I’m willing to bet the majority of the public has never heard of Legg-Calve-Perthes disease and that’s exactly what this little blog is hoping to remedy. Commonly known as Perthes disease this condition typically affects boys age 4-8. It begins with the blood supply to the femoral head inexplicably stopping. Once the blood supply ends the femoral head begins to slowly die and misshapen.
As the contact between the femoral head and the acetabulum decreases, pain, limping and range restrictions increase. This is when parents will typically notice children complaining of pain with activity and seek medical attention.
After proper diagnostic imaging and orthopaedic assessment the normal course of treatment includes: physical therapy to maintain range of motion, activity restriction and bracing. All of these methods are in an effort to maintain mobility until proper blood supply does return. Understandably children who have suffered from Perthese disease are more likely to have arthritis later in life, at which point additional treatment may be necessary.
If you have any concerns regarding your child’s hip development and walking please call us to book an assessment with a Certified Pedorthist.
I tore my lateral meniscus this year because I play like I think I’m 21 ( I’m not- I’m 42!) Yes, it hurt, it was swollen and I felt like an idiot for pushing myself so hard. I did a lot of physio and therapy and everything I was supposed to. The Canadian long drive championships were 4 weeks away, and I did not have enough time to repair it and recover in time. Thankfully I found the Bauerfeind Genutrain S brace. The brace gave me enough compression and knee joint stability with its compression knit technology and dual plastic hinges, which decreased my tracking issues in half! Be fully aware that bracing is a band aid solution, and the best option is always to strengthen and fix the underlying issue. Given that I had to continue to compete at an elite level, I needed something to give me the confidence to keep swinging out of my shoes and not hurt myself more.
Meniscal tears are a common injury of the knee. The meniscus are c-shaped discs that are designed to add a cushioning layer inside the knee joint. A torn meniscus can alter the way the knee joint functions, and can be painful.
Signs and symptoms of a torn meniscus:
Instability or sensation of giving way
pain with range of motion
decreased range of motion
any clicking or catching inside the joint
Diagnostic imaging is usually needed in order to properly diagnose any meniscal tear. Depending on the severity of the tear, rest may be all you need. If there is any clicking or decreased range of motion at the joint or pain with movement, then an orthopedic surgeon will arthroscopically scope the knee and repair or remove any damaged portion of the meniscus. In which case the healing process is that much longer of a timeline.
Depending on the severity of the tear, the Bauerfeind Genutrain S and the custom Bledsoe Z12 brace are great. The genutrain S will act on minor meniscus tears and the Z12 will act on more severe tears.
Haglund’s is a fancy name for the bump at the back of the heel that forms in some people. It is also called pump bump because it is quite common in women who wear dress shoes. The action of the shoe rubbing up and down on the back of the heel could be a contributing factor. There is a hereditary factor that may contribute to Haglund’s and people with high arches may be predisposed. When you have a high arch it causes the uppermost portion of the back of the heel bone to rub against the Achilles tendon, which in combination with certain styles of footwear can lead to the formation of the bony protrusion seen in Haglund’s deformity. Once this protrusion has formed, the bursa in the area tends to become inflamed leading to painful bursitis.
The majority of children I have seen with a Haglund’s deformity have been competitive hockey players playing 5-6 times per week. This is thought to be due to how rigid hockey skates are and at times they have pressure points at the back of the heel where the Haglund’s deformity is formed. Once the deformity has formed, it is common for the continuous irritation between the bony growth and back of the skate to lead to rbursitis. This is typically when children begin having symptoms.
A Pedorthic assessment can determine if custom foot orthotics would help reduce the discomfort or if accommodation pads can be implemented in footwear to reduce the irritation between the deformity and the shoe. Heel lifts can be added to custom foot orthotics or placed separately in footwear to slightly raise the heel to help relieve some tension in a tight Achilles tendon. This should be accompanied with a stretching program for the calf muscles to help lengthen the tendon.
Footwear that are backless or have a soft back would help limit irritation to the area associated with this condition. Accommodation pads can also be added to the interior portion of the back inside footwear to help create a pocket for any bony growth at the heel. These pads are intended to reduce any rubbing between the bony growth and interior portion of the shoe.
Childhood developmental milestones are a huge concern for parents. Everyone wants to make sure their little one is hitting the landmarks they should be. Crawling, walking, and running; these are all things we assess to ensure our child is where they should be. So it comes as no surprise that when something appears amiss we are quick to look for confirmation of normalcy.
