LER: Pediatrics – February 2016
So much depends on the ankles
Several stories in this issue of LER: Pediatrics emphasize the long-term consequences of ankle instability and other problems at this important joint. Compromised ankle function can cause declines in physical activity and put children at risk for obesity, weak bones, and other problems that threaten quality of life.
More than half of all ankle sprains occur in kids and young adults aged between 10 and 24 years (see “Treating and preventing ankle sprains in children,” LER: Pediatrics, February 2015, page 9).
Lingering instability is common, as well. An Australian study, for example, found that 71% of children with a history of ankle sprain had perceived instability and as many as 47% had mechanical instability (see “Rates of chronic ankle instability in children are surprisingly high,” LER: Pediatrics, November 2014, page 5). Appropriately treating initial ankle sprains can give typically developing children and those with neuromuscular conditions better odds of living an active lifestyle.
In pediatrics, early care for ankle injuries isn’t happening enough, according to orthotist David Misener, CPO, MBA, who discusses sprain prevention in “Improving foot posture, balance in CMT may aid ankle stability,” page 8.
Too often, he said, parents wait to seek care until ankle injuries become chronic. Parents need to get more timely care for their children’s ankle injuries, and practitioners and coaches need to up their awareness and actively encourage intervention.
Balance exercise and bracing have been shown to help prevent sprains in adolescents. Once a sprain occurs, initial immobilization, followed by restoring range of motion and strength and addressing issues with neuromuscular control and balance, can help protect children from a lifetime of weak ankles.
By Emily Delzell, Senior Editor
Large forces can cause severe fractures: Multiple trampoline jumpers are a primary cause of “trampoline ankle,” according to a recent Canadian study, which also noted that, when two individuals are bouncing out of sync, they generate kinetic energy forces that produce a high-impact effect that can cause serious growth-plate injuries in children.
By P.K. Daniel
Early care advised for FAI prevention: Functional ankle instability (FAI) is a common problem in children and adolescents with Charcot-Marie-Tooth disease (CMT), according to Australian research that advises further study of interventions that target balance and normalize foot structure to evaluate whether they can help improve ankle stability in this population.
By Katie Bell
Helps protect ACL in both genders: A one-time neuromuscular training intervention designed to prevent anterior cruciate ligament (ACL) injury is more effective than a traditional warm-up for improving landing technique in youth athletes, according to a study that could help convince coaches and athletes to embrace such training programs.
By Chris Klingenberg
Cerebral palsy (CP) can decrease mobility, which is key to quality living. Children with CP and compromised mobility are at risk for low bone mineral density and fragility fractures, but physical therapy programs and orthoses can help kids be more active to build stronger bones.
By Hank Black
More than a third of Ponseti-corrected clubfeet relapse and require additional treatment. Making a complete initial correction, ensuring optimal brace comfort, and encouraging parental buy-in to bracing over the long term reduces brace nonadherence, a major cause of recurrence.
By Barbara Boughton