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Paediatrics patient advice

Discussion in 'General Issues and Discussion Forum' started by spike2260, Mar 25, 2009.

  1. spike2260

    spike2260 Member


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    Hi there,

    Recently have spoken to a colleague who was concerned about whether their childs feet were normal, they explained they were pes planus, and no orthotics have been prescribed as she was seen by orthopeadics who told her she would grow out of it (a good few years ago) , well she has not.

    And as a consequnece has developed, what i can only describe as the symptoms of post tib tendon dysfunction. The mother explained to me where her daughter was experincing the pain and was describing what appeared to sound like post tib tendon dysfunction, is this even possible in a child, who displays pes planus? and if not, what would be the most likely factor for the pain? unfortunatly i have examined the child myself so am only going on what has been told to me,

    any help would be appreciated.
     
  2. Sammo

    Sammo Active Member

    Re: paediatrics

    I think it would be much more helpful if you could give us some more information on the child. If you could examine her and post your findings we could give you a slightly more focused opinion than giving a huge list of DDx.

    How old is the person in question? Where does it hurt (what structures exactly are painful on palpation), when does it hurt, what time of the day does it hurt, better or worse with exercise/rest, how long has it hurt for, how old is she(!?), what is her activity level, how flexible is she (as in what is her mobility in her feet, knees etc., not "she can't do tuesdays"), did she have a normal term and birth, what sort of pain is it, how much has she grown over the last 6 months.

    I'll go out on a limb and say it is very very unlikely to be PTTD in a normal child.

    We really need alot more information, or get stuck into the textbooks.

    Kind regards,

    Sam
     
  3. Aldrin C

    Aldrin C Member

    Hi,

    A good article to read is by Angela Evans who specialises in pediatrics.

    Angela Margaret Evans
    The Flat-Footed Child—To Treat or Not to Treat: What Is the Clinician to Do?
    J Am Podiatr Med Assoc 2008 98: 386-393

    http://www.japmaonline.org/cgi/content/abstract/98/5/386

    Hope this helps

    Kind regards,

    Aldrin
     
    Last edited by a moderator: Mar 26, 2009
  4. Bug

    Bug Well-Known Member

    Re: paediatrics

    I agree with both of the above posts. That article is a great guide.

    Basically whether it is PTTD (which I've seen in 7-8 year olds) or not, there is a child in pain. It needs to be investigated further.The list of what is causing the pain could be a mile long however without knowing the age, sex, medical hx, etc etc etc no one can really make that call.
     
  5. Sammo

    Sammo Active Member

    Re: paediatrics

    Hi cylie, I just want to clarify that we are talking about the same level of pathology..

    PTTD = complete incompetency and dysfunction of the tibialis posterior tendon due to chronic overuse, which is very diificult to be corrected surgically and impossible to correct conservatively, and exhibits an acquired flat foot where the patient is unable to stand on tiptoes on the effected foot and you definitely see no calcaneal inversion when standing on tiptoes?

    Not just a tib post tendonopathy?

    Kind regards,

    Sam
     
    Last edited by a moderator: Mar 26, 2009
  6. Bug

    Bug Well-Known Member

    Re: paediatrics

    Sure am Sam, unilateral flat foot, unable to heel raise, poor rehab due to us all thinking just tendonopathy ended up in surgery by 12 (due to the public wait list) with now not great results due to the difficulty in correcting. Presence of a very large os navicularis now removed etc. Have had 2, cousins. Though the second had better outcomes as we didn't faff around for so long to get a surgical consult and we were fussier with the surgeon due to the outcomes of the first. She had her surgery at 10. Both children were larger than average, played a stack of sport and waited on a public wait list for treatment. Both were totally unable to heel raise on the affected foot by the time they got in. I'll be honest, both the physio and I missed it due to us thinking it was not a possibility and that it was just tendonopathy in the first on. However the surgical report clearly stated it was, so I don't know.....can I blame the surgeon if I have been thinking it was all along? However it unfortunately totally fit the clinical picture, just on a little body.

    I do agree it is very rare but sometimes to never say never. I generally work with the theory of good old Dr Woodward and "When you hear hoofbeats, think horses, not zebras" however am finding lately I'm am working way too close to a zebra herd.
     
    Last edited: Mar 26, 2009
  7. spike2260

    spike2260 Member

    Re: paediatrics

    thank you both very much for the article, i will definetly get stuck into that, the only other information i have regarding the child is that the patient is female, 8 years old and she is very active. Iam very keen to examine her further to at least be able to deduce at the least the list of other possible complications. If i examine her in the immediate future i will post my findings so each of you can have a clearer picture,

    thank you both for your time
     
  8. Admin2

    Admin2 Administrator Staff Member

  9. Sammo

    Sammo Active Member

    Re: paediatrics

    Hi Cylie,

    Really appreciate the post.. I like the horse analogy. This is one of the great things about tha arena, we can share those very very rare cases and we can all learn from them.

    Kind regards,

    Sam
     
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