Congenitally clubfoot can be unilateral or bilateral. Some of these feet are not genuine clubfoot and can be corrected with simple massages. In true clubfoot, the primary health problems of the mother and baby are resolved immediately after birth. Improvement is achieved with weekly casts repeated 6-7 times. A small intervention called tenotomy is required in 90% of patients. (Ponseti Method) The success of the treatment depends on the compliance of the family, child and physician.
Cerebral Palsy.
It is a disease that develops as a result of the brain being deprived of oxygen. This may occur while the mother is pregnant with the baby, or for various reasons that develop during and after birth. The condition is not progressive in the brain. However, involuntary contractions that develop in the muscles cause deformities in bones and joints over time. This may lead to difficulties in meeting the child's basic needs. Collaboration between Physical Therapy and Orthopedics plays an important role in its treatment.
Spina Bifida (Myelomeningocele)
Pregnancy It is a disease that can be diagnosed during the period. Depending on the degree of inflammation at different levels in the spinal cord, patients come to the doctor with varying degrees of loss of strength in the lower extremities and problems with urination and defecation. The orthopedic approach is the treatment of spinal cord and spine problems, as well as eliminating the deformity in the lower extremities and ensuring adaptation to the device. Sometimes it is difficult under the feet. Healing wounds can be opened. These problems can be resolved with appropriate orthopedic treatments
Internal and external pressure in children
Internal and external pressure in children
Assoc. Dr.Abdullah Eren
• Inward or outward turning of the foot is one of the main reasons why families consult a physician in walking children.
• Inversion: Single or multi-level, simple or It can also be complex
• Reasons for in-toeing
1 y = metatarsus adductus
3-4 y = int. tibial torsion(tibial introversion)
6 y = femoral anteversion
• Reasons for extrusion
External rotation contracture of the hips 0- 1 y
Femoral extroversion
Tibial extroversion
Footing calcaneovalgus(pesplanovalgus)
Initially mother Outward rotation of the lower extremities depending on the posture position on the abdomen is 2-3 degrees It then gives way to introversion. Three anatomical regions should be evaluated in in-out pressing. Foot-Tibia-Femur. When evaluating rotational problems, the patient begins with observation while walking. Femoral rotation is best measured by prone assessment. Rotations of the tibia are evaluated in the prone examination; Thigh-Foot Angle and TMA. A careful neuromuscular examination should be performed in these patients. In asymmetric rotations, neuromuscular disease and hip dysplasia should be excluded. Radiological evaluation can be made with AP-Lateral radiography and CT
Toe-toeing may be seen together with O-leg deformity in toddlers. There are also deformities in which femoral internal rotation and tibial external rotation occur together.
Spontaneous correction in inversion: approximately 25° (from 40° to 16°) in femoral anteversion, approximately 25° in tibial internal rotation. It is 10°(5° to 15°). Spontaneous recovery is not observed in patients with muscle imbalance such as Cerebral Palsy. These improvements do not occur in femoral and tibial external rotation. Femoral external rotation is associated with slipped upper end of the femur epiphysis and hip osteoarthritis. These patients get tired quickly during sports activities. Femoaral internal rotation does not have such an effect. Children with tibial internal rotation are more active in sports than those with external rotation.
Surgical correction is required more frequently in tibial external rotation in these patients. One should wait 8–10 years for correction. Supramalleolar level should be preferred for corrections in the tibia, and subtrochanteric level in the femur.
Developmental Hip Dislocation:
Hip dislocation and deficiency is a problem seen in newborns and childhood. Sometimes, as a result of delayed diagnosis, children come to the doctor limping. Hip dislocation in children; It can be corrected with early diagnosis and appropriate treatment. What is meant by appropriate treatment: During this period, it is to ensure that the hip settles gently into its socket without causing damage to the vessels feeding the hip bone. This problem that occurs after the treatment causes serious disabilities in the late period. One should remember that there is no beauty in this treatment by force. Even if these patients are late in the treatment, they will be unilateral. Successful results are obtained for dislocations up to the age of 10-11, and for bilateral dislocations up to the age of 6-7. However, previous head surgery Improper interventions have negative effects on the results.
Developmental Hip Dysplasia: (Socket insufficiency)
We cannot see the lameness seen in hip dislocation here. For this reason, it may not be noticed for a long time. They often present with pain radiating to the knee. Therefore, it is an insidious disease. It can sometimes be confused with a herniated disc. These inadequate hip joints play an important role in early arthritis. Early recognition of these patients and treatment before the age of 30-35 prevents early arthritis. .This treatment is an approach that corrects hip joint insufficiency and delays the need for a hip prosthesis.
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