What Is Cerebral Palsy?

 

A number of disorders of the developing brain affecting body movement, posture and muscle coordination.

• Caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during or shortly after birth; during infancy; or during early childhood.
• Not a disease, not progressive, nor communicable.

Types of Cerebral Palsy:

• Spastic Cerebral Palsy: characterized by muscle stiffness and permanent contractions
• Athetoid or Dyskinetic Cerebral Palsy: characterized by uncontrolled, slow, writhing movements
• Ataxic Cerebral Palsy: characterized by poor coordination and balance

Cerebral palsy (CP) is a term used to describe a problem with movement and posture that makes certain activities difficult. Even though someone who has Cerebral palsy has problems moving his or her muscles, this is not because there is something wrong with the muscles or nerves. These difficulties are caused because of problems in the brain. The child might have had an injury to the brain, or had a brain that did not develop properly. These problems can affect the way the brain controls movement and posture.

Simply stated, “cerebral” refers to the brain, and “palsy” refers to muscle weakness/poor control. Although the brain itself will not get worse, people who have cerebral palsy will usually change over time. Sometimes they will get better, and some patients will stay the same. Occasionally they will get worse, usually because of contracture of the joints or changes in the muscle tone.

There is currently no cure for cerebral palsy, however there are different treatment options for people who have cerebral palsy. These options include therapy, medications, surgery, education and support. By taking advantage of one or more of these options, people with cerebral palsy can learn to improve their function and the quality of their lives.

How is Cerebral Palsy Diagnosed?

Parents are often the first to notice that their infant is not developing normally. Infants with cerebral palsy are often slow to roll over, sit, crawl, or walk. When an infant develops more slowly than usual it is called developmental delay.

Some of the skills that infants should have include:

• Holding own head up when lying flat in a bed at 3 months
• Sitting and rolling over by 6 months
• Walking by 12-18 months
• Speaking simple sentences by 24 months

Most children with cerebral palsy are diagnosed by the time they are two years old. But if a child’s symptoms are mild, it can be hard for a doctor to make a true diagnosis before the child is four or five years old. If the doctor thinks a child has cerebral palsy, he or she will probably schedule an appointment to see the child and talk to the parents about their child’s physical and behavioral development.

Doctors diagnose cerebral palsy by obtaining a complete medical history of development and examining the child, paying special attention to the child’s movements. In addition to checking for the most common symptoms — such as slow development, abnormal muscle tone, and unusual posture — a doctor also has to make sure the child doesn’t have something else that could cause similar symptoms.

Some children have hypotonia, which means that their muscles are too relaxed. In this case, the baby may seem floppy. Other children have hypertonia which makes their muscles seems stiff. Sometimes a child can have hypotonia that later become hypertonia two to 24 months after birth. Children may also have unusual posture or favor one side of their body.

What’s most important to the doctor is making sure that the child’s condition is not getting worse. Although cerebral palsy symptoms may change over time, children with cerebral palsy do not usually lose function. That means, if a child does seem to be losing motor skills, the problem is probably not cerebral palsy. It more likely a genetic or muscle disease, a metabolism disorder, or tumors in the nervous system. A complete medical history, special medical tests, and, in some cases, repeated check-ups can help confirm whether or not the child has cerebral palsy for certain.

Once the diagnosis of cerebral palsy has been made based on medical history and physical examination, your doctor may order tests to try to figure out the cause of the cerebral palsy (Ashwal et al., 2004). Tests (like MRI scans), that allow doctors to look into the brain, can find problems that may be able to be treated. If it is cerebral palsy, an MRI scan can also show a doctor the location and type of injury to the brain.

Some other tests a doctor might order include:

Cranial ultrasound

This test is used for high-risk premature infants because it is the least intrusive of the imaging techniques. However, it is not as effective as the two methods described below at seeing small changes in “white matter” – which is the type of brain tissue that is effected in cerebral palsy.

Computed tomography (CT) scan.

This technique creates images that shows brain injury.

Magnetic resonance imaging (MRI) scan

This test uses a computer, a magnetic field, and radio waves to create a picture of the brain’s tissues and structures. Doctors prefer MRI imaging because it offers better detail and does not involve radiation.

Metabolic Disorders

On rare occasions, metabolic disorders can be mistaken as cerebral palsy and some children will require additional tests to rule them out.

Specialized Knowledge and Training

To confirm a diagnosis of cerebral palsy, a doctor may send a child to other doctors who have specialized knowledge and training or to specialty clinics where these doctors work with a team of health professionals who specialize in working with children with cerebral palsy and other developmental delays. These doctors might be child neurologists, developmental pediatricians, ophthalmologists (eye doctors), or otologists (ear doctors). Additional observations by these specialists can help the doctors make a more accurate diagnosis and begin to develop a specific plan for treatment.

