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Femoral epiphysis slip whilst wearing orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by nicpod1, Jan 5, 2006.

  1. nicpod1

    nicpod1 Active Member

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    Trying not to panic!

    I've just received word back from a patient's mother re a teenage girl who I saw in October 2005 and gave orthoses to. Her presenting pain was tib post bilaterally and she was hypermobile and over-pronating (she was referred from a Consultant Orthopod).

    10 days after wearing the Orthoses, she developed right hip pain and presented to the GP, who said that the orthoses were the cause and that she should stop wearing them.

    He subsequently left her for 2 months and then sent her for x-ray and she has apparently slipped her femoral epiphysis, which now needs pinning.

    GP is still adamant that the Orthoses are to blame and the war drums are sounding!

    Has anyone had experience of growth plate fracture subsequent to orthoses wear?

  2. Craig Payne

    Craig Payne Moderator

    The GP should be shot...SCFE is a surgical emergency. Leaving it for 2 months significantly affects the outcome.

    I fail to see how the foot orthoses could have caused it.

    Here is the notes I give the students:
    Last edited by a moderator: Jan 6, 2006
  3. nicpod1

    nicpod1 Active Member

    Patient is actually seeing another Orthopod this morning, so hopefully she will get the surgical intervention she needs as soon as possible.

    Don't suppose you'd like a trip over to England, Craig, to be my expert witness!!

    Thanks for the info!
  4. I have never seen foot orthoses cause a slipped capital femoral epiphysis and have never heard of this. The GP is wrong on this one, like they are wrong on so many other foot and lower extremity biomechanical problems.

    The epiphysis was going to slip regardless of whether the patient was wearing orthoses or not.
  5. Ian Linane

    Ian Linane Well-Known Member

    Hi Nichola

    Whilst I can understand that the claim from the GP can cause alarm, and whilst not wishing to discuss the situation here too openly, I would want to reassure you that, from an expert witness point of view (which is part of my work), there would be a lot of difficulty backing up the GP statement. If possible put the concerns on the back burner for now and wait and see what the orthopod suggests.

    I have experienced something similar once, but coming via a neurologists statement. It never amounted to anything and the pt eventually B****Ked the neurolgist for their attitude.

    You can pm me if it is at all helpful.

  6. nicpod1

    nicpod1 Active Member

    Thank you all for these comments as, although I knew deep down that my actions were not causative of these events, it's sometimes difficult when you work in isolation of other Podiatrists (mainly) and are meant to be a specialist in your field, to be supremely confident of yourself and your, hopefully, best practice.

    It has demonstrated to me, though, the good that a forum such as this can achieve, as it will enable me to progress with communication with this patient's family and, potentially, GP with the knowledge that, although I may not be backed my the GP, I am backed by my peers, theoretically, which is a lot more meaningful!

    Thanks for your speedy advise!
  7. Admin2

    Admin2 Administrator Staff Member

    Slipped capital femoral epiphysis

    Slipped capital femoral epiphysis (SCFE or skiffy, slipped upper femoral epiphysis, SUFE or souffy, coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis). Normally, the head of the femur, called the capital, should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip. The femoral epiphysis remains in the acetabulum (hip socket), while the metaphysis (end of the femur) move in an anterior direction with external rotation.

    SCFE is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. One in five cases involve both hips, resulting in pain on both sides of the body. SCFEs often occur in obese adolescent males, especially young Black males, although it also affects females. Symptoms include the gradual, progressive onset of thigh or knee pain with a painful limp. Hip motion will be limited, particularly internal rotation. Running and other strenuous activity on legs will also cause the hips to abnormally move due to the condition and can potentially worsen the pain. Stretching is very limited.


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