As Certified Pedorthists we assess gait patterns in people of all ages and young children are no exception. One of the most common reasons for a pediatric assessment is worry regarding in-toeing. It is important to remember that in-toeing is very common in young children due to the structural position of their hips and legs at a young age. In the majority of children these structural positions resolve by eight years old.
It is possible to aid in correcting childhood in-toe. A specialized orthotic called a “gait plate” is used to gently guide the child toward a more straight foot position. In addition it is important to use well-structured footwear, verbally encourage pointing the toes forward with walking and reinforce sitting with legs crossed in front of them. The commonly seen “W” position, when sitting can encourage the continued internal rotation that perpetuates in-toeing.
I have been an avid tennis player and golfer my whole life and I consider myself in pretty decent shape. When I developed elbow tendonitis, it was debilitating! I was so sore after a round of golf, I couldn’t even lift a cold drink can to my mouth! I would take the can and place it on my elbow for some relief instead. I didn’t think much about it, but then it started to affect every aspect of my life. I couldn’t carry grocery bags, my briefcase, anything. More importantly, it hurt a lot when I was trying to hit a forehand or swing a golf club. Icing and some active release and massage certainly made a big difference and it was a “good pain” during treatments! But I needed something to make sure that I could still play – yes, I know I’m supposed to rest it, but if it flared up in the middle of a competition I needed something more than Advil to help me get through. Cue the Epitrain elbow brace from Bauerfiend. Don’t know what it is about German engineering, but this brace saved my round many times! It’s an easy to wear, simple pull on piece that works for either golf or tennis elbow , and it breathes so you can wear it in the heat and it will not smell too much ! The gel pads go right over the points of nerve entrapment on your elbow and provide instant relief. As soon as I pulled it on and started swinging I felt better right away. Not only did the pain diminish but it also gave me the confidence to swing hard which is something that I really enjoy doing when it comes to driving the golf ball!
Fareen Samji, 4 Time ILDC Canadian Women’s Long Drive Champion
There are so many over the counter knee braces that sometimes it’s hard to decide which one is better for you. The concept of all them are the same. Compress the area around the knee and keep the swelling down. My personal favourite is the Genutrain by Bauerfeind, for several reasons, the first being that it is very comfortable to wear. The knit fabric that is integral to all Bauerfeind products is breathable and washable. No more sweaty, stinky, black neoprene sleeves that feel disgusting after one use! The silicone omega pad surrounds the knee cap keeping the patella in place so that it tracks efficiently and provides a great feeling of stability around the knee. The fact that the knee cap is closed means that any swelling in the knee is dissipated nicely in conjunction with the compressive actions of the fabric. The sense of instant relief is second to none when you have the Genutrain on. It’s lightweight, fits under most pants discreetly and is very comfortable to wear. I play a fair amount of golf and badminton and my kids keep me pretty active playing with them or hiking the Bruce Trail. My knee doesn’t always hurt but when I push it too hard or am on uneven surfaces, it starts to bother me. I immediately go to my Genutrain and feel instant relief. Theoretically, the best cure for knee pain is to strengthen the muscles around the knee. My feeling is that if your knee hurts and you can’t do the exercises you need to do to stay healthy then please wear the brace. It’s lightweight, easy to slide on and it works, and did I mention it was breathable and washable!
Sometimes as parents of an athletic child you get hit with so many aches and pains and you begin to wonder which ones are serious and which ones aren’t. Do you have a young athlete in your life? Have they ever complained of knee pain after competition or practice? They may have developed a common condition called Osgoode-Schlatters Disease, which even though it sounds scary is not really a disease at all. It is basically a function of the muscles and tendons not developing at the same speed. It is typically seen in pre-teen and teenage athletes who are involved in running and jumping sports and manifests itself as a lump or bump or bony outgrowth at the front of the knee.
Osgoode-Schlatters develops when the quadriceps muscle group pulls excessively at its attachment on the tibia. This happens easily in young people because their bones are growing at such a fast pace. The patellar tendon attaches into the tibial tuberosity, which has yet to fuse to the rest of the tibia. As the quads contract they pull the tuberosity away at the growth plate causing a lot of pain.
The good news is Osgoode-Schlatters will not last forever! It can occur on an off throughout puberty but typically lasts 12-24 months. If your child has been diagnosed with Osgoode- Schlatters your best approach is physiotherapy, taping or bracing, cushioned custom orthotics and supportive sports specific footwear.
