Inhyuk Lee, orthopedic specialist at Seoul Bumin Hospital
[이인혁 서울부민병원 정형외과 전문의] In some cases, it is difficult to determine the cause of pediatric orthopedic conditions because it is not easy to accurately communicate how much and how children are ill and, contrary to parents’ concerns, they may simply be part of the growth process. In relation to this, we introduce three questions that are frequently asked in pediatric orthopaedics.
I can’t squat and only try to walk on tiptoe: short Achilles tendon
There are more cases than you might think of children going to hospital worried because they are unable to squat or prefer to walk on tiptoe. Most symptoms are caused by a short Achilles tendon and, unless it is serious, a strain
Lee In-hyuk, an orthopedic specialist at Bumin Hospital in Seoul, can improve with physical therapy alone. Walking on tiptoe is a temporary symptom until the age of two, when the child is just learning to walk and no special treatment is needed since the muscles and ligaments necessary for future walking are adequately developed.
These symptoms can be relieved by doing regular exercises to relax the Achilles tendon. It’s a good idea to stretch by holding onto the wall with both hands, sending one foot back with the knee straight, and slowly bending the other leg. However, children may have poor concentration or be unable to follow instructions well, so it is helpful to have systematic physical therapy performed by an expert in rehabilitation treatments.
I was playing well, but suddenly I can’t move my legs and it hurts: transient synovitis of the hip
There are cases in which a child who played well and was in good health suddenly cannot open her legs well and complains of severe pain when she moves, even if she did not fall or nothing happened. In this case, transient synovitis of the hip may be suspected. The synovial membrane plays a role in producing lubricating fluid that facilitates joint movement. The pain occurs when the synovial membrane surrounding the hip joint becomes temporarily inflamed and swollen, causing pressure on the hip joint.
Transient synovitis of the hip is a common disease in children under 10 years of age, and the incidence rate in boys is relatively higher than in girls. Patients mostly complain of pain in the hip joint or groin and may be accompanied by symptoms such as walking with a limp or having a slight fever.
Since this is a temporary illness, the condition will improve after a few days of rest. However, if the pain continues even after sufficient rest and is accompanied by high fever, it may have progressed to purulent arthritis, so it is better to go to the hospital for a thorough examination.
Fractures in children: there are problems with growth – Damage to the growth plate
Children often suffer fractures from falling or jumping from high places. Fracture rates appear mostly in the order of wrists, elbows and knees, but it is difficult to immediately check for growth plate damage immediately after a fracture. After receiving adequate treatment and observing the improvement of the condition, it is possible to determine whether the growth plate is damaged, and depending on the shape of the fracture, the probability of damage to the growth plate can be estimated.
If the fracture line passes only through the growth plate, there is a low probability of future growth failure. However, if the fracture line crosses the growth plate and invades the joint, surgical treatment should be used to carefully adjust the fractured and misaligned joint surface and then monitor the progress. In particular, the more we know how the injury occurred, the more useful it is for diagnosis, so the guardian on site should calmly and explain the circumstances of the injury in detail.
If the growth plate is damaged, the child’s bone age is measured before treatment. If the remaining growth period is less than 1 to 2 years, functional disability due to growth plate damage is rare and does not require special treatment, but it is recommended to receive individualized guidance based on the diagnosis of a pediatric orthopedic specialist.
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