Most Common Characteristics:

A person with cerebral palsy may exhibit one or more of the following effects:

• muscle tightness or spasticity
• disturbance in gait or mobility
• involuntary movement
• difficulty in swallowing and problems with speech

An individual with cerebral palsy may also exhibit:

• difficulty in feeding
• impairment of sight, hearing or speech
• abnormal sensation and perception
• seizures
• difficulty with bladder and bowel control
• mental retardation
• learning disabilities
• problems with breathing because of postural difficulties
• skin disorders because of pressure sores

Treating Cerebral Palsy:

At this time, there is no cure for the developmental brain damage that causes cerebral palsy. Training and therapy, however, can help improve muscle function and coordination. Studies have found that children who receive early intervention services are more likely to lead a typical life.

Although there is no cure, recent advancements in neurological studies have vastly expanded our knowledge of brain development, and are allowing researchers to explore new treatments focused on the protection and care of children with cerebral palsy and other developmental brain disorders that strike early in life.

Cerebral Palsy Treatment

Although cerebral palsy cannot be cured, treatment will often improve a child’s capabilities. Many children with cerebral palsy go on to enjoy productive adult lives if their disabilities are properly managed. In general, the earlier that treatment begins the better chance the child has to learn new ways to accomplish the tasks that challenge them.

There is no single therapy that works for every child who has cerebral palsy. A team of healthcare professionals and community-based providers can help identify specific needs and develop a plan to help improve your child’s quality of life.

Who is on the team?

Doctors may include:

• Neonatologists
• Pediatricians
• Developmental Pediatricians
• Neurologists
• Orthopedists
• Physiatrists (Physical Medicine and Rehabilitation)
• Ophthalmologists
• Neurosurgeons
• Gastroenterologists
• Urologists
• Otolaryngologists (Ear Nose and Throat physicians)

Other health care professionals may include:

• Physical Therapists
• Occupational Therapists
• Speech Language Pathologists
• Social Workers
• Nurses
• Audiologists
• Psychologists
• Nutritionists/Dietitians

About United Cerebral Palsy

Founded over 60 years ago by parents of children with cerebral palsy, today United Cerebral Palsy (UCP) is a leading service provider and advocate for children and adults with disabilities. The UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network. This includes approximately 100 local service providers reaching over 176,000 individuals daily in the U.S., Canada, Scotland and Australia. The national office in Washington DC advocates on behalf of individuals with disabilities; advances federal disability public policy (Disability Policy Collaboration and develops forward-thinking programs.

Content Source: Parentingspecialneeds.org

 

 

Flat Feet Treatment Strategies for Children

You may have heard the term pes planus, flat feet, poor arch support, or overpronation… You may notice your child’s feet turning out significantly when standing or walking. You may even notice a more significant wear pattern on the inside of the child’s shoe. So what exactly does a flat footed presentation entail? Flat Feet (aka Pes Planus) Children who present with flat feet may have been late ambulators, may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”, denoting a lack of true control as compared to more typical gait pattern (as weight shifts from heels to toes). Children with flat feet will experience overpronation or excessive pronation, which refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leading to poor lower extremity alignment and the potential for future orthopedic concerns. It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. We anticipate early ambulators to display a flattened arch with forefoot pronation while weight bearing. Over time most children develop the musculature of their intrinsic foot and plantar arch. Intervention is not necessary if this presentation is not otherwise affecting function. Here are some fun treatment ideas to promote development of the arch muscles to encourage lower extremity alignment, fluidity of gait mechanics and prevent any potential long term musculoskeletal issues that may arise as a result of this presentation. All exercises should be done barefoot without sock or shoes, to encourage activation of the intrinsic muscles of the foot. We want child to experience both tactile and proprioceptive input through the soles of their feet. Treatment for Flat Feet Targets: • Arch Activation/Strength • Lower Extremity Strength & Alignment • Efficient and Fluid Motor Patterns • Biomechanics of Gait Intrinsic Plantar Muscle (Arch) Activation Gentle Foot Massage • Apply gentle pressure to bottom of child’s foot. • Use circular motion to activate muscles of medial foot. Vibration or Tactile Input Use vibrating node or tactile ball along arch of foot with child comfortably seated, to activate muscles of foot. Can do this before other more challenging activities to ensure arch is activated and ready to “work”. Scarf Lifts Using fun play scarves, start with material flat on floor. With child seated or standing, encourage child to place one foot on top and use muscles of foot to lift scarf up! Toe Basketball For increased challenge, have child pick up marbles or flat “chips” with toes and drop in small container, this requires greater control and prolongs muscle activation. Single Leg Balance With the standing on foam balance pad or firm cushion, practice balancing on each leg for 10 second intervals to challenge arch activation. Half Kneel Ball Toss • Pass ball back & forth while maintaining half kneel on balance pad. Dyna-Disc Balance Maintain balance on dyna disc during game of catch, balloon volleyball, Velcro ball, etc. Half Moon Balance Stand to squat on half moon foam roller – also great for arch activation! Tandem Stance • Standing with one foot in front of the other. Use colorful tape for helpful visual cue to promote alignment. Tactile footprints are great visual and tactile cues for foot placement to help engage foot musculature and promote development of arch! Scooter Adventure Seated floor scooter, forwards and back using heels to dig in and muscles of foot to initiate movement. Bridge Pose Push into dyna disc with both feet, lifting bottom for sustained hold or lift & lower for more dynamic activation. Crab Kicks Hold bridge position and perform alternate leg kicks while saying the ABCs. To increase challenge and to target muscles of the foot, place dyna disc under feet, while alternating leg kicks! Ball Marching With child seated on therapy ball, balance pad under feet, encourage alternating marching movement. Engaging lower body disassociation while promoting lower body and trunk engagement. Brick Kicks With child standing on balance pad or dyna disc encourage kicking down either soft blocks or cones to promote weight shifting and balance. Bear Walks Have child walk across the room like a bear to complete a puzzle. You can increase the challenge and provide sensory input by lining the floor with pillows or bubble wrap! Penguin Walks Encourage child to walk forward with heels on the ground and toes up! Shoe Suggestions for Children with Flat Feet The appropriate shoe or sneaker: • Provides Support • Offers Stability • Facilitates Weight Bearing • Promotes Lower Extremity Alignment • Encourages Fluidity and Efficiency in Motor Patterns Some great options include: • ASICS: ASICS Contend & ASICS Jolt • Saucony: Saucony Cohesion & Saucony Ride • Keen: Keen Newport Sneaker & Keen Newport Sandal • Pediped: Pediped Max & PediPed Flex Dakota • Stride Rite: Stride Rite Cannan & Stride Rite Racer For more information about shoe recommendations for common Pediatric gait presentations, check out our post on What a Difference a Shoe Makes! Content Source: Dinopt.com

