmental orthopaedic problems in children and adolescents.

The key task is to be able to distinguish conditions that can be considered simple variations of normality from those that constitute true pathological conditions.

There are, in fact, certain developmental stages that are characterised by abnormalities that we can define as physiological, such as flat feet in very young children (a condition that is physiological under 3-4 years of age, but which usually tends to improve spontaneously with growth).

બાળ આરોગ્ય: ઇમર્જન્સી એક્સ્પોમાં બૂથની મુલાકાત લઈને તબીબી વિશે વધુ જાણો

Paediatric orthopaedics and limb alignment

Another example is the alignment of a child’s lower limbs, which naturally goes through a first phase of physiological varus (so-called “bracket knees”) in the first 2 years of life, and tends spontaneously to evolve towards a second phase of valgus (so-called “X-knees”).

This second phase is also usually transitory: although the deviation may be more or less pronounced, it reaches the peak of valgism around the age of 3.5-4 years, then the axis spontaneously returns towards the neutral axis, reaching, more or less at the age of 7-8 years, the typical axis of adulthood (physiological valgism).

These two phases of varus knee, and later valgus knee, are often a cause of concern for families.

The paediatric orthopaedist’s task is to be able to distinguish between physiological cases, for which evolutionary control is sufficient without taking measures, and cases that may conceal other problems for which earlier treatment is indicated.

The child’s flat foot … a problem that alarms many parents: what paediatric orthopaedics can do

As mentioned above, flat feet represent one of the most frequent reasons for a paediatric orthopaedics visit (and is often a source of concern for families), also because it is also one of the most controversial areas.

Flat foot (more correctly called “valgus foot”) is characterised by a reduction of the plantar vault (or plantar arch), often associated with hindfoot valgism (the heel makes an outward angle when viewed from behind, relative to the leg).

In children who begin to walk, the plantar vault is physiologically flat due to the presence of abundant subcutaneous fat tissue in the plantar part of the foot, but this tissue atrophies with growth.

Furthermore, physiologically, the foot shows a progressive development of the plantar arch, foot support and an improvement in heel valgus during the first ten years of life or so.

Basically, a high percentage of children have a flexible flat foot, which in the vast majority of cases will resolve spontaneously.

This implies that rigid orthopaedic insoles or rigid corrective shoes are of little use for prophylactic purposes for asymptomatic flexible flat feet.

Unfortunately, although most flat feet will meet with resolution, there are no studies or methodologies or rating scales that can help predict which feet will not show this physiological development and will remain flat.

However, the other important aspect to note is also that a large percentage of feet that will remain flat in adulthood will not show significant functional consequences or clinical problems and will not require surgery.

The paediatric orthopaedic surgeon’s role is therefore to assess the individual clinical picture in order to discern between physiological flat feet and some less frequent pathological forms (e.g. associated with neuro-muscular pathologies, abnormal formation of bone structures …), and to follow the patient during the course of growth to assess whether there may be indications for treatment.

Are there any signs in the child that paediatric orthopaedic eyesight is necessary?

In this regard, it is correct to specify that for each age group there are aspects to be evaluated.

In all infants between 4 and 6 weeks of age, a clinical and ultrasound assessment of the hips is very important in order to rule out hip dysplasia.

Also in this age group, particular attention must be paid to head deviations that may depend on simple positional factors, as well as muscular retractions or real bony deformities of the cervical spine.

Another typical aspect of the neonatal age is the evaluation of the feet: in fact, there may be mild pictures with deformities of postural origin (e.g., postural club-foot, foot-valgus-pronatus, metatarsus varus), or pictures resulting from congenital pathologies such as congenital club-foot, hypoplasia or reflex foot.

Asymmetrical deviations of the lower or upper limbs certainly require rapid evaluation by the paediatric orthopaedist.

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So do lamenesses or gait defects (a child who still walks on his toes after 2 years of age certainly deserves careful evaluation).

Again, in school age and adolescence, evaluation of the spine and lower limbs is important.

The finding of asymmetries of the trunk or differences in the length of the lower limbs must be carefully assessed in order to rule out scoliosis or asymmetrical growth between the two limbs.

Orthopaedic evaluations of young sportsmen and sportswomen are also quite common in these age groups (some foot and knee disorders may be typical of specific growth phases, but must still be evaluated and contextualised).

These are just a few examples of the many pathologies that a paediatric orthopaedist faces in his daily work.