Are My Child’s Limbs Normal?

The term orthopedic means, “Straight child”. It is a misnomer as legs are usually not straight. There is always a normal range of variation. It is also true that a child is not a miniature adult. There are certain peculiar features which Mother Nature has bestowed upon the growing child’s skeleton which are lost in a skeletally mature adult.

Most children outgrow and spontaneously correct the apparent developmental abnormalities in their skeleton. Children have growth plates at the ends of their long bones which help them grow in height and width. Certain injuries can affect them and alter the growth pattern. Luckily the serious form of such injuries is rare. Children have great remodeling potential, which means that a lot of malalignments of the long bones after fractures correct themselves with growth. This nature’s tool to correct abnormalities without treatment is more powerful in younger children. Fortunately, children’s fractures also heal much faster than adults and therefore require much shorter periods of immobilization. Furthermore, there is seldom any joint stiffness after injuries even after prolonged immobilization in casts or braces.

A lot of children seen in orthopedic clinics are normal but the parents are anxious and concerned as they are not able to differentiate a normal variation from a true abnormality. This differentiation is very important as early diagnosis and treatment could be instituted in case of a true abnormality or at least the anxiety and apprehension could be alleviated by reassuring the parents about a normal variant or an abnormality which only needs observation and most likely will correct itself with growth. Certainly, parents cannot make this decision.

Parents have only a few options:

  1. Ignoring the problem and leaving it to nature
  2. Consulting the internet (and getting confused about all the jargon online) 3. Taking opinions from friends and relatives
  3. Consulting a non-orthopedic doctor.
  4. Expert opinion from an orthopedic and preferably one with special interest in pediatric orthopedics.

We all understand now that in children most of the abnormalities correct themselves with growth but what if the child is one of those in whom a problem really exists and could be detected early and managed expertly. In my opinion the last option is by far the best option.

Medical field has now entered an era of sub specializations and special interests. Same applies to orthopedics where sub specializations such as pediatric (children’s) orthopedics, sports medicine, spine surgery and joint replacement surgery are the most common ones.

Awareness and education campaigns amongst parents, nurseries, schools and even health care professionals will go a long way in promoting better skeletal health and in instituting and promoting policies of preventive medicine and early referral systems.

The most common problems in pediatric orthopedics seen in a regular clinic are:

  1. Flat and high arched feet
  2. In toeing or out toeing gaits
  3. Bowed legs or knock knees
  4. limb length problems
  5. club feet
  6. Hip disorders like dysplastic hips and perthes disease
  7. Limping
  8. fractures especially around growth plates and Neurological abnormalities as in cerebral palsy.

In certain cases like club feet, surgery is not the preferred way of treatment anymore. Well proven techniques especially one which has lasted the test of more than 50 years, called Ponseti’s technique entails gradual manipulation and casting done as an out patient procedure and yields more than 90 percent good results. This technique is done in a very few centers in the world and fortunately is available at the Zia Medical Center.

The pediatric orthopedic services at the Zia Medical Center also cater for early detection and management of pediatric hip disorders like congenitally dislocated hips. Screening and early detection and management of limb malalignment and malrotation is also undertaken. Serious conditions are out ruled & differentiation between severity of condition and all management options are discussed with the parents in detail. This enables parents to make informed and educated decisions about their child’s condition. Trust and good working relationship is thus created between the clinician and the parents.

Mother Nature looks after children in a special way. Observational management in most of the pediatric conditions is a safe, inexpensive and effective method. In most of the conditions we allow the magic of time and growth correct the problem and if necessary a helping hand is offered by the surgery by an expert pediatric orthopedic surgeon.

Last but not the least, a lot of aches and pains in childhood are attributed as “Growing Pains”. Is it a true entity? The answer is Yes, but it is a diagnosis of exclusion meaning that all the other reasons for leg pains should be sequentially and systematically excluded by history and physical examination and possibly by investigations before making such a diagnosis.

In conclusion, the symptoms of limb pain, deformity, swelling, length deficit, limping and weakness should be taken seriously by the parents and expert opinion sought at the earliest.

Dr. Salman Hameed

  • Specialist Orthopedic Surgeon
  • MBBS, FRCS (Ire), FRCS (Tr. & Orth) UK