Presentation on theme: "PIGEON TOES, KNOCK KNEES, AND FLAT FEET: WHEN TO SEE THE ORTHOPAEDIC SURGEON I.M. Doctor, M.D. My Office My City, State."— Presentation transcript:
PIGEON TOES, KNOCK KNEES, AND FLAT FEET: WHEN TO SEE THE ORTHOPAEDIC SURGEON I.M. Doctor, M.D. My Office My City, State
2 The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred. Thank you to Members of the Pediatric Orthopaedic Society of North America for contributions to the content of this presentation.
3 What is an orthopaedic surgeon? MD who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)
4 What is an orthopaedic surgeon? The expert in treating the musculoskeletal system The expert in maintaining musculoskeletal health
5 Educating an Orthopaedic Surgeon College Medical School Internship Orthopaedic Residency Fellowship (optional) 2 Years Practice TOTAL (1) 2 16 years!
6 What do orthopaedic surgeons do? Diagnose Treat Medication Physical Therapy Exercise Brace Surgery Prevent
7 What is a pediatric orthopaedic surgeon? Orthopaedic surgeons who have chosen to make the core of their practice the care of children and adolescents who have musculoskeletal conditions Typically have completed additional subspecialty training (fellowship) in pediatric orthopaedics
8 Why pediatric orthopaedics? Children are not just small adults Bodies are still growing Responses to injuries and conditions are different Communication skills, emotions and cooperation are different
9 When is a pediatric orthopaedic surgeon the best choice? For uncommon conditions When adult orthopaedic surgeons are not comfortable with evaluation or treatment When you have concerns that pediatric-focused orthopaedic care is needed
10 Pigeon Toes, Knock Knees, and Flat Feet zFeet turn out/in zKnock knees zBow legs zFlat feet Common conditions that are often normal:
11 What is normal? What is abnormal?
12 History What is the specific concern? When does it manifest? Duration? Improving or worsening? Patient’s medical history and family medical history
13 Who is concerned? Parents Grandparents Pediatrician Teachers Others
14 In-toeing and Out-toeing
15 In-toeing Common in babies and toddlers Almost always resolves without treatment
16 In-toeing Not painful in and of itself Not associated with early arthritis Can rarely be associated with knee pain and problems
18 In-toeing: Causes Metatarsus adductus – atypical twisting or bending of the foot Tibial torsion – twisting of the shin bone (tibia) Femoral antetorsion – twisting of the thigh bone (femur)
19 In-toeing: Metatarsus Adductus Majority are flexible Resolves by 3-4 years of age 10% stiff and may benefit from casting
20 In-toeing: Tibial torsion Common in infants Usually resolves itself May be treated with surgery in more serious cases
21 In-toeing: Femoral antetorsion
23 In-toeing: Treatment No treatment necessary in most cases Ongoing observation may be recommended Surgery in some severe cases
24 Out-toeing Toes pointing outward Less common than in-toeing Caused by twisting of hip, thigh, shin, or foot Unlikely to improve over time, unless a result of flat feet
25 Out-toeing Usually in normal range Usually causes no problems Rarely requires special care