Perthes’ Disease

Perthes’ disease affects children, most commonly boys aged between four and ten years old, but can also occasionally occur in younger children and teenagers. Tiredness and groin pain are two common symptoms, and they may have a noticeable limp.

Symptoms Symptoms of Perthes’ disease are usually on one side only and include: • Tiredness and pain in the groin, thigh, and sometimes in the knee • Pain in the knee only, even though the disease affects the hip • Stiffness and reduced range of motion at the hip joint • Walking with a limp • The affected leg may appear shorter than the other leg Diagnosis It is important a medical professional examines any knee or hip pain in children. An early diagnosis is important to avoid long-term complications. A doctor may X-ray the hip to help diagnose the cause of hip pain. However, in the early stages of the disease, X-rays may appear normal. Therefore, your doctor uses other investigations such as MRI or bone scans. What is Perthes’ disease? Perthes’ disease commonly affects children between the age of 4 and ten years old. But can also occasionally occur in older children and teenagers. Another name for Perthes’ disease is Legg–Calvé–Perthes disease. The exact cause of the disease is unknown. It affects the hip joint, where the top of the femur (thigh bone) meets the socket of the pelvis (acetabulum). The blood supply to the head of the femur is disrupted, resulting in necrosis. This is where the bone softens and begins to break down. Once the blood supply returns to normal, bone tissue is laid down and the femoral head reforms and hardens. This occurs over a period of 1 to 3 years. Due to the joint being a ball and socket, one of the main problems is that the re-growth may not form in a spherical shape as before. The severity of deformity of the head of the femur determines the degree of symptoms and if there are likely to be any future problems such as a permanently decreased range of motion at the joint and arthritis. Boys are far more likely to develop this condition than girls, although girls tend to suffer from more severe symptoms and future problems. Symptoms are usually only in one hip, although occasionally can affect both sides. Treatment and management of Perthes’ disease Depending on how severe the disease is will determine whether it requires conservative treatment or surgery. Treatment consists of rest from any aggravating activity or exercise and maintaining range of motion in the hip through mobility exercises. In particular, exercises to maintain abduction of the hip (moving the leg out sideways) and internal rotation of the hip. Treatment will depend on the age of the child and the severity of the condition but may include bed rest, crutches, traction, a plaster cast, leg brace, or surgery in extremely severe cases. Your surgeon performs arthroscopic (keyhole) surgery to remove loose bodies within the joint and repair damaged cartilage (chondroplasty). Perthes’ disease usually resolves over time as the athlete grows, as long as they manage it properly. Athletes can return to sport when they are free of symptoms. With competitive young athletes managing injuries and diseases is important. This may mean changing sporting activity for a while, or reducing the volume of training and focussing on quality. For example, a young soccer player may play once or twice a week and substitute other activities such as swimming, or light technical training. If Perthes’ disease is not managed correctly then long-term complications include arthritis because the surface of the joint is irregular, resulting in faster wear and tear. Content Source: Sportsinjuryclinic

Radial Club Hand Treatment & Management

“Radial Club Hand Syndrome” can be defined as the medical condition in which there are deficiencies in the extremities of the pre-axial and radial side of the arms. Although the deficiencies are confined to the extremities, forearm and hand, the deficiencies may stretch to the whole of the arm. Radial club hand syndrome is usually detected by the radio graphs that are performed on the patient or by the ultrasound imaging of the affected or suspected areas.

