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Digital deformities in children under 6

Discussion in 'Pediatrics' started by whaley, Jan 19, 2006.

  1. whaley

    whaley Welcome New Poster


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    Hi all,

    I have been receiving recently quite a few referrals for children with digital deformites, usually adductovarus digits of the 3rd or 4th toes. These toes deformities are flexible and usually unilateral.

    I have been looking into newer treatments/interventions for these toes. Much of what I have read suggests that taping and splinting are not great treatments for these toes. I have been looking more into manipulation/stretching for the parents to do.

    I have been creating silicon toe props/wedges for these children as they produce a good aesthetic results - however I am well aware that when the device is removed the toe will return to its 'natural' position. Is there any point in trying to straighten these toes?

    I'm looking for other treatments/interventions that I can try on these little children some of which are only 8weeks old.

    Any suggestions would be greatly appreciated.

    Kirsten
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Next to nothing has changed in a very long time with regard to the management of this. Splinting, by whichever method (tape, moldable compounds, toe props etc) have been around for a very long time and guess they will be the mainstay for a very long time. Surgery reseverd for the severe, rigid and older, though minor soft tissue procedures are sometimes used on the less rigid and younger.

    One thing to keep in mind is that "critical" age in which heel-toe gait develops (ie 6+ years) - as soon as that happen the MPJ's start dorsiflexing and the windlass starts working (and it works on ALL digits, not just the hallux - its just works to a lesser extent on digits 2-5). The reverse windlass is a powerfull means of digital purchase which starts when the windlass get activated in these kids -- the finds of forces involved may go a long way to "self correcting" these problems to a certain extent.

    There certainly is limited (or probably no) data on the natural history of these types of digital deformity in kids.

    CP (looking out over Times Square :cool: )
     
    Last edited: Jan 21, 2006
  3. emoclew

    emoclew Member

    Hi Kirsten,

    I feel the same way too. Often the parents want a quick fix, and people seem to be looking for a lot more intervention these days. I generally don't intervene at all with the under 5's if their gait appears "normal" in other areas and they are not in pain or have any other symptoms. Sometimes we just have these quirky little traits and if they're not causing any harm or pain then what does it matter.Sorry I have no suggestions though.

    Lisa
     
  4. Cameron

    Cameron Well-Known Member

    Kirsten

    A high percentage of curly toes will self correct as femurs derotate. Some argue to wait until the child is seven plus, before seriously attempting any treatment and only when there are other symptoms suggesting abnormal development. Under sixes also present other challenges such as non compliance even with concerned parents and patient practitioners. Taken these as givens combined with parent (unrealistic but understandable) concerns for their off spring silicone props provide some comfort with measurable results. This may be argued as better than nothing and provided there is no harm done then all we can do.

    As clinicians we can underestimate ourselves and the value we give to ourtclients by seeking to do more. As Craig has pointed out nothing has emerged to replace conservative palliation at this age.

    Cheers
    Cameron

    New York Craig? There is a brilliant Sex Museum in the big Apple.
     
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