Paediatric (0-12)
Orthopaedic Conditions

Developmental Dysplasia of the Hip (DDH)

DDH is a condition where the ball and socket joint do not form properly. While some children are born with the condition, many children develop DDH in their early years.

Hips affected by DDH are easily dislocated. This causes the “clicky hips” often picked up by Child and Maternal Health Nurses or Family Doctors. Many babies respond well to wearing a brace and go on to develop normal hips. Some children will need an operation to help align the hip joint and some will need further surgery.

If not treated early, children with DDH may start walking later and may limp. Without appropriate management, DDH can develop into early onset osteoarthritis.

During your consultation, I will discuss all the options with you and your family.

Neuromuscular Hip

Neuromuscular disorders occur when the nerves that control the voluntary muscles and sensory information to the brain are not working properly. Children with the condition often have problems with their hips.

Because of muscle imbalance, the hip joint is pulled out or partially dislocated. This can result in an inflamed joint, premature joint degeneration and pain that is difficult to manage.

While the method of treatment will depend on the cause of the pain and the state of the hip joint, I will weigh up the options with you and your family. My aim is to provide the most reliable and least traumatic solution for your child.

Legg-Calve-Perthes Disease of the Hip

Perthes Disease is caused by a disruption of the blood supply to the head of the femur (thigh bone). The lack of blood causes the bone to degrade, change shape and eventually die. It mostly affects four to eight-year-old children. As the disorder progresses, the head of the femur progressively collapses. Both hips can often be affected.

I will always take you through the options before starting any treatment. An important part of the treatment is to rest and keep weight off the hip. Sometimes surgery is needed to make sure the head of the femur fits snugly in the socket.

Children do best when referred quickly to a surgeon, because without appropriate management Perthes Disease can lead to early osteoarthritis.

Obstetric Brachial Plexus

The brachial plexus is the group of nerves in the neck that control movement and feeling in the arms and hands. This group of nerves can be injured during birth.

Most children recover from this mild injury without surgery. However some children with more severe conditions may need surgery to help their shoulder work properly.

When surgery is necessary I work with plastic surgeons, who operate on the nerves, while I rebalance the shoulder tendons and reposition the bony components to help the shoulder develop and move.

Before any treatment begins I will discuss the options with you to make sure your child gets the best possible result.

Discoid Meniscus / Popping Knee Syndrome

The meniscus is the rubbery, cartilage cushion in the knee, between the thigh and shin bones. Occasionally the meniscus does not develop correctly and can cause pain, the knee to lock and pop.

The treatment can include surgery to reshape the meniscus.

Before any treatment I will discuss with you and your family the best ways to treat your child’s condition.

ACL, PCL, Collateral
ligament injuries

The four main ligaments in the knee hold the joint steady. Twisting can cause these ligaments to stretch and even rupture. Quite frequently a ligament injury is associated with the tearing of the meniscus, the rubbery knee cartilage that cushions the shinbone from the thighbone.

In severe injuries the knee will be swollen and very tender. It may lock, get stuck and be unable to straighten. Ligaments that have been completely ruptured generally need surgical repair to help them heal. If it is not repaired, the knee may be unstable, prone to further injury and osteoarthritis in later years.

Milder injuries do well with physical therapy and a carefully managed rehabilitation programme.

I will help diagnose the injury and discuss with you and your child the most effective treatment.

Clubfoot / Congenital Talipes Equino Varus (CTEV)

Club foot is a condition where a baby’s foot is twisted out of shape or position. The muscles of the leg and foot are often shorter than they should be making it hard for the child to walk normally. For best results treatment is started soon after birth.

The treatment often includes a series of casts that gently alter the position of the foot.

Sometimes, surgery is needed to balance the foot. I will discuss with you and your family the best options for your child.

Skewfoot

Skewfoot is an uncommon condition that affects both the front and the back of the foot to make it Z shaped.

When I examine your child’s foot I will check the condition of their foot and discuss with you a plan for the best possible treatment. The purpose of the treatment is to provide your child with a foot that fits shoes and is comfortable to walk on.

I often recommend a series of casts that gently reposition the foot and bracing to hold it in the correct position. If this treatment is not effective, surgery may be necessary.

Flatfoot

All children are born with flat feet. By the age of six most will have developed an arch in their foot, although about one in five never develop an arch.

Flat feet often occur in more than one member of a family. Most adults with flat feet have no long-term problems or pain.

When you come along to my consulting rooms I will examine your child’s foot, to see if it is mobile. If I find that the foot is painful and stiff and restricts their activity, I will discuss treatment with you.

Toe walking

When learning to walk, children often walk on their toes. Occasionally it can become a habit. As they develop most children go on to walk normally.

However, toe walking can be associated with a range of conditions such as cerebral palsy, muscular dystrophy and other diseases of the nerves and muscles. Occasionally, toe walking occurs for no known reason.

If you are concerned, it is important for your child to have a thorough examination.

I will try to find out what is causing the toe walking and then discuss with you a plan for the best management of the condition.