Recommended
More Related Content
Similar to Threenagers to teenagers
Similar to Threenagers to teenagers (20)
Recently uploaded
Recently uploaded (20)
Threenagers to teenagers
- 1. Threenagers to Teenagers Musculoskeletal Development and Related Injuries of Kids
- 3. Topics 1. Knock Knees 2. Foot Development 3. Calcaneal Apophysitis (Sever’s) 4. Osgood Schlatter’s
- 4. Knock Knees (Genu Valgus)
- 5. Knock Knees (Genu Valgus) Summary ● Normal from ~1.5-12 years old ● Slows and eventually self corrects through normal development ● Can be problematic if: ○ Extreme angle (over 15 degrees knock-knee or 10 degrees bowlegged) ○ In 25% percentile for height ○ Increasing in severity (or not decreasing) AND ○ Asymmetrical ● Exacerbated by: ○ Inactivity ○ How they sit ■ “W sitting” worsens knock knees ■ “Cross-Legged” worsens bow-leggedness ● Helped by: ○ Playing! ○ Minimal shoes ○ Foot strengthening exercises ○ Walking barefoot on sand and uneven surfaces
- 7. Foot Development Summary ● We are all born with Flexible Flat Feet (FFF) ○ The arch normally develops by 10-12 years old ○ 54% have a FFF @ 3 years old, 24% @ 6 years old. ○ 1 out of 5 never develop a visible arch ■ The foot can still be flexible and strong! ○ Only ~1% have a rigid flat foot! ○ No scientific correlation between FFF and pain or disability ● How to test: ○ Doming, Lift Toes ○ Weight-bearing vs. non-weight bearing ○ If they can create an arch, there’s hope! ● If arch is rigid and there is persistent pain, assistance through orthotics, shoes, and/or surgery may be needed ● Treatment ○ Reassurance & Education ○ Avoid inserts & rigid shoes (FFF) - go barefoot as much as possible!! ○ Stretches and Strengthening exercises & BE ACTIVE
- 8. What Parents Should Know ● www.global-help.org ● Search for “What Parents Should Know” ● There is a great booklet they can download and a video about: ○ Flat feet ○ Intoeing (knock-knees) ○ Bent Legs (Bow-legs) ○ Shoes ○ Inserts
- 10. Calcaneal Apophysitis (Sever’s Disease)
- 11. Calcaneal Apophysitis (Sever’s) Summary ● Inflammation of growth plate on heel ● Typically affects children from 8-14 ● Symptoms worsen with activity ● Muscle and tendon growth cannot keep up with bone growth ○ Causes tightness ● Exacerbated by sports with explosive movement such as jumping & cutting ● Cleats can create excessive movement ● Symptoms can be treated, but cannot be “cured” ○ Must wait for growth to slow and growth plate to ossify ● The most minimal treatment is the best treatment! ○ heel pad/cup/lift > arch support > supportive shoes ● Stretching, Strengthening, & Rolling!
- 12. Stretching, Strengthening, and Rolling (hint, hint)
- 14. Osgood Schlatters Summary ● Inflammation of growth plate under patella on tibia ● Typically affects children from 8-15 ● Onset is usually gradual ● Symptoms worsen with activity ● Muscle and tendon growth cannot keep up with bone growth ○ Causes tightness ● Exacerbated by sports with explosive movement such as jumping & cutting ● Cleats can create excessive movement ● Symptoms can be treated, but cannot be “cured” ○ Must wait for growth to slow and growth plate to ossify ● The most minimal treatment is the best treatment! ○ Patellar Tendon Strap > Knee brace > Foot Support ● Stretching, Strengthening, & Rolling!
- 15. Stretching, Strengthening, and Rolling (hint, hint)
- 18. Review ● Knock Knees ○ Normal in ages ~3-10 ○ Resolves itself over time through development ○ Should only be concerned if: ■ >25% average height, extreme for their age, increasing severity, AND asymmetrical (at least 3/4) ○ Exacerbated by: ■ Inactivity & how you sit ○ Treatment can include: ■ Playing, minimal shoes, going barefoot (especially in sand & uneven surfaces) ● Foot Development ○ Begin with flexible flat foot and develop arch by 10-12 ■ 54% FFF @ 3 years old, 24% @ 6, 20% into adulthood ● Doesn’t mean it can’t be strong! ○ Only ~1% have rigid flat foot ○ Test whether flexible by doming, lifting toes, and weight-bearing vs. non weight-bearing ○ Rigid flat foot may need assistance from orthotics, shoes, and/or surgery ○ Treatment through reassurance & education, avoiding inserts & corrective footwear unless symptomatic, being active, and stretching, strengthening, & rolling!
- 19. Review ● Calcaneal Apophysitis (Sever’s) and Osgood Schlatter’s ○ Inflammation of growth plate on heel or tibia below Patella ○ Typically affects children from 8-15 ○ Symptoms worsen with activity ○ Muscle and tendon growth cannot keep up with bone growth ■ Causes tightness ○ Exacerbated by sports with explosive movement such as jumping & cutting ○ Cleats can create excessive movement ○ Symptoms can be treated, but cannot be “cured” ■ Must wait for growth to slow and growth plate to ossify ○ The most minimal treatment is the best treatment! ■ heel pad/cup/lift > arch support > supportive shoes ■ Rest! ■ Stretching, Strengthening, & Rolling!
Editor's Notes
- Normal in kids from starting from 1.5-3 years old and resolves as we become adults Should resolve to a “normal” angle (5-7 degrees) by at around 10 years old We are actually bow-legged at birth because of external femoral rotation As we age, the femur rotates internally ~1.5 degrees/year and the Medial Condyle (bony protrusion on inside of knee) is overdeveloped through weight-bearing, creating the knock-knees As the Tibial growth plate and lateral condyle develop through maturation and normal weight bearing, the knees become less valgus (bow legged) and eventually varus (knock knees) Problem when Extreme angle for their age. >15 degrees valgus (knock knees) and 10 degrees varus (bow legged) ~1-1.5 degrees per year from 3-10 Height greater than 25% percentile Increasing in severity AND How to monitor? Place knees together and measure distance between ankles (measuring monthly) If continues beyond 7 or 8 years, is progressing , or is asymmetric then perhaps needs orthotics or brace Asymmetrical Not uncommon Extreme difference Can be exacerbated by: Inactivity Development of the medial condyle and tibial growth plate does not occur How you sit W Sitting exacerbates knock knees Cross-legged sitting exacerbates bowleggedness What can help? Encouraging good foot biomechanics with minimally supportive shoes, foot strengthening exercises, encouraging walking on sand & uneven surfaces barefoot
- "Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life." 10-12 Normally! Risk Factors: Ligamentous laxity, obesity, rotational deformities, limited dorsiflexion Underdevelopment Early shoe wear Chances double with persistent shoe wearing before the age of 12 Inactivity Flexible flat foot vs. Rigid Flat Foot (Acquired flat foot) Flexible flat foot can develop an arch but does not have the muscular or neurological tools to do so Training 54% at age 3 24% at age 6 Only 1 in 5 develop a visible arch This doesn’t mean it can’t be strong! Only 1% have rigid flat feet No disability from flexible flat foot into adulthood How to test: Doming Lift toes Weight-bearing vs. non-weight bearing. If the arch lifts during these there’s hope! Stretching and strengthening does not help, a rigid flat foot may need more help through shoes and orthotics Only if there is pain Most common cause of RFF is tight calves and achilles! Children often are noncompliant with such treatments as stretching and orthotic maintenance. Support from parents is crucial! What can be helpful? Reassure family of the normal development of the foot Educate & give advice Avoid inserts and rigid shoes Appropriately sized, flexbile, and unsupportive Stretches and strengthening exercises
- Inflammation of the growth plate on the heel bone Typically affects children between the ages of 8 & 14 High intensity and repetitive stress causes inflammation of the undeveloped growth plate Symptoms Pain worsens with activity With achilles tendinitis in adults, pain gets better with activity as the tendon loosens Limping Foot & ankle stiffness or discomfort upon waking in the morning Swelling and/or tenderness in the heel Causes: As the bones grow, the muscles and tendons often have a hard time keeping up in length This causes tightness, particularly in the calves and achilles, which attaches to the heel bone and the growth plate Rapid growth between the ages of 8 & 14 Sports with repetitive explosive movements (Jumping on hard surfaces and cutting) Improper footwear Cleats are usually rigid with a narrow platform, creating excessive movement Treatment: Although symptoms can be treated, the only true “fix” is to wait for for the growth spurt to end and the growth plate to fully develop Cushion & supportive shoes/insoles can help alleviate symptoms Simplest solution is always the best Just a heel pad/cup/lift if possible => arch support => supportive shoes Stretching & Myo-fascial release Reducing stress on the insertion point though calf/achilles/PF Strengthening Strengthening the lower leg and foot can help with control and reduce excessive movement Rest Products: Insoles, massage ball, heel cups, KT tape, foam roller
- Inflammation of the growth plate on the heel bone Typically affects children between the ages of 8 & 14 High intensity and repetitive stress causes inflammation of the undeveloped growth plate Symptoms Pain worsens with activity With achilles tendinitis in adults, pain gets better with activity as the tendon loosens Limping Foot & ankle stiffness or discomfort upon waking in the morning Swelling and/or tenderness in the heel Causes: As the bones grow, the muscles and tendons often have a hard time keeping up in length This causes tightness, particularly in the calves and achilles, which attaches to the heel bone and the growth plate Rapid growth between the ages of 8 & 14 Sports with repetitive explosive movements (Jumping on hard surfaces and cutting) Improper footwear Cleats are usually rigid with a narrow platform, creating excessive movement Treatment: Although symptoms can be treated, the only true “fix” is to wait for for the growth spurt to end and the growth plate to fully develop Cushion & supportive shoes/insoles can help alleviate symptoms Simplest solution is always the best Just a heel pad/cup/lift if possible => arch support => supportive shoes Stretching & Myo-fascial release Reducing stress on the insertion point though calf/achilles/PF Strengthening Strengthening the lower leg and foot can help with control and reduce excessive movement Rest Products: Insoles, massage ball, heel cups, KT tape, foam roller
- Growth plate just below the patellar tendon become inflamed from repetitive stress Usually between the ages of 8 &15 Symptoms usually subsite between the ages of 15 & 18 when the bone fully ossifies Symptoms: Pain directly below the Patella Onset usually gradual Sudden onset could be more severe Worsens with activity Pain, swelling, tenderness Noticeable bump may form on growth plate Normally no long-term residual effects (even if the bump forms) Possible causes: As the bones grow, the muscles and tendons often have a hard time keeping up in length This causes tightness, particularly inte quadriceps Rapid growth between the ages of 8 & 15 Sports with repetitive explosive movements (Jumping on hard surfaces and cutting) As the body attempts to repair the micro avulsions (small tears), the bony bump may appear Overpronation Muscular imbalances 4 quad muscles, an imbalance can cause improper Patella tracking Improper footwear Cleats are usually rigid with a narrow platform, creating excessive movement at the foot and up the chain Treatment Although symptoms can be treated, the only true “fix” is to wait for for the growth spurt to end and the growth plate to fully develop Support Insoles/shoes if overpronation is determined to be a contributing factor Brace to reduce tension from PT Stretching, strengthening and rolling to allevaite muscular imbalances Rest
- Growth plate just below the patellar tendon become inflamed from repetitive stress Usually between the ages of 8 &15 Symptoms usually subsite between the ages of 15 & 18 when the bone fully ossifies Symptoms: Pain directly below the Patella Onset usually gradual Sudden onset could be more severe Worsens with activity Pain, swelling, tenderness Noticeable bump may form on growth plate Normally no long-term residual effects (even if the bump forms) Possible causes: As the bones grow, the muscles and tendons often have a hard time keeping up in length This causes tightness, particularly inte quadriceps Rapid growth between the ages of 8 & 15 Sports with repetitive explosive movements (Jumping on hard surfaces and cutting) As the body attempts to repair the micro avulsions (small tears), the bony bump may appear Overpronation Muscular imbalances 4 quad muscles, an imbalance can cause improper Patella tracking Improper footwear Cleats are usually rigid with a narrow platform, creating excessive movement at the foot and up the chain Treatment Although symptoms can be treated, the only true “fix” is to wait for for the growth spurt to end and the growth plate to fully develop Support If overpronation is determined to be a contributing factor Stretching, strengthening and rolling to allevaite muscular imbalances Rest