Classification: The radial club hand has various kinds of types which need to be handled in different manners. The disease is classified as follows: 1. Type N: Isolated thumb anomaly 2. Type 0: Carpal bone deficiency 3. Type I: Short distal radius 4. Type II: Miniature hypoplastic radius 5. Type III: Absence of distal radius 6. Type IV: Radius being completely absent 7. Type V: Complete absent radius along with proximal humerus manifestations Treatment: Just like stated above the different types of radial club hand requires various kinds of treatments to be rectified most of which usually involve surgical process for rectification. The most common treatments that are applied to children suffering from this condition are: Splinting and Stretching: Splinting and stretching is sufficient in cases where the disease is minimalist and confined to slight abnormality of the wrist. This should be followed by regular exercise which helps in fixing the extension of the wrist and relapse of the condition can be avoided. 1. Centralization: This treatment is usually applied in the severe cases where a notch is used as a replacement in the central position. Centralization is usually done to return the normal functionality of the hand by fixing the position of the ulna. The method is accomplished by the removal of the carpal bones to adjust the ulna which is followed by the wearing of a sling for an extended period of time to hold the position of the rectified bones. Although this method may cause certain damages to the ulna, this process usually cures situations like stiff elbow which helps the patient feed on her own. 2. Radialization: Radialization is a surgical treatment in which the extensors are added to the ulna and the metacarpal is pinned to it for proper movement of the hand. Usually, the ulna is overcorrected to prevent the relapse of the radial club hand syndrome. 3. Vascularized Metatarsophalangeal (MTP)-Joint Transfer: Vascularized metatarsophalangeal (MTP)-joint transfer is the method of transferring the second toe to the ulna on the radial side of the same to provide it with an extra platform which will help in the proper movement of the wrist. These treatment processes along with the proper exercises can help the patient keep radial club hand syndrome at bay and prevent it from relapsing again in the future. At Kids Orthopedics, special attention is given to the various types of radial club hand syndrome that may occur and the treatment and management is done accordingly to achieve the best possible end result.

Hip, Developmental Dysplasia of the, When Your Child Has

Your child has been diagnosed with developmental dysplasia of the hip. Hip dysplasia (also called hip dislocation) is a problem with the hip joint. This condition is congenital, meaning it’s present at birth. It is not often painful. And it is very treatable in young children. If your child has this problem, he or she may see a pediatric orthopedist. This is a doctor specializing in treating bone and joint problems in children. What are the causes of developmental hip dysplasia? Developmental hip dysplasia happens when the rounded top of the leg bone (the femoral head) slips partly or completely out of the hip socket. The hip socket may be too small or too shallow. This problem is more common in female children, in firstborn children, and in children born into families with a history of this condition. It is also more common in babies who are positioned feet first (breech) in the uterus. What are the signs of developmental hip dysplasia? Signs of this problem may be noted at birth. But the hip may also seem fine at birth and not show problems until later weeks. Common signs include: • A hip that is dislocated at birth • A hip that is “loose” (this may get worse as the child grows and becomes more active) • A hip that is less flexible than normal • A shorter leg, or a leg that turns outward (on the side of the dysplasia) • Uneven skin folds on the thighs or buttocks • Limping, walking on the toes, or a waddling “duck-like” gait in children who have begun to walk How is developmental hip dysplasia diagnosed? The condition may be noticed just after birth. Or, it may not be found until later screenings are done. Very mild cases may not be noticed until the child begins to walk. If this problem is suspected, imaging tests such as an ultrasound or an X-ray may be done to confirm the diagnosis. How is developmental hip dysplasia treated? In 1/4 of the children with hip dysplasia, the problem goes away without treatment. If treatment is needed, the options depend on the child’s age: • Infants. A Pavlik harness is used for 2 to 3 months. This harness holds the hip joint in place so the tissues around the joint can tighten and hold the joint in normal position. Once the harness is removed, the child should grow and develop normally. • Children 6 months and older. A procedure called closed reduction may be done. This moves the hip joint into place without surgery. In some cases, surgery may be needed to move the hip joint into place. After either closed reduction or surgery, a cast is put on the leg and hip to hold the joint in place. The cast may stay on for several months. Once the cast is removed, the child should grow and develop normally. What are the long-term concerns? After hip dysplasia goes away on its own or is treated, most children grow normally. But if the dysplasia remains and isn’t treated, long-term joint problems can result. So to be sure there are no lingering problems, your child will likely need to see the doctor regularly for monitoring. This is usually done at ages 6 months, 12 months, 4 to 6, and 14. Content Source: Mount Nittany

Is High Muscle Tone related to Cerebral Palsy?

