Library Type: Condition
Brachycephaly
Sagittal Synostosis
Traumatic Brain Injury
Signs & Symptoms
Following a TBI, a person’s ability to move can be affected. This can disrupt normal walking patterns. The patient may require an orthosis (brace) to support the limbs and improve their ability to stand and walk.
Some common gait issues might include:
- Walking with a toe-to-heel rather than heel-to-toe pattern
- Knee bending backward when walking
- Rigid or tight joints in the ankle
- Muscle tightness in the toes, ankle, and wrist/hand
Treatment
Many of the symptoms of TBI can be treated using a brace, which can be used to assist or control motion, improve walking ability, and decrease the risk of falls.
Centers for Disease Control and Prevention (2019). Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. | Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003. | Brunnstrom S. Movement Therapy in Hemiplegia. Hagerstown, MD: Harper and Row; 1990. | Review of Traumatic Brain Injury with Orthotic Considerations. | JPO Journal of Prosthetics and Orthotics: March 2002 – Volume 14 – Issue 1 – p 31-35.
Femoral Anteversion
Causes
Femoral anteversion is usually considered to be a variation of normal development. Doctors don’t know what causes it or why some children develop severe femoral anteversion.
Treatment
In the typically developing child, femoral anteversion will generally resolve itself over time. It is part of the normal growth and development process that takes place between birth and age 8.
In children with neuromuscular disorders, such as cerebral palsy or spina bifida, femoral anteversion often does not resolve itself, because these children may not walk very much or at all. Although specialized shoes and orthoses (braces) are often prescribed by the child’s doctor to address femoral anteversion, most studies have found these interventions to be of little benefit.
In most cases, femoral anteversion has a good prognosis, as many cases correct themselves as the child grows. On rare occasions, femoral anteversion can be severe and surgery may be required to straighten the thigh bone. However, it is important to know that femoral anteversion typically does not lead to arthritis or any other future health problems.1
1. https://www.chop.edu/conditions-diseases/femoral-anteversion
