Presentation is loading. Please wait.

Presentation is loading. Please wait.

PIGEON TOES, KNOCK KNEES, AND FLAT FEET: WHEN TO SEE THE ORTHOPAEDIC SURGEON I.M. Doctor, M.D. My Office My City, State.

Similar presentations


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:

1 PIGEON TOES, KNOCK KNEES, AND FLAT FEET: WHEN TO SEE THE ORTHOPAEDIC SURGEON I.M. Doctor, M.D. My Office My City, State

2 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 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 4 What is an orthopaedic surgeon?  The expert in treating the musculoskeletal system  The expert in maintaining musculoskeletal health

5 5 Educating an Orthopaedic Surgeon  College  Medical School  Internship  Orthopaedic Residency  Fellowship (optional)  2 Years Practice TOTAL (1) 2 16 years!

6 6 What do orthopaedic surgeons do?  Diagnose  Treat  Medication  Physical Therapy  Exercise  Brace  Surgery  Prevent

7 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 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 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 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 11 What is normal? What is abnormal?

12 12 History  What is the specific concern?  When does it manifest?  Duration?  Improving or worsening?  Patient’s medical history and family medical history

13 13 Who is concerned?  Parents  Grandparents  Pediatrician  Teachers  Others

14 14 In-toeing and Out-toeing

15 15 In-toeing  Common in babies and toddlers  Almost always resolves without treatment

16 16 In-toeing  Not painful in and of itself  Not associated with early arthritis  Can rarely be associated with knee pain and problems

17

18 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 19 In-toeing: Metatarsus Adductus  Majority are flexible  Resolves by 3-4 years of age  10% stiff and may benefit from casting

20 20 In-toeing: Tibial torsion  Common in infants  Usually resolves itself  May be treated with surgery in more serious cases

21 21 In-toeing: Femoral antetorsion

22

23 23 In-toeing: Treatment  No treatment necessary in most cases  Ongoing observation may be recommended  Surgery in some severe cases

24 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 25 Out-toeing  Usually in normal range  Usually causes no problems  Rarely requires special care

26 26 Angular Problems  Knock-knees (genu valgum)  Bow legs (genu varum)

27 27 Angular Problems

28 28 Angular Problems  Physiologic  Pathologic  Trauma or injury  Rickets  Tibia vara (Blount’s disease)  Skeletal dysplasia

29 29 Angular Problems

30 Age 2Age 4

31

32 2 2+4

33

34 34

35 35 Flatfoot  All infants have it  Most children have it  More than 15% of adults have it

36 36 Flexible flatfoot  Often resolves with growth  Not correlated with disability in military populations  Not affected by special shoes, inserts, or braces

37 37 Stiff flatfoot on the right – does not correct on toe standing Stiff flatfoot

38 38 More foot pathologies to consider  Clubfoot  Calcaneovalgus foot

39 39 Clubfoot  Incidence 1:1000  Boys > girls  One or both feet turned inward  May sometimes be genetic

40 40 Clubfoot treatment  Serial manipulations and casting  Begin first week of life, if possible  Perform weekly  90% of routine clubfoot respond

41 41 Calcaneovalgus foot  Most common foot deformity at birth  Foot points up  Resolves spontaneously  Associated with hip dysplasia

42 42 When do you need to see a pediatric orthopaedic surgeon?  Over three years of age with documented progression of deformity  Stiff metatarsus adductus

43 43 When do you need to see a pediatric orthopaedic surgeon?  Bowing  below the 5th percentile for height  marked asymmetry  Marked knock-knees or in- toeing in patients over 8 years of age

44 44 American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL Resources

45 45 What are your questions and concerns? Pigeon Toes, Knock Knees, and Flat Feet

46 46  Thank you for participating today  Remember, your orthopaedic surgeon can help get you back in the game Pigeon Toes, Knock Knees, and Flat Feet


Download ppt "PIGEON TOES, KNOCK KNEES, AND FLAT FEET: WHEN TO SEE THE ORTHOPAEDIC SURGEON I.M. Doctor, M.D. My Office My City, State."

Similar presentations


Ads by Google