High muscle tone, or hypertonia, is a condition that causes tight muscles and stiff or rigid movements. It is especially common in cerebral palsy patients. Symptoms of high muscle tone include loss of function and limited range of motion, causing a child to have issues properly sitting or standing up. However, cerebral palsy is not the only cause of hypertonia. Read more to learn about what to do if you think your child has hypertonia possibly caused by cerebral palsy. Cerebral Palsy & High Muscle Tone Cerebral palsy is caused by damage to the parts of the brain that control motor functions, such as muscle tone. This is especially true in the most common form of CP that accounts for 70% of all cases — spastic cerebral palsy. Muscle tone in cerebral palsy patients can be low, high, or a combination of both. The type of muscle tone abnormality a person experiences is based on the severity and location of damage to the brain. High muscle tone is called hypertonia and is often seen within the first 18 months of life. Hypertonia causes too much muscle tone which causes arms or legs to be stiff and, therefore, difficult to move. Hypertonia doesn’t mean anything is wrong with the muscles, but rather that the brain cannot voluntarily control them. This causes the muscles to over- or under-develop, leading to high or low muscle tone. Since their muscles are constantly contracting, cerebral palsy patients with hypertonia tend to have stiff or rigid movements. What Causes High Muscle Tone? Although hypertonia in cerebral palsy patients is common, high muscle tone does not always mean your child has developed cerebral palsy. Other conditions that are linked with high muscle tone are: • Brain bleeds • In-utero strokes • Multiple sclerosis • Parkinson’s disease • Toxins in the brain Traumatic birth injuries or injury to the spinal cord can also cause hypertonia to occur. Birth trauma may be preventable with proper care during childbirth. Treatment for High Muscle Tone If high muscle tone is not managed correctly, it can limit a child’s range of motion and overall independence. This is the result of consistently pulling the body into abnormal positions due to muscle spasticity. Severe cases of hypertonia may cause joints to become frozen (joint contractures). Very high muscle tone can also cause secondary conditions such as scoliosis or hip displacement. One of the most common types of treatment for high muscle tone is physical therapy. Physical therapy for high muscle tone includes: • Exercises to relax tight muscles • Muscle stretching for pain and tightness • Strength training • Weight training Another option for treating high muscle tone includes managing the patient’s posture by relaxing them, which can help the body naturally fall into more comfortable positions. Your child’s doctor may also prescribe muscle-relaxing medications such as baclofen, diazepam, and dantrolene. These drugs can be used to reduce muscle tightness and spastic movements. Orthotics — medical devices that help correct musculoskeletal abnormalities — may also be beneficial for children with high muscle tone. Orthotics can hold limbs in place to ensure the correct muscles are stretched. Another important treatment for high muscle tone is practicing daily activities with your child under guidance from their healthcare provider. Helping your child practice movement involved in daily living can allow them to complete these activities on their own. Diagnosing The Cause of Your Child’s Hypertonia Hypertonia is usually noticeable within the child’s first 18 months of life as their bodies start to develop. One of the tell-tale signs of high muscle tone is developmental delays with fine and gross motor skills. Hypertonia signs and symptoms may include: • Crossed or scissored legs • Fisted hand after 6 months of age • Joint and muscle pain • Lack of flexibility • Moving slowly and rigidly • Musculoskeletal deformities • Spasms/involuntary movements • Walking in abnormal patterns Since the symptoms of hypertonia are different for each patient, it is essential to talk with your child’s doctor. This is the best and only way to diagnose the cause of your child’s high muscle tone. You can expect your child’s doctor to examine their symptoms. If the doctor believes your child suffered from trauma during birth, they will conduct brain imaging tests such as MRI (magnetic resonance imaging) and CT (computer tomography) scans to diagnose cerebral palsy. From there, your doctor can determine the cause of your child’s symptoms and start treatment.

