Knee valgus, hip dysplasia, congenital clubfoot, Osgood Schlatter’s disease, hyperkyphosis or scoliosis: these are just some of the most common problems that parents find themselves having to face during the growth of their children or adolescents. These are not always actual pathologies, rather paramorphisms, i.e. conditions that resolve spontaneously with growth: in the field of pediatric orthopedics the distinction is, in fact, a must. The orthopedists of the Italian Society of Orthopedics and Traumatology (Siot) and the Italian Society of Pediatric Orthopedics and Traumatology (Sitop) have developed a guide to discover the ‘true and false’ on what to do and when to worry.
“During childhood and adolescence – explains Alberto Momoli, president of Siot and director of Uoc Orthopedics and Traumatology, San Bortolo Hospital, Vicenza – orthopedic pathologies may occur such as hip dysplasia in newborns or spinal defects, typical of pre-adolescent age, such as scoliosis or hyperkyphosis, which an attentive pediatrician will be able to intercept by suggesting a subsequent check-up by a pediatric orthopedist. In fact, many pathologies, if not treated during childhood and adolescence, can manifest themselves with major complications and more difficult to treat in adulthood”.
Among the real pathologies in pediatric age we can include developmental dysplasia of the hip and congenital clubfoot which are typical of newborns; among those affecting pre-adolescent children between 10 and 13 years old, Osgood Schlatter’s disease and adolescent idiopathic scoliosis are very frequent. Then there are those forms that are considered paramorphisms, i.e. situations that are often present but have no real influence on the child’s development nor impact on his function such as lax valgus flat foot, valgus knee, hyperkyphosis and scoliotic paramorphisms.
“In pediatric age, it is It is essential to distinguish between true pathologies and paramorphisms – underlines Antonio Andreacchio, president of the Italian Society of Pediatric Orthopedics and Traumatology and director of the Complex Structure of the Pediatric Orthopedics and Traumatology department of the Buzzi Children’s Hospital in Milan – because they require necessarily different management and intervention by the orthopedist. Paramorphisms, in fact, are false pathologies that represent stages of passage in the developmental age which in most cases do not impact the life of the child or adolescent but resolve spontaneously. However, it is often precisely these paramorphisms that greatly worry parents who take their child to the orthopedist. We always recommend contacting pediatric orthopedic specialists to avoid incurring anxiety or risking unnecessary, if not sometimes harmful, treatments for the child or adolescent.”
The most common problems and what to do
There developmental dysplasia of the hip Is it a congenital pathology? Real. “Developmental dysplasia of the hip is a congenital malformation which gradually causes the head of the femur to dislocate from the acetabular cavity, intended to contain it – underline the orthopedists – To verify the possible presence of developmental dysplasia of the hip, the first orthopedic check-up already takes place at birth, it is subsequently possible to carry out a further check with an ultrasound examination, within the first 60-90 days of life, in fact, if diagnosed early, developmental dysplasia of the hip can be easily treated in dislocation which, not infrequently, requires surgery”.
The clubfoot. Is the only definitive treatment surgical? False. “Clubfoot is among the most widespread congenital orthopedic diseases with an incidence of 1 case in every thousand births. Like developmental dysplasia of the hip, it must be treated early, possibly within the first 15 days of life. The diagnosis – write the specialists – is of an inspection nature and often occurs already during pregnancy through fetal ultrasound. In cases of clubfoot, therapy should be started as early as possible to obtain the best results, taking advantage of the marked malleability of the newborn’s tissues most used (Ponseti method) is the non-invasive technique with the best evidence of effectiveness and involves a series of manipulative maneuvers and casts that allow progressive correction of the foot Achilles and the subsequent application of the cast for approximately 20 days. To maintain the correction obtained, a brace is recommended to be worn at night until the age of 5”.
Osgood Schlatter disease, is it a pathology that resolves spontaneously? Real. Osgood Schlatter disease is one of the most common causes of anterior knee pain that occurs in adolescents during the growth acceleration that occurs in puberty. It is due to vascular-based suffering of the growth cartilage of the anterior tibial apophysis or osteochondrosis, where the patellar tendon inserts. The disease begins between the ages of 10 and 15 for males and between 8 and 13 years for females. It occurs more frequently in boys and girls who play sports such as running, jumping, basketball, volleyball, gymnastics and football. It usually affects one knee, but can involve both knees (20-30% of cases). The frequency of Osgood-Schlatter disease is three times higher in boys than in girls and resolves spontaneously as the boy grows.
Valgus knee. Are special shoes, orthotics or braces necessary to correct it? False. “Knee valgus (commonly referred to as ‘X’ knee) is a defect of the bones of the thigh (the femur) and the leg (the tibia) that deviate inward, so that the knees come closer to each other other It mostly occurs around the age of 3. Knee valgus is not a real pathology but is one of the so-called paramorphisms, i.e. a postural effect. a disorder that in 98% of cases resolves spontaneously within 7/8 years. Special shoes, insoles or braces are needed, it tends to return on its own.
Flatfoot Lax valgus Is early diagnosis essential to prevent painful flat feet as an adult? Real. “Flat foot which is evident in the first years of life due to ligament laxity is not a real pathology. In general, the majority of children up to 5-6 years of age have a flat foot with retro valgus foot, it is of the so-called infantile loose foot, a physiological disorder due to the immaturity of the musculoskeletal system, not yet adapted to support. In 90% of cases a spontaneous correction occurs with development, while in the remaining 10% it may be advisable to intervene.” , the specialists reply.
Idiopathic scoliosis in adolescents. Do idiopathic scoliosis and scoliotic attitude have a different meaning? Real. Idiopathic or adolescent scoliosis is a developmental deformity of the spine that appears during adolescence and progresses until the end of growth (around 15 years for females; around 16 years for males). It affects females with a ratio of 4 to 1 compared to males and in 1 in 3 cases it is hereditary. The causes that produce the deviation of the column are not yet completely known, what is certainly known is that the malformation has a genetic transmission. Scoliosis is different from the scoliotic attitude which is instead a curve of the spine on the frontal plane but without vertebral rotation and does not evolve over time, the cause of which is not genetic and therefore can be corrected.
Idiopathic scoliosis can be successfully treated using orthopedic braces, other times however the braces are unable to block the progression of the deformity for which it is necessary to resort to surgical treatment. The modern surgical correction of scoliosis is based on the use of bars, usually made of titanium, which are fixed to the column using screws or hooks. Their use allows for an immediately stable correction to be obtained, so the use of plaster casts is no longer necessary in the post-operative phase.
Hyperkyphosis. Can it be caused by excessive use of tablets, PCs and smartphones? Real. “It is a pathology which, in the majority of cases, concerns adolescents. It is a forward deformity of the spine on the sagittal plane essentially caused by incorrect postures which today are often associated with the excessive use of technological devices: the use excessive use of tablets, PCs and smartphones is responsible in many cases for kyphosis. Therefore, early diagnosis is essential. While in the initial phase it is possible to intervene with motor re-education and medical gymnastics, in the advanced phase it is necessary to make the child or adolescent wear a brace. orthopedic. If the diagnosis arrives too late, surgery may be necessary.
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