Lower Extremity Review
These children often have wider, more flexible, and more pronated feet than typically developing kids that don’t fit well into conventionally sized and shaped footwear. Ill-fitting shoes are linked to foot-specific disability and many other issues. Here, clinicians share strategies for finding the right fit.
By Lori Roniger
Trampoline use, both in backyards and in large recreational parks, is up. So are injuries incurred on the equipment, including fractures with potentially serious long-term sequelae. Some groups advise a ban on home use, but other experts disagree, citing the equipment’s benefits for motor learning and active play.
By P.K. Daniel
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
The most public battles about barefoot running and minimalist footwear have been fought over their use by adult athletes and the clinicians who treat them. There is, however, a separate discussion underway regarding barefoot and minimally shod running in children.
By Cary Groner
Juvenile idiopathic arthritis (JIA) affects nearly a quarter of a million US kids younger than 16 years. The hallmarks of the autoimmune disorder include joint inflammation, stiffening, and damage, as well as changes in joint growth, all of which can prove painful.
By Shalmali Pal
Accommodating growth without compromising fit and function is a challenge for practitioners who prescribe orthotic devices for young patients. Adjustments and add-ons—as well as educating parents about expected changes—can make for smoother transitions.
By Shalmali Pal
Osteoarthritis (OA) risk factors and symptoms seen in adults have been found in obese kids, who often have musculoskeletal pain. Weight loss may help, but preventing OA may also require gait and exercise interventions, particularly those that reduce pain that leads to inactivity.
By Erin Boutwell
As hip arthritis becomes a growing concern in adults with Down syndrome, clinicians are also becoming more attuned to hip issues in children with DS, in hopes that early intervention in the pediatric population will help reduce the risk of disability later on.
By Shalmali Pal
Once pain and inflammation have been addressed, clinicians can implement interventions—including orthotic devices, stretching, and strengthening—to address the biomechanical factors that are believed to contribute to heel pain and other symptoms in this population.
By Erin Boutwell
High rates of chronic ankle instability in children suggest a need for better prevention and treatment of ankle sprains in young patients, but researchers are just starting to explore whether clinical approaches designed for adults will also be effective in their younger counterparts.
By P.K. Daniel
Knee pain is common in children with CP, but given the many health challenges facing this patient population, knee symptoms may not be given high priority. Proper diagnosis and treatment of knee pain, however, can be key to maximizing a childʼs mobility and quality of life.
By Shalmali Pal
While the patient is always the practitionerʼs first priority, establishing a convivial relationship with a childʼs parents can mean the difference between victory and failure when it comes to diagnosing, treating, and rehabilitating lower extremity problems in pediatric patients.
By Shalmali Pal
Two recent literature reviews underscore the lack of high-level evidence to support the various treatments available for idiopathic toe walking. But new research is starting to fill that void, and is also engendering new theories about factors that may contribute to the condition.
By Larry Hand
Some evidence suggests that neuromuscular training before puberty can help further reduce anterior cruciate ligament (ACL) injury rates. But young children respond differently to instruction than their older counterparts, which means early intervention requires some creativity.
By P.K. Daniel
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