Clubfoot: Risks, Diagnosis, & Treatment Options

What is clubfoot? Clubfoot is a birth defect that causes your baby's foot to point down and be turned inward. One or both feet may be affected. Your baby's foot bones, muscles, tendons, and blood vessels may also be affected. Clubfoot can range from mild to severe. Clubfoot develops because the tendons in your baby's leg and foot are shorter and tighter than normal. This causes the foot to be pulled into an incorrect position. What increases my baby's risk for clubfoot? • A family history of clubfoot • Being male • Having another birth defect, such as spina bifida • Not enough amniotic fluid during pregnancy • Cigarette smoking or drug use by his or her mother during pregnancy What are the signs of clubfoot? • Toes point down or toward the opposite foot • Foot turned upside down (severe clubfoot) • A deep crease on the bottom of the foot • Foot stiffness • Foot joints that do not move correctly • Smaller foot, heel, or calf muscles than normal How is clubfoot diagnosed and treated? Your baby's healthcare provider may be able to see the clubfoot on an ultrasound before your baby is born. He or she will be able to see the clubfoot after your baby is born if it is not found before birth. X-rays may be used to find specific bone problems and help plan treatment. Your baby may need any of the following depending on how severe the clubfoot is: • Stretching and casting means stretching the foot toward the correct position and applying a cast to hold the position. The cast will go from your baby's foot to his or her upper thigh. One or 2 times a week, the cast will be removed so the foot can be moved closer to the correct position. A new cast will be applied each time. This will continue for 6 to 8 weeks. Your baby's provider may cut the Achilles tendon, or heel cord, before the final cast is applied. This helps the tendon grow longer before the cast comes off. Ask for information on cast care and safety. • Stretching, taping, and splinting may start soon after your baby is born. Your baby's provider will stretch your baby's foot toward the correct position. He or she will tape and splint the foot to hold it in the correct position. This will continue each day for 2 months. Then it will be done less often until your baby is 6 months old. Stretching and splinting at night will continue until your baby starts to walk. • Surgery may be needed if other treatments do not work or if your baby's clubfoot is severe. Surgery is used to make the heel cord longer, and to fix other foot problems. Your baby will be in a cast for 6 to 8 weeks after surgery. Surgery may not fix clubfoot completely, but it can help improve your child's ability to walk. What are the risks of clubfoot? • Your child may have trouble walking, even after treatment. If only 1 foot was affected, it may be about 1½ shoe sizes smaller than the other foot. The affected leg may be slightly shorter than the other leg. Even after treatment, your child may get leg cramps or become tired when he or she plays sports. Clubfoot can come back, even with treatment. Your child will need more treatment if clubfoot returns. • Left untreated, clubfoot may lead to arthritis. Your child may walk on the balls of his or her feet or on the outer edge. This may prevent his or her calf muscles from developing normally. It may also cause sores or calluses to form on his or her feet. What can I do to manage clubfoot? Help your child do stretching exercises provided by his or her provider. After casting, splinting, or surgery, he or she may also need to wear a brace for 3 to 4 years. A brace is a pair of shoes connected to a metal bar. He or she will wear the brace for 23 hours every day for 3 months. The hour it is off is for when you bathe your child. Your child's provider may also recommend other activities he or she can do while the brace is off. Your child will transition to wearing the brace when he or she sleeps at night and during naps. It can be difficult to make sure your child wears the brace, but it is important so clubfoot does not return. The following can help make it easier to stay with the routine: • Encourage your child to walk and play in the brace. The way your child walks will depend on the kind of brace he or she has. Some braces have bars that bend as the baby walks. You may be able to move his or her legs up and down to help him or her get used to the motion. Other braces have solid bars that do not move. You may be able to help by pushing and pulling on the bar to make his or her legs bend and straighten. Your child may adjust to wearing a brace more easily if you play with him or her while he or she wears it. • Create a brace wearing routine. Tell your child when it is time to put on the brace. Make it a normal part of getting ready for overnight sleep and naps. The brace may prevent your child from sleeping well. Talk to his or her provider if you notice your child is fussy or irritable from not getting enough sleep. • Make your child's foot comfortable. Check that his or her heel is all the way down in the shoe. Tighten the straps to make sure the heel does not slide. It is normal to have some redness at first from the shoes. Do not put lotion on your child's feet. Lotion will make your child's foot slide in the shoe. Check his or her foot a few times every day for blisters, sores, and redness. These may mean his or her heel is sliding in the shoe. • Prevent your child from getting out of the brace. Check that the straps and laces are tightly secured. It may help to have your child wear 2 pairs of socks or to use socks with nonslip soles. You can also try removing the tongue of the shoe. You can make the laces harder to loosen by lacing the shoe from top to bottom. • Make the brace safe. Put a pad on the metal bar. This will help protect your child and anyone who is caring for him or her. It will also help protect furniture as your child walks. Ask your child's provider how to pad the bar and what to use for padding. How can I prevent clubfoot in a future pregnancy? Clubfoot often has no clear cause to prevent, but you can lower your baby's risk. Do not smoke cigarettes or take drugs while you are pregnant. To prevent other birth defects that may lead to clubfoot treatment, take a prenatal vitamin. Start taking it at least 1 month before you get pregnant. Continue as directed through the first trimester. Look for prenatal vitamins that have at least 400 micrograms of folic acid. Folic acid helps prevent birth defects. When should I contact my baby's healthcare provider? • You have questions or concerns about your baby's condition or care. Care Agreement You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's healthcare providers to decide what care you want for your baby. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. © Copyright IBM Corporation 2022 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

