IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April :;;<• <=>>?
Yorkhill Division
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TTTTTOEOEOEOEOE P P P P PROBLEMSROBLEMSROBLEMSROBLEMSROBLEMS
INININININ C C C C CHILDRENHILDRENHILDRENHILDRENHILDREN
Minor toe variations are common� Parentsoften think that the unusual shape of a toeis the reason their child is slow or reluctantto walk� This is never the case� Some toeproblems are discussed below�
OOOOOVERVERVERVERVER�����RIDINGRIDINGRIDINGRIDINGRIDING SECONDSECONDSECONDSECONDSECOND TOETOETOETOETOE
The second toe quite often lies cocked upabove the first and third toes in the plumpinfant foot� As the foot becomes thinnerwith growth and spreads with weightbearing the toe comes to lie in line with theothers� Treatment with strapping has nobenefit and is not needed for somethingthat will get better anyway�
WWWWWEBBEDEBBEDEBBEDEBBEDEBBED TOESTOESTOESTOESTOES
Webbing between the second and thirdtoes is common� It never causes symptomseven if complete and attempts to separatethe toes with surgery can cause majorproblems with skin healing and infections�The fear that the child will be teased rarelyoccurs because children seldom go far withbare feet� The webbing is not easy to see inan active child� Webbing often runs infamilies�
CCCCCURLYURLYURLYURLYURLY THIRDTHIRDTHIRDTHIRDTHIRD ANDANDANDANDAND FOURTHFOURTHFOURTHFOURTHFOURTH TOESTOESTOESTOESTOES
This condition often runs in families� It isdue to a minor imbalance of the smallmuscles in the foot� These toes rarely cause
on shoes� Any shoes that fit1 includingtrainers and sandals1 are perfectly OK�There is no treatment1 other than wearingshoes that fit and possibly barefootwalking1 which can prevent bunions fromdeveloping� Surgery may eventuallybecome necessary for severe bunions�Operation is best left till adulthood sincethe bunions tend to recur rapidly if the footis still growing�
OOOOOTHERTHERTHERTHERTHER TOETOETOETOETOE PROBLEMSPROBLEMSPROBLEMSPROBLEMSPROBLEMS
There are several other variations of toesthat can cause anxiety� The big toe can behooked inwards (called metatarsusadductus)1 curled (called hallux flexus) orpointing upwards (called hallux erectus)�Metatarsus adductus has all butdisappeared since we stopped lying babiesface down in the cot� Some children willactively hook their big toe inwards whenstanding in bare feet but the toe liesnormally in the shoe� They always grow outof it so no treatment is needed� It is thesame for hallux flexus and hallux erectuswhich always disappear in time�
problems even though they tend to situnder the next toe� Curly toes are never thereason for late walking in a child�
If the toe causes no pain there is no needfor treatment� Strapping the toe or toespacers do not correct the toe shape� If thetoe causes pain it will show as redness ofthe tip or damage to the nail� A simpleoperation to cut the tendons to the toe willusually sort the problem though it may takesome weeks to get better afterwards� If toeshape is the only problem the risks ofsurgery are probably too high�
OOOOOVERVERVERVERVER�����RIDINGRIDINGRIDINGRIDINGRIDING FIFTHFIFTHFIFTHFIFTHFIFTH TOESTOESTOESTOESTOES
In this condition the fifth toe lies on top ofthe fourth toe� It looks quite ugly butcauses little in the way of complaints� Ifthere are complaints1 treatment can beused� Strapping or splints do not work sosurgery is needed� There is a very small riskof losing the toe with surgery�
BBBBBUNIONSUNIONSUNIONSUNIONSUNIONS
In the adolescent bunions may begin todevelop� The most important cause ofbunions is inherited but there isn’t muchyou can do about your genes! Shoes areimportant� Bunions are ten times morecommon in women than men despite bothsexes having the same genes for bunions�Fashion shoes with pointed toes areespecially harmful� Don’t be conned intothinking that you have to spend a fortune
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April BCC5• 54++D
Yorkhill Division
