Musculo-skeletal (muscles, bones & joints) problems of children are special and specific. Their growth and development follow a pattern which varies at different ages. For example bowing of the knees looks abnormal but it is quite physiological before the age of two. Bowlegs, knock knees, pigeon toe walking, tip toe walking, flat feet are often seen in children. They usually do not require surgery but will require clinical examination, observation and reassurance for the parents.
A limp often refers to anormal walking due to pain, weakness or deformities. The causes may lie at any part of the lower limbs and sometimes even in to the pelvis and spine. Limping can be acute or chronic. Infection, inflammation and trauma are some of the causes of acute limping. When limping becomes chronic, diseases of the hips like Perthes’ disease or slipped upper femoral epiphysis etc should be considered.
It is not unusuale for a child to walk with his/her foot turned in which is called in-toeing or pigeon toe gait. Turning the foot and the leg out wards whilst walking is called an out-toeing gait. These types of gait are due to persistent rotational problems of the hips etc, which usually get corrected, but it may take a number of years. It is interesting to note that when the child starts standing or walking the foot is usually turned outwards, which is normal and physiological.
Sometimes the children walk on tiptoes. Although this may be due to persistent habits, tightness of the Achilles tendon should be excluded. This could be treated with physiotherapy and stretching exercises. These children would also require a neurological evaluation as tiptoe walking is not uncommon in cerebral palsy.
True pain from the hip joint is experienced in the groin region. Acute hip pain with reduction of movements, demands emergency treatment as the diagnosis could be septic arthritis or osteomyelitis (infection of the bone). Other causes of hip pain are inflammation trauma, Perthes’ Disease etc. Often a hip disease results in pain of the knee.
Children often suffer with knee pain, especially at the front of the joint, which may be activity related. The pain could be due to chondromalacia talar (softening of the gristle behind the kneecap), Osgood Schlater disease, jumper’s knee, cartilage problems etc. Often the pain over the knee joint is referred from problems of the hip joint like Perthes’ disease, slipped upper femoral epiphysis. A thorough examination of the hip is required to exclude these problems.
These deformities could be normal and physiological dependent upon their ages. If the deformities are mild and similar on both sides, they will resolve in time. However, if the deformities are severe and on to one side, they need to be investigated particularly with X-rays and the treatment needs to be planned.
Parents are often concerned about curly toes, flat feet etc of their children. These deformities could be familial and resolve or get better. After clinical examination the parents could be reassured. Sometimes they can be treated with insoles and stretching exercises. The surgery could correct some of the toe deformities, especially in adolescence. Other deformities of the feet are bunions, high arched feet, club feet etc., which merit examinations, investigations with X-rays etc.