A Guide to The Ponseti Method for Clubfoot Correction

Introduction: A Brief History of the Ponseti Method Ignacio V. Ponseti can be credited with developing a comprehensive technique for treating congenital clubfoot in the 1940s. One of the major principles of this technique is the concept that the tissues of a newborn's foot, including tendons, ligaments, joint capsules, and certain bones, will yield to gentle manipulation and casting of the feet at weekly intervals. By applying this technique to clubfeet within the first few weeks of life, most clubfeet can be successfully corrected without the need for major reconstructive surgery. This technique is based upon Ponseti's experiences with the wide variety of treatments being applied at that time and his observations in the clinic and operating room, as well as his anatomic dissections and analysis by using a movie camera to produce radiographic images. Utilizing these principles and his understanding of clubfoot anatomy, Dr. Ponseti began employing this technique in 1948 at the University of Iowa. Recently, his observations have been confirmed using modern techniques, including Magnetic Resonance Imaging (MRI). The Ponseti technique has become the most widely practiced method for initial treatment of infants born with clubfeet. It is an easy technique to learn and, when applied accurately, it yields excellent results. The Ponseti Technique The corrective process utilizing the Ponseti technique can be divided into two phases: The Treatment Phase - during which time the deformity is corrected completely The Maintenance Phase - during which time a brace is utilized to prevent recurrence During each of these phases, attention to the details of the technique is essential to minimize the possibility of incomplete correction and recurrences. The Treatment Phase The treatment phase should begin as early as possible, optimally within the first week of life. Gentle manipulation and casting are performed on a weekly basis. Each cast holds the foot in the corrected position, allowing it to gradually re-shape. Generally, five to six casts are required to fully correct the alignment of the foot and ankle. At the time of the final cast, the majority of infants (70% or higher) will require a percutaneous surgical procedure (with a small incision through the skin) to gain adequate length of their Achilles tendon. The Maintenance Phase The final cast remains in place for three weeks, after which the infant's foot is placed into a removable orthotic device. The orthosis is worn 23 hours per day for three months and then during the night-time until 5 years of age. Failure to use the orthosis correctly may result in recurrence of the clubfoot deformity. Good results have been demonstrated at multiple centers, and long-term results indicate that foot function is comparable with that of normal feet. Manipulation and Casting - Distinct Elements of the Ponseti Method The unique manipulation and casting maneuvers used in the Ponseti technique are just two examples of several elements which make it quite distinct from other casting methods. First Cast: Prior to casting, the position of the forefoot (front of the foot) in relation to the heel creates cavus (abnormally high arch) of the foot. The first cast application addresses the foot deformity, aligning the forefoot with the hindfoot (back of the foot). In doing so, the cavus (Figure 1) is corrected (Figure 2), typically after one cast. It is usually easiest to apply the cast in two stages: first a short-leg cast to just below the knee, which is then extended above the knee up to the groin once the plaster sets. This is preferable in older children (beyond 2 to 3 months) who are stronger and less easily consoled during the casting. Ponseti emphasizes the importance of long-leg casts, which are essential to maintain adequate stretching of tendons and ligaments. Second Cast: One week later, the first cast is removed and, after a short period of manipulation, the next toe-to-groin plaster cast is applied. This phase in the manipulation and casting process is focused on straightening the foot, aligning the forefoot with the heel. Care is taken to maintain the downward tilt of the foot; correction of this downward tilt - due to tightness of the ankle - will occur in subsequent casts. Before casting, the physician manipulates the forefoot according to Ponseti's carefully described technique in order to stretch the foot, determining the amount of correction that can be maintained when the plaster cast is applied. Another crucial point in the Ponseti technique, which is radically different than other techniques, is that the heel is never directly manipulated. The gradual correction of the hindfoot and midfoot are such that the heel will naturally move into a correct position. Further Casting: Manipulation and casting are continued on a weekly basis for the next two to three weeks in order to gradually straighten the forefoot, allowing the forefoot to move in line with the heel. After four or five casts have been applied, normal position of the foot will begin to be observed. The Achilles tendon: The Achilles tendon is the cord behind the ankle that allows the ankle to move up and down. In children with clubfoot this tendon is shortened, which prevents the ankle from bending up properly. In the majority of these children the tendon must be lengthened in order to allow sufficient ankle motion. In the Ponseti technique, this is accomplished with a percutaneous surgical release of the tendon, which allows the ankle to be positioned at a right angle with the leg. The percutaneous release is a quick, sterile procedure that is typically done through a small puncture, under local anesthesia. The final cast: The foot and ankle are then casted in the final, corrected position. A total of five or six casts are typically needed to correct the foot and ankle. More are needed in the most severe cases of clubfoot treatment. Maintenance and Recurrence Prevention Upon removal of the final cast, the infant is placed into an orthosis, or brace, which maintains the foot in its corrected position. The purpose of this splinting, after the casting phase in the Ponseti method, is to maintain the foot in the proper position, with the forefeet set apart and pointed upward. This is accomplished with a brace consisting of shoes mounted to a bar. The brace is worn 23 hours per day for the first three months following casting and then while sleeping for several years to follow, usually until around age five. Multiple studies have demonstrated the high risk for recurrence if the brace is not worn according to these guidelines. The reasons for recurrence in feet that appear to be corrected fully have not yet been clearly proven, but regardless of the cause, recurrence appears to be close to zero when the bracing regimen is followed accurately. In one study, researchers reported no recurrences among patients compliant with the foot abduction orthosis compared with 57% recurrence among non-compliant patients when studied at short-term follow-up. (Thacker MM, Scher DM, Sala DA, et al: Use of the foot abduction orthosis following Ponseti casts: Is it essential? Management of Recurrence The risk of recurrence persists for several years after the casting is completed. Ponseti reported a recurrence rate of approximately 50% in his early series, but noted a decrease with greater emphasis placed on the use of the foot orthotic. Early recurrences are best treated with several long-leg plaster casts applied at two-week intervals. The first cast may require correction of recurrent foot deformity, with subsequent casts to correct ankle tightness. An Achilles tendon lengthening may be necessary if there is insufficient correction at the ankle, and a tendon transfer (of the tibialis anterior tendon) may be performed in older children to help maintain the correction. Following this additional surgery, the child is then placed in a long-leg cast for four weeks with the foot in neutral position.

How to Keep Child Safe from Common Outdoor Games Injuries?

According to several studies, a large percentage of children are addicted to mobile devices, television, and video games. But the smarter parents encourage children to play outside to avail benefits of fresh air and physical exercise. Also, the outdoor games help children to prevent eye problems, stay active and improve social skills. While playing outdoor sports, children often find riskier sports and games more appealing. Hence, they often sustain varying injuries while playing outdoors. The parents must keep in mind some simple safety tips to keep their children safe from outdoor game injuries. The simple tricks will further help them to encourage kids to play outdoor on a daily basis. Tips to Protect Your Child from Common Outdoor Game Injuries Biking Related Injuries It is common for kids to sustain injuries while bicycling, skateboarding and scootering. You can prevent the biking-related injuries by supervising the child consistently. Also, you must make the kid wear helmet to reduce chances of brain injuries when the he indulges in biking activities. Likewise, you can make the child wear protective gears to prevent injuries while playing football, baseball or softball. Injuries Caused due to fall from Playground Equipment Children often sustain injuries due to falling from various playground equipments. It is very difficult for you to prevent this type of playground-related injuries. But you can always keep your kids safe by opting for a playground with shock-absorbing surfaces made of sand, rubber or synthetic. Sports-Related Injuries Many children sustain injuries while playing common sports and games. You must prepare the child properly for the outdoor sports to prevent these injuries. For instance, the child must drink adequate water to stay hydrated throughout the physical activity. Likewise, you must make the child stretch before the game to reduce chances of sports-related injuries. Drowning Many children nowadays love to swim in varying water bodies. Hence, drowning has become a major cause for injury-related death among kids. Before allowing the child to swim, you need to teach him swimming properly. Also, you must supervise the kid constantly around each water body, while being familiar with lifesaving techniques and CPR. Don’t Allow the Child to Play When He is injured In addition to saving your child from varying outdoor game injuries, it is also important dissuade him to play outside when he is hurt. If the child gets back to the outdoor game before injury is healed fully, the injury will get worse and take more time to heal. You can even consult a skilled orthopaedic to know the time required to heal the injury completely and get back to practice. It is also important for parents to pick the right play area to keep child safe from outdoor game injuries. In addition to keeping an eye on the children consistently, the parents must get debris and similar things that may harm the child removed from the playground. Also, they can provide a variety of play tools to the children to indulge in outdoor games more safely. Content Source: Kids Orthopedic Blog

5 Barefoot Workouts to Cure Flat Feet

Often flat foot develops in a person in childhood. But many adults also experience back and leg pain and find it difficult to walk due to flat feet. Each individual can wear shoes with arch support to alleviate pain of flat feet and walk comfortably. He can further treat flat feet in a number of ways – losing weight, wearing custom supportive shoes, and intensive physical therapy. However, each individual can also cure flat feet by performing some simple exercise steps on a daily basis. 5 Simple and Easy Flat Feet Exercise Steps 1) Start this flatfeet workout by placing the flat your feet flat on a floor in sitting position. Keep lifting the toes and foot gradually while keeping the heel stagnant. After holding the stretch for about 15 seconds, you have to switch to the right feet. The flat feet exercise needs to be repeated 5 times a day. 2) This exercise also requires you to sit on a flat floor. But you have to bend the knees and hold your hands in the back to support your body. After sitting in the floor with bending knees, start separating the foot from the floor while keeping the heel on the floor. Keep cramping the toes and remain in this position for 15 seconds. 3) This workout requires you to put one foot over the other. You have to lift the left upper foot slowly and put it over the right foot. Move the left foot gradually till its middle rests on the other foot. Remain in the position for 1 minute while exerting pressure on the left foot. Repeat the exercise with your right flat foot. 4) You can alleviate the pain of flat feet by stretching the tight Achilles tendons several times a day. You can easily stretch the tight Achilles tendons by repeating this simple workout 50 to 10 times a day. Place your hands against a wall, and start outstretching the legs one by one. Keep the outstretched foot on the floor till you experience a stretch above the heels. Keep the foot outstretched for about 30 seconds. 5) You can further cure flat feet by performing a simple foot exercise. The foot exercise will help you to build an arch through stretching. Start the exercise by sitting in a position to make your legs touch the floor directly. Lift your right foot gradually till it touches the last toe finger of the left foot. You can easily cure flat feet by performing some simple workouts. Each of the flat feet exercises can be performed without any hassle. But you must repeat the flat feet exercises to alleviate the pain and symptoms of flat feet. It is also a great idea to decide the right flat feet exercises based on the diagnosis made by an expert paediatric orthopaedic. Content Source: Kids Orthopedic Blog