War to see if flat feet should be a reasonfor refusing entry to the army found thatsoldiers with flat feet had the leastproblems. while high arched feet causedserious problems� Soldiers with normalarches were in between�
WWWWWHYHYHYHYHY DODODODODO SOMESOMESOMESOMESOME PEOPLEPEOPLEPEOPLEPEOPLEPEOPLE URGEURGEURGEURGEURGE FORFORFORFORFOR
TREATMENTTREATMENTTREATMENTTREATMENTTREATMENT OFOFOFOFOF FLATFLATFLATFLATFLAT FEETFEETFEETFEETFEET?????Research has shown that some adult highclass athletes with flat feet can get foot.shin or knee pain when pushing their bodyto the limit� Many high>class athletes haveloose ligaments. which also means thatthey are more likely to have flat feet thatpersist as an adult� Arch support insolesworn during training can improve theirpain and performance though there is noevidence of benefit for every day activities�
Some professionals believe that flat feetcan be eliminated in adults by giving archsupports to children with flat feet� Thereare studies showing that such treatmentdoes not work�
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FFFFFLATLATLATLATLATFFFFFEETEETEETEETEET
Your child has flat feet� This leafletwill help you to learn more about thisnormal stage of growth of a child’sfoot�
WWWWWHATHATHATHATHAT AREAREAREAREARE FLATFLATFLATFLATFLAT FEETFEETFEETFEETFEET?????A foot is called flat if the arch on the innerborder of the foot is not as high as normal�It may also look like the ankle bone on theinside is more obvious or that the wholefoot seems tilted out the way�
IIIIISSSSS ITITITITIT SERIOUSSERIOUSSERIOUSSERIOUSSERIOUS?????No!Flat feet occur as part of normaldevelopment in *+, of children� It is the-, who do not have flat feet who areabnormal� Some children have looserligaments. which is why some feet seemflatter than others� Your doctor hasexamined your child to exclude flat feetcaused by abnormal bones in the feet.which produce stiff painful feet rather thanflexible normal young feet�
SSSSSHOULDHOULDHOULDHOULDHOULD THEYTHEYTHEYTHEYTHEY BEBEBEBEBE TREATEDTREATEDTREATEDTREATEDTREATED?????Studies by Professor Staheli in Americahave shown that insoles or arch supportsdo not help the arches of the foot todevelop� Indeed there was a hint that suchdevices slowed down the normal arch
development� We know that withouttreatment *3, of children will havenormal arches by age 45� A child who “getsbetter” with arch supports was going todevelop normal arches anyway and did sodespite. rather than because. of thetreatment�
CCCCCANANANANAN ARCHARCHARCHARCHARCH SUPPORTSSUPPORTSSUPPORTSSUPPORTSSUPPORTS CAUSECAUSECAUSECAUSECAUSE
HARMHARMHARMHARMHARM?????Possibly� Professor Staheli found thatchildren who were prescribed arch supportsfor flat feet did less well at school and inlife when compared to similar children withflat feet who did not have arch supports�He thought this might be because childrenwith arch supports were teased by theirfriends�
A study in England by Professor Wallaceon children with flat feet and early bunionslooked to see if arch supports wouldprevent the bunions getting worse� Itshowed that it was the children treatedwith arch supports who developed theworst bunions�
However most trainer shoes have smallbuilt in arch supports which are unlikely todo harm or cause a child to be teased�
DDDDDOESOESOESOESOES Y Y Y Y YORKHILLORKHILLORKHILLORKHILLORKHILL H H H H HOSPITALOSPITALOSPITALOSPITALOSPITAL EVEREVEREVEREVEREVER
RECOMMENDRECOMMENDRECOMMENDRECOMMENDRECOMMEND ARCHARCHARCHARCHARCH SUPPORTSSUPPORTSSUPPORTSSUPPORTSSUPPORTS?????Not for normal children though trainerscan be useful for the child who rapidlydestroys their shoes� Occasionally if feetare painful they can help� We sometimesuse supports for children with severe flatfeet caused by an underlying problem suchas cerebral palsy or a bony abnormalitycausing a painful stiff flat foot� In the adult.supports are only of value in athletes andare best custom made for that individual�
IIIIISSSSS THERETHERETHERETHERETHERE ANYTHINGANYTHINGANYTHINGANYTHINGANYTHING THATTHATTHATTHATTHAT CANCANCANCANCAN
HELPHELPHELPHELPHELP?????Yes� Professor Joseph in India found thatchildren who did not wear shoes before age3 always developed normal foot arches asthe foot matured� Obviously in Scotland itis not possible to go outside without shoeson most occasions but where possible youshould encourage your child to run aroundbarefoot and on tip>toe since this willstrengthen the muscles which help thearches of the foot to develop�
WWWWWHATHATHATHATHAT IFIFIFIFIF FEETFEETFEETFEETFEET AREAREAREAREARE STILLSTILLSTILLSTILLSTILL FLATFLATFLATFLATFLAT AGEAGEAGEAGEAGE
45 45 45 45 45 YEARSYEARSYEARSYEARSYEARS?????In most people flat feet cause nocomplaints and can be ignored� Indeed. astudy done just after the Second World
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April =>>?• ?@AAB
Yorkhill Division
CCCCC
HHHHHEELEELEELEELEEL P P P P PAINAINAINAINAIN
ligament that it develops tiny cracks� Thesecracks are painful but the pain is important�It stops your child from pulling off thetendon� which would leave them disabled�Adults cannot get Sever’s disease becausewe don’t have growth plates�
HHHHHOWOWOWOWOW ISISISISIS ITITITITIT TREATEDTREATEDTREATEDTREATEDTREATED?????The most important thing is to reduce yourchild’s level of sport to the point where theheel pain is only minor� Rest� ice� elasticbandages and sitting with the foot up canhelp with flare&ups� Once the bone is nolonger being pulled by excessive activity thecracks heal� It is then usually possible toagain increase activity� However� becausethe growth plate remains weak duringrapid growth the problem can recur� If itdoes� you will have to reduce their sportuntil things once more improve� Thisusually happens when growth slows again�since growing occurs in spurts�
WWWWWHYHYHYHYHY ARENARENARENARENAREN’’’’’TTTTT THETHETHETHETHE CRACKSCRACKSCRACKSCRACKSCRACKS TREATEDTREATEDTREATEDTREATEDTREATED
WITHWITHWITHWITHWITH AAAAA PLASTERPLASTERPLASTERPLASTERPLASTER?????They can be� However plasters areuncomfortable� weaken the bones andmake the joints stiff� The crack fractureswill heal just as well without a plaster�There is then less risk that the problem will
Your child has been referred to theclinic because of heel pain�Examination and X&rays have shownno serious disease� The pain is due toa condition called “Sever’s Disease”�This leaflet tells you about Sever’sDisease�
WWWWWHATHATHATHATHAT ISISISISIS S S S S SEVEREVEREVEREVEREVER’’’’’SSSSS DISEASEDISEASEDISEASEDISEASEDISEASE?????It is not really a disease at all� It is a type ofgrowing pain� which protects your child’sgrowing skeleton from damage caused byover activity at a time when rapid growthof the heel bone makes the bone weakerthan normal�
SSSSSOOOOO WHATWHATWHATWHATWHAT CAUSESCAUSESCAUSESCAUSESCAUSES THETHETHETHETHE PAINPAINPAINPAINPAIN?????At the back of a child’s heel there is a thinslice of bone that is separated from the restof the heel bone by a growth plate� Agrowth plate is made from gristle and isweaker than bone� Attached to one end ofthis slice of bone is the Achilles’ tendon andcalf muscle� At the other end is the strongligament that supports the long arch of thefoot� When a child is growing fast thegrowth plate becomes thicker and evenweaker� The thin slice of bone� particularlyin a very active child� is pulled so hardbetween the Achilles’ tendon and the arch
immediately recur because the child thinksthe plaster has cured them and again runsaround wild�
CCCCCANANANANAN ANYTHINGANYTHINGANYTHINGANYTHINGANYTHING ELSEELSEELSEELSEELSE BEBEBEBEBE DONEDONEDONEDONEDONE TOTOTOTOTO
HELPHELPHELPHELPHELP?????Yes� Sometimes the calf muscles tighten upbecause they grow more slowly than thebones� Tight muscles will pull harder on theheel bone through the Achilles’ tendon andmake the pain worse� Exercises to stretchout the calf muscle may therefore help thepain� Wearing trainers or shoes with a bitof a heel may also help� The reason ladieswear high heels is that the calf muscleworks less hard which makes it slimmer(and thus more attractive!)� If the musclepulls less hard� the pain should also be less�
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April 7889• 9:;;<
Yorkhill Division
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IIIIINTOEINGNTOEINGNTOEINGNTOEINGNTOEING
Your child walks with the feet turnedin or intoed� Some call this hen toeingor pigeon toeing� The problemappears to be in the feet but carefulexamination reveals that the wholeleg� not just the foot� is turned in theway� The in�turning is at the hip�Whilst intoers seem rather clumsyand may fall a lot they are quitehealthy� Intoers commonly havesupple joints and examination showsthat the hips can be turned in morethan out�
IIIIISSSSS INTOEINGINTOEINGINTOEINGINTOEINGINTOEING AAAAA DISEASEDISEASEDISEASEDISEASEDISEASE?????Intoeing is too common to be thought ofas a disease� One child in six is an intoer� Itis more common than blue eyes or beingleft handed and no one would considerthese conditions as a disease�
WWWWWHATHATHATHATHAT CAUSESCAUSESCAUSESCAUSESCAUSES INTOEINGINTOEINGINTOEINGINTOEINGINTOEING?????The supple ligaments mentioned above�The hip is a ball and socket joint� At birth ababy’s hips point partly forward in thesocket� In toddlers with supple ligamentsthe hip takes longer to sort itself out andduring this time the leg turns furtherinward during walking�
WWWWWILLILLILLILLILL INTOEINGINTOEINGINTOEINGINTOEINGINTOEING GETGETGETGETGET BETTERBETTERBETTERBETTERBETTER ONONONONON
ITSITSITSITSITS OWNOWNOWNOWNOWN?????In children under 1 years of age intoeingusually corrects on its own� Some childrenand their parents will be able to turn thehip further inwards than outwards Walkingintoed is a habit and there is nothing to stopyour child walking with their feet pointingforwards if they want to� It just happens tobe easier to walk with the foot pointinginwards� Many children improve with time�However� they will tend to intoe whentired� not concentrating or running fast�
WWWWWHATHATHATHATHAT ABOUTABOUTABOUTABOUTABOUT THETHETHETHETHE CLUMSINESSCLUMSINESSCLUMSINESSCLUMSINESSCLUMSINESS?????Many parents worry that their child istripping and falling� The in�turned foot mayadd to this but supple joints are also linkedwith clumsiness� Children are always moreclumsy than adults�
As they practice doing things they learn todo them with better co�ordination andbecome less clumsy�
WWWWWILLILLILLILLILL MYMYMYMYMY CHILDCHILDCHILDCHILDCHILD ALWAYSALWAYSALWAYSALWAYSALWAYS BEBEBEBEBE
CLUMSYCLUMSYCLUMSYCLUMSYCLUMSY?????Most intoers do not remain clumsy� Indeedmany intoers become above averagesportsmen and women as supple joints arehelpful for many sports�
CCCCCANANANANAN PHYSIOTHERAPYPHYSIOTHERAPYPHYSIOTHERAPYPHYSIOTHERAPYPHYSIOTHERAPY OROROROROR SPECIALSPECIALSPECIALSPECIALSPECIAL
SHOESSHOESSHOESSHOESSHOES HELPHELPHELPHELPHELP?????There has been research to see ifphysiotherapy or various shoemodifications will help intoeing but noneshow any benefit beyond the normalimprovement occurring anyway with age�The same would apply to surgery�
IIIIISSSSS THERETHERETHERETHERETHERE ANYTHINGANYTHINGANYTHINGANYTHINGANYTHING WEWEWEWEWE CANCANCANCANCAN DODODODODO
TOTOTOTOTO HELPHELPHELPHELPHELP?????One thing you can do is to prevent yourchild from sitting splay�legged in the Wshape� Many intoers do this� Sitting cross�legged or with the legs dangling down ispreferable�
IIIIINNNNN SUMMARYSUMMARYSUMMARYSUMMARYSUMMARY
Intoeing is a harmless normal variation thatmay be beneficial to the human race�Treatment cannot cure the intoeing butstopping your child from sitting splay�legged can prevent problems in the future�
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April 411A• A:22B
Yorkhill Division
LLLLLEGEGEGEGEGPPPPPAINSAINSAINSAINSAINS
