Common conditions

Intoeing and Sitting in W position

You might notice your child walking with toes facing inwards (intoeing or intoe gait) instead of pointing straight ahead during walking or running. Children who intoe often also sit in the “W” position with their feet to the sides of their legs. This is OK and does not do the child any harm. The child should be allowed to sit as they are comfortable to do so.

This is sometimes called walking pigeon-toed and is commonly found among children at various ages and for different reasons. Intoeing almost always corrects without treatment as the child grows older, although some adults also intoe. 

Orthopaedic assessment is suggested for older children who continue to intoe. Visit your doctor (GP) to arrange for a referral for your child to be assessed. 

The British Society for Children’s Orthopaedic Surgery website offers a range of patient information and leaflets: https://www.bscos.org.uk/public/events-education/patient-information-leaflets

Flat feet

Parents and carers are often concerned about the shape of an infants foot. Terms often used include “dropped arches” or “walking on the inside of the foot”. This usually causes no problems for the child but may cause shoes to wear quickly.

The height of the foot arch varies from person to person and indeed from age to age. It often reflects the childs flexibility which may be evident in other joints. As children age and become less flexible the arch becomes more obvious.

The presence of the arch can be confirmed by asking the child to walk on tip toes. This will accentuate a flattened arch and confirm if it is actually present.

Using insoles

An insole will not improve the appearance of the arch but may help with footwear if shoes become mis-shapen rapidly due to the shape of the flexible flat foot. 

A medial wedge insole can be obtained from most chemists or from internet retail outlets without orthopaedic assessment. Surgery is very rarely required and is reserved for teenagers who have major problems with shoewear.

Orthopaedic assessment for flexible flat feet is advised in those over 6 years of age who have tried medial wedge insoles without any benefit.

The British Society for Children’s Orthopaedic Surgery website offers a range of patient information and leaflets: https://www.bscos.org.uk/public/events-education/patient-information-leaflets

We often see children whose parents are concerned about the shape of their childs’ legs. Toddlers often have quite bowed legs especially when they first start walking.

This usually straightens up quickly and actually goes the other way, becoming quite knocked knee by the age of 3-4. The adult shape of legs is most often seen by the age of 6-7.

This process is the normal way that children’s legs grow and is called the Salenius curve. Orthopaedic assessment is recommended if this normal development is either not seen or significantly delayed.

The British Society for Children’s Orthopaedic Surgery website offers a range of patient information and leaflets: https://www.bscos.org.uk/public/events-education/patient-information-leaflets

Growth related anterior knee pain

Unexplained knee pain is extremely common in teenagers and older children. There is often a history of several months of knee pain prior to seeking medical advice.

It is rare for an injury to be responsible for the pain. The knee examination is usually normal. 

Knee pain can come from the hip. If your child or teenager has knee pain with groin or anterior thigh pain, please seek medical attention. If they cannot weight bear, this needs urgent medical attention.

Growth spurts

Current medical thinking behind this syndrome relates to the rapid growth that occurs in most 14 -16 year olds. The bones on either side of the knee joint (femur and tibia) lengthen, tensioning the hamstrings and quadriceps muscles thus reducing their flexibility.

A musculoskeletal specialist may pick up signs of poor hamstring length. This is easily detectable when teenagers can’t touch their toes or are unable to perform a single leg raise with their knee perfectly straight.

Get fit and flexible

Rather than avoiding physical activity it is best to encourage your teenager to keep fit by doing exercise such as dance, yoga and martial arts that improve flexibility.

These activities have been shown to reduce the severity of unexplained knee pain in teenagers.

The British Society for Children’s Orthopaedic Surgery website offers a range of patient information and leaflets: https://www.bscos.org.uk/public/events-education/patient-information-leaflets

We use the Ponseti method of treating club feet (also known as talipes, CTEV or talipes equinovarus). The Ponseti method is a technique to straighten the feet, which has been successfully used for over 45 years.

The treatment manipulates the bones and stretches the contracted tissues of the foot. The foot is held in place with a plaster cast. The cast is left on for seven days and then changed in clinic. This allows enough time for the muscles and ligaments to relax and for the bones to grow into the corrected position. Towards the end of cast treatment your child will undergo a small procedure to release the Achilles tendon. In small babies, this is usually done under local anaesthesia in clinic. 

Once your child’s feet have been corrected, you will need to maintain the correction using a brace called “boots and bar”.

Find our more information about clubfoot and treatments on the STEPS website: https://www.steps-charity.org.uk/conditions/talipes-clubfoot/

Another common condition we treat is DDH (also known as developmental dysplasia of the hip, dislocated hip or clicky hips). The treatment for this condition depends on the age at which the diagnosis is made. In babies treatment is often successful with a harness (Pavlik harness). In infants and pre-school children some form of surgery is nearly always required.

If your GP or midwife is concerned about your baby’s hips you will be referred for an ultrasound either in the radiology department or in the clinic. If needed treatment with the harness will be started, it is usually possible to start treatment on the day you are seen.

Find our more information about hip dysplasia and treatments on the STEPS website: https://www.steps-charity.org.uk/conditions/hip-dysplasia-ddh/

Perthes’ disease

Perthes’ disease is a painful disorder of childhood in which the blood supply to the head of the thighbone (femoral head) is reduced. This causes the femoral head (the ‘ball’ in the ‘ball and socket’ joint of the hip) to soften and break down; a process known as ‘avascular necrosis’. The underlying cause for this reduction in blood supply is currently unknown.   

It is not a common disorder and only affects about one in 10,000 children. It tends to affect children between the ages of four and eight years, although rarely it has occurred in children as young as two and as old as 12 years.  Boys are more likely to be affected than girls.   

The main way to diagnose Perthes’ disease is to x-ray the hips. This is done at regular intervals to look for any changes in the hip joint and the shape of the head of the femur. 

Children with Perthes’ disease tend to complain of pain in their hip, which is worse during movement and causes them to limp. They usually become less active because of this. In 90% of cases the disorder will only affect one hip, although it can affect both. Symptoms can continue for weeks at a time, or they may recur now and then.  

Orthopaedic staff help to relieve the symptoms of the disease when the hip is painful or irritable, which usually lasts about three weeks.  We encourage patients to rest the hip and take gentle exercise, give pain relief and hold regular reassessments.

The hip joint often recovers over time and children may just have to attend regular check-up appointments over two or three years. However, in some cases an operation is required to position the head of the thighbone correctly within the hip joint.   

Find our more information about Perthes’ disease and treatments on the STEPS website: https://109.108.132.232/aboutus/departments-services/childrens-services/orthopaedics/common-conditions/perthes-disease/CENEWLINK