Shannon White, Certified Pedorthist. C.Ped ( c ) Milton Orthotic & Wellness Centre
I have worn a custom knee brace for my knee injuries and as a therapist and brace fitter I feel a certain kinship with my clients. When I injured my ACL playing soccer, I was so afraid that my soccer playing days were over. The pain was so intense and I was sure I would never get back on the field. Once I got my custom brace and finished my rehab, I was back! Without my custom knee brace to give me the stability I wanted, I would never have felt safe enough to return to the same level. But what I didn’t know at the time was that I would probably develop arthritis in my knee! When you are young and active, no one ever tells you that may get injured! No one ever tells you that the wear and tear on your joints could lead to premature arthritis! I quite often see patients who are still young, in their late 40’ s and 50’s who have stopped doing their activity because of arthritis in the knee. A lot of them will gradually gain more weight due to the drop in activity level and the weight gain doesn’t help with the increased joint pain one bit. It’s kind of like a vicious cycle- how do you stay active to stay healthy when arthritis in your knee prevents you from doing the activity you love? Well, motion is lotion – the more you are able to move, the more nutrients you send to your joints. Yes, it’s hard to move when you have bone on bone and the knee hurts when you walk. There are so many Osteoarthritis braces like The Thruster or the The Offloader that has a hinge that you can crank up to increase the amount of offloading on the joint space. The relief is almost instantaneous. There is no reason to let Arthritis slow you down, motion is lotion!
Most people don’t think of Bunions when they think of children’s feet! However, I see a fair amount of bunions in children (kids, you can thank your parents for some of that!). Bunions affect the alignment of the big toe as well as lead to bone growth on the inside of the foot near the big toe joint. In my experience children with bunions usually have flat feet, very flexible joint articulations in the feet, and are involved in sports that either require tight fitting footwear or cause repetitive stress to the first toe joint (cleats, skates, dance). When we work out, we stress our muscles and they respond to the stress by growing bigger. Same thing happens in bone. When you stress the big toe joint by rolling onto it when your arches collapse or by wearing a tight cleat or skate that rubs along the side of the toe, you are creating stress to that bone and if you have hereditary factors you are going to stimulate the growth of the bone in the big toe area. Probably one of the worst cases I saw of adolescent bunions were in a 14 year old girl who skates 5x per week and whenever she takes off her skates there is marked redness in the bunion area. When she is not in skates, she is in a Puma style flat shoe. Most of the kids I see nowadays are unfortunately not wearing well structured shoes and this leads to a big discussion about style when I try and educate them about the virtues of a good shoe. Parents, you are not held harmless on this one! There have been many a conversation in my assessment room on footwear when the parent says to me “she’s never going wear a running shoe, she only wears flats.” If you have a family history of bunions and your child’s foot is flexible, they are at risk of bunions. Help them, work with them to find a compromise. I certainly am not suggesting that your child wear an ugly orthopedic shoe! The difference a good Asics, Brooks or New Balance running shoe can make to your child’s feet is quite significant, and with the cool colours and styles nowadays surely we can find a compromise. My goal for bunion treatment is accommodation to limit any future growth. This begins with footwear education as well as supporting the arches of the foot to take the pressure off the big toe.
I have been playing competitive soccer ever since I can remember, and I like to move fast. I guess that warranted my dad’s nickname for me, “Scooter!” Never once did I ever think I would be needing reconstructive surgery on my knee to repair my ACL that was fully torn. I was just winding up for a shot, planted my leg and twisted and that’s when I felt my entire joint open and crumbled to the ground. I had never felt pain like that as I heard the “pop” in my knee and instantly knew something major had happened. As a kid playing rep sports, you think you are invincible! Who knew that girls are more predisposed to ACL injuries than boys because we have a wider pelvic angle? I certainly didn’t at that time.
After a year of waiting, I finally had my knee repaired and soon after I was getting fitted for my first Bledsoe ligament instability brace. I was so amazed at how light this brace was. When you look at them they appear bulky and restrictive, but the magnesium frame was so light and the brace was custom made so it moved perfectly with my leg. This brace became a part of me, and helped in my recovery process.
I was motivated to get back into playing soccer again but I was quite afraid of pushing my knee too hard. I didn’t want to go through the pain that I had just gone through! The brace was literally a helmet for my knee and gave me the stability, control and confidence to get back into what I loved doing most, playing soccer. I had to make sure there were no metal hinges showing or exposed on the brace, and thankfully they all come with outer covers to make sure the brace is in compliance or the refs wouldn’ t have let Scooter back on the field!