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Leg pains seem to occur in almost allchildren at some stage during growth� Theyare often known as growing pains thoughgrowth itself is not painful� We call theseBenign Leg Pains because the pains do notcause long term problems even if they canbe quite distressing at the time� There aretwo different patterns of leg pains� The firstseems to occur in a very active child in theevening after excessive running about� Thesecond occurs in the middle of the nightwhen the child awakes screaming in pain which they may localise to a foot or kneeor hip�
WWWWWHATHATHATHATHAT CAUSESCAUSESCAUSESCAUSESCAUSES BENIGNBENIGNBENIGNBENIGNBENIGN LEGLEGLEGLEGLEG
PAINSPAINSPAINSPAINSPAINS?????No one knows for certain� We do knowthey are harmless� The pains that occurafter exercise are probably the body’s wayof protecting the growing bones againstoveruse damage� Unlike adults childrenhave gristle plates scattered through theirbones to provide growth� The bodyprotects itself against overactivity andpossible damage to the gristle plates withpain� During growth spurts these plates areweaker so the pain starts sooner� This iswhy the pains are called growing pains�
The pains that occur in the middle of thenight are frightening because they seem sosevere but they are just cramp� We all knowhow painful cramp can be! Cramp occurswhen muscles are not getting enough
blood� Your blood pressure is lower duringsleep and muscles are covered in a tightsheath� During muscle growth spurts theblood pressure may not be enough tosupply the muscle during deep sleep�Alternatively the inflow of blood may berestricted because the child sleeps withtheir legs folded under themselves�
WWWWWHATHATHATHATHAT CANCANCANCANCAN BEBEBEBEBE DONEDONEDONEDONEDONE ABOUTABOUTABOUTABOUTABOUT THETHETHETHETHE
PAINPAINPAINPAINPAIN?????There are no magic wands but there isevidence that stretching exercises bothmorning and evening help� Stand your childfacing a wall with their feet about 1�2metres (4 feet) away� With their heels onthe ground they should lean towards thewall with their hands ( elbows bent) on thewall to stretch the calf muscles� To stretchthe muscles at the back of the thighs yourchild should sit on the floor with their legsout straight in front of them and leanforward towards their toes keeping thebacks of their knees on the floor�
Leg pains caused by over6activity will notoccur if the child reduces their level ofexercise to minimize the pain� This will varydepending on how fast they are growing�Remember that the pain is nature’s way ofprotecting your child from more seriousharm� Painkillers may allow the child todo more damage to themselves�
The night cramps are best managed byrubbing the sore leg and reassurance� The
pain usually settles before a painkiller hastime to work since this can take up to halfan hour� Giving a painkiller before bed doesnot help because no painkiller is strongenough for cramp� In any case the painhelps by raising the blood pressure whichrelieves the cramp more quickly� Going inat your bedtime to untangle folded legshelps to reduce the number of attacks�Eventually the child grows out of thecramps but this may not be until age 9 or:1�
CCCCCANANANANAN LEGLEGLEGLEGLEG PAINPAINPAINPAINPAIN BEBEBEBEBE MOREMOREMOREMOREMORE SERIOUSSERIOUSSERIOUSSERIOUSSERIOUS?????Yes� A persistent limp or pain occurring dayand night might be investigated further� AnX6ray of the hips can exclude rareconditions such as Perthes’ disease or aSlipped Upper Capital Epiphysis� Theseconditions may be suspected if your GP hasnoted abnormal movement of the hips�Knee pain can come from a hip problem�Localised pain and swelling should alwaysbe investigated�
These conditions have been excluded as thecause of your child’s leg pains at presentbut if the pattern changes in the future youmay wish to see your GP again�
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April +::;• ;<==>
Yorkhill Division
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POPLITEALPOPLITEALPOPLITEALPOPLITEALPOPLITEALCCCCCYSTSYSTSYSTSYSTSYSTS
WWWWWHATHATHATHATHAT SHOULDSHOULDSHOULDSHOULDSHOULD BEBEBEBEBE DONEDONEDONEDONEDONE ABOUTABOUTABOUTABOUTABOUT ITITITITIT?????
Nothing! The cyst is totally harmless�In most children it causes noproblems� Occasionally after unusualexercise the cyst will get bigger andbe uncomfortable� However( a day’srest will settle both the pain andenlargement� The cyst will eventuallydisappear on its own( though it cantake + years�
WWWWWHATHATHATHATHAT ABOUTABOUTABOUTABOUTABOUT SURGERYSURGERYSURGERYSURGERYSURGERY?????
Surgery to remove the cyst ispossible� We do not think removingthe cyst is a good idea for tworeasons� Firstly( because the cystusually goes away itself andsecondly( because half of the cystscome back after surgery� It seemsunfair for your child to suffer thepain and risks of surgery only to endup with the same swelling and also ascar( especially if the lump is totallyharmless and will go away in time onits own� Very rarely the cyst becomesso big and sore that an operation isneeded� When this happens we justhave to accept the risk of the cystcoming back�
WWWWWHATHATHATHATHAT ISISISISIS AAAAA POPLITEALPOPLITEALPOPLITEALPOPLITEALPOPLITEAL CYSTCYSTCYSTCYSTCYST?????
A popliteal cyst is a benign fluid4filledswelling that appears at the back ofthe knee in some children� It connectswith a cyst that we all have at theback of our knees� This cyst oils thehamstring tendons as they moveover the back of the knee so theydon’t fray through� The cyst has afancy name 4 the semi4membranousbursa4but most people find“popliteal cyst” easier to say�
WWWWWHYHYHYHYHY DOESDOESDOESDOESDOES ITITITITIT APPEARAPPEARAPPEARAPPEARAPPEAR?????
We don’t know� Extra fluid may bemade to improve “oiling” of thetendons in supple children who canover4straighten the knee� This doesnot explain why only one knee isusually affected� Nor does it explainwhy not all children who can over4straighten their knees get a poplitealcyst� There is still a lot we don’t knowin medicine�
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April /..C• C-HH2
Yorkhill Division
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KKKKKNEENEENEENEENEE�����CAPCAPCAPCAPCAP PPPPPAINAINAINAINAIN
WWWWWHATHATHATHATHAT ISISISISIS KNEEKNEEKNEEKNEEKNEE�����CAPCAPCAPCAPCAP PAINPAINPAINPAINPAIN?????Knee�cap pain is pain that comes from theknee�cap or patella� It is usually felt at thefront of the knee though it sometimesseems to spread around the sides andoccasionally to the back of the knee� Manydifferent names have been given to thistype of knee pain including anterior kneepain& chondromalacia patellae and patello�femoral pain� Patello�femoral pain is theterm used by most doctors�
WWWWWHATHATHATHATHAT CAUSESCAUSESCAUSESCAUSESCAUSES THETHETHETHETHE PAINPAINPAINPAINPAIN?????The knee�cap is the most heavily loadedjoint in your body� The most commonreason for the pain is that your child hasbeen growing or putting on weight� Thisincreases the load the knee�cap has to bearat a time when it is still immature and notable to cope� A sudden increase in activitycan also overload the joint� Pain is probablynature’s way of protecting the knee�capfrom overuse damage�
It is very rare that there is any abnormalityof the bones or joint�
IIIIISSSSS KNEEKNEEKNEEKNEEKNEE�����CAPCAPCAPCAPCAP PAINPAINPAINPAINPAIN COMMONCOMMONCOMMONCOMMONCOMMON?????Yes� A survey of over -... schoolchildrenfound that /-0 (- in 2) of girls and 40 (-in -4) boys had knee�cap pain� It becameless common by the end of their teens�
CCCCCANANANANAN ANYTHINGANYTHINGANYTHINGANYTHINGANYTHING BEBEBEBEBE DONEDONEDONEDONEDONE TOTOTOTOTO HELPHELPHELPHELPHELP
THETHETHETHETHE PAINPAINPAINPAINPAIN?????Nobody can cure the pain� Since the pain isprotective& removing it would risk doingserious damage to the knee� However thereare several things that your child can do toreduce the pain to a nuisance level� Theseare listed below:
-� Quadriceps exercises�-� Quadriceps exercises�-� Quadriceps exercises�-� Quadriceps exercises�-� Quadriceps exercises�The quadriceps are the thigh muscles thathold the knee straight when standing� If theknee is sore the muscles become weak veryquickly� Weak muscles ache when asked towork& so they are rested more and becomeeven weaker and more sore with use� Weakmuscles are sometimes not able to supportyour weight& which may cause the knee togive way� This risks injury to the knee�Strong muscles help this pain and improvecontrol of the knee�cap movements Theexercises are simple to do and can be doneanywhere and any time without othersrealising� However& they only work if doneregularly� We think they should be done 4times an hour every day!
/� Sit with the knees straight�/� Sit with the knees straight�/� Sit with the knees straight�/� Sit with the knees straight�/� Sit with the knees straight�Another name for this condition is “TVknee”� Many children sit with their legsfolded under them& which puts high loadson the knee�cap� Sitting with the legsstraight takes this pressure off the knee�cap and allows the joint fluid to circulatein the knee� This fluid is vital to nourish theshiny gristle lining the joint� It also acts asa shock absorber between the joint surfaces
and to “oil” the surfaces� Sitting with theknee bent for a long time squeezes out thisfluid and can make the knee seize upbecause there is nothing to oil the surfaces�
B� Keep active and avoid things that makeB� Keep active and avoid things that makeB� Keep active and avoid things that makeB� Keep active and avoid things that makeB� Keep active and avoid things that makethe knee painful�the knee painful�the knee painful�the knee painful�the knee painful�Exercise is vital to make the skeletondevelop properly so we are not saying giveup all sport� We do suggest reducing thelevel of activity when the knee is sore� Thistends to be more common during a growthspurt when the bones may be slightlyweaker�
C� Weight reduction where needed�C� Weight reduction where needed�C� Weight reduction where needed�C� Weight reduction where needed�C� Weight reduction where needed�The knee�cap carries between 4 and -/times body weight during normal use�Being overweight or carrying very heavyschool bags can greatly increase the loadon the knee�
2� Shock absorbing footwear�2� Shock absorbing footwear�2� Shock absorbing footwear�2� Shock absorbing footwear�2� Shock absorbing footwear�Running& jumping and even walking appliesjarring forces to the knee� These cannot beavoided& but the use of shock absorbingshoes may reduce these jarring forces�Some types of trainers have been designedfor this purpose and are popular with kids�Where possible it is also sensible to walkor run on grass rather than concrete�
4� Simple painkillers�4� Simple painkillers�4� Simple painkillers�4� Simple painkillers�4� Simple painkillers�Even with these measures the knee willsometimes be painful� Simple painkillers&such as Paracetamol& will help the pain� Itis best only to give Paracetamol at night toavoid the temptation to do too muchwithout the protective pain�
IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April -110• 0)++,
Yorkhill Division
CCCCC
BBBBBOWOWOWOWOW�����LEGSLEGSLEGSLEGSLEGS
K K K K KNOCKNOCKNOCKNOCKNOCK�����KNEESKNEESKNEESKNEESKNEES&&&&&
Your child has been sent to the clinicwith either bow�legs or knock�knees�This leaflet will try to help you learnmore about these knee shapeproblems� Bow�legs means that thereis a gap between the knees when theankle bones are pressed together�Knock�knees are present when thereis a gap between the ankle boneswhen the knees are pressed together�
AAAAARERERERERE BOWBOWBOWBOWBOW�����LEGSLEGSLEGSLEGSLEGS OROROROROR KNOCKKNOCKKNOCKKNOCKKNOCK�����KNEESKNEESKNEESKNEESKNEES
ABNORMALABNORMALABNORMALABNORMALABNORMAL?????Not in most children� Astudy in )*+, found thatall children had bow�legsup until age - years� Afterthis they became knock�kneed� The degree ofknock�knee is mostobvious between age /and 0� The legs thenslowly straighten to the adult shape by age)1 to )-� Heavy children and children withloose ligaments stretch their knee jointsand knee shape appears to be worse� Manybabies have big calf muscles4 which canmake the leg seem quite bent even whenthe bones are only slightly curved�
We call bow�legs before age -4 and knock�knees between age - and )- years normalbecause this is how a human is supposedto develop�
If a child has bow�legs beyond the age of /4or knock�knees before age - or after age )1to )-4 this may be a problem� X�rays maybe advised for these children� Even then thechild may be normal since there is a widerange of “normal” which can sometimesoverlap with the abnormal�
WWWWWHATHATHATHATHAT AREAREAREAREARE ABNORMALABNORMALABNORMALABNORMALABNORMAL CAUSESCAUSESCAUSESCAUSESCAUSES OFOFOFOFOF
BOWBOWBOWBOWBOW�����LEGSLEGSLEGSLEGSLEGS OROROROROR KNOCKKNOCKKNOCKKNOCKKNOCK�����KNEESKNEESKNEESKNEESKNEES?????There are a number of causes�
Rickets is a cause4 both of abnormal bow�legs or knock knees� Rickets results fromlack of vitamin D� This occurs eitherthrough poor diet4 lack of sunlight (whichmakes vitamin D in the skin) or becausesome people’s bodies can’t use vitamin D�A blood test tells the doctor if this is thecause� Rickets is treated with medication�Sometimes surgery is needed if the boneshape does not get better with medicationtreatment�
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The other most common cause of abnormalbow�legs is genetic� If a close relative hasbow�legs as an adult this may suggest thatyour child’s bow�legs are genetic if they arestill there after age /� Treatment withsplints or even surgery may be needed tosort the problem� Your Orthopaedic doctorwould keep an eye on this problem with X�rays�
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IIIIINFORMATIONNFORMATIONNFORMATIONNFORMATIONNFORMATION FORFORFORFORFOR PARENTSPARENTSPARENTSPARENTSPARENTSDesign & Layout Medical Illustration•April 7889• 9:;;<
Yorkhill Division
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IIIIIRRITABLERRITABLERRITABLERRITABLERRITABLE HHHHHIPIPIPIPIP
HHHHHOWOWOWOWOW ISISISISIS IRRITABLEIRRITABLEIRRITABLEIRRITABLEIRRITABLE HIPHIPHIPHIPHIP TREATEDTREATEDTREATEDTREATEDTREATED?????
Usually rest until it is better and thehip movements have recovered# Thepain normally settles over a few days#The limp can take longer to go(especially if the child starts to runaround too soon#
If the hip pain or fever are increasingdespite rest and simple painkillers likecalpol you should contact yourG#P#for advice# Your G#P# may wantto refer you to hospital as X,rays andblood tests may be needed# If theseare OK your child can be treated athome with rest# When the hip is quitepainful or the blood tests areabnormal( your child will be admittedto hospital for observation#Sometimes we have to take fluid offthe hip under an anaesthetic to becertain infection is not present# Thiswill help the pain by taking thepressure off the hip and confirms thecause of the limp#
Your child has been diagnosed ashaving an irritable hip# Thiscondition is also known astransient synovitis# It is veryworrying for a parent if yourchild suddenly cannot walk orhas a marked limp# However itis transient or short,lived andgets better#
WWWWWHATHATHATHATHAT ISISISISIS ANANANANAN IRRITABLEIRRITABLEIRRITABLEIRRITABLEIRRITABLE HIPHIPHIPHIPHIP ? ? ? ? ?
When a hip is irritated more fluid ispresent and the joint becomes a littleswollen# Fluid in the hip joint reducesnormal movements in the hip# Thisfluid can be shown by an ultrasoundscan of the hip( though examiningyour child is often enough#
WWWWWHATHATHATHATHAT CAUSESCAUSESCAUSESCAUSESCAUSES ANANANANAN IRRITABLEIRRITABLEIRRITABLEIRRITABLEIRRITABLE HIPHIPHIPHIPHIP?????
A few happen after falls( over,activity or follow a viral upset# Manychildren have none of these and itjust seems to have happened#
AAAAARERERERERE THERETHERETHERETHERETHERE SERIOUSSERIOUSSERIOUSSERIOUSSERIOUS CAUSESCAUSESCAUSESCAUSESCAUSES OFOFOFOFOF ANANANANAN
IRRITABLEIRRITABLEIRRITABLEIRRITABLEIRRITABLE HIPHIPHIPHIPHIP?????
An irritable hip seems to be a simplecondition and gets better# If theyoungster returns to vigorousactivities too soon it may come back#After a few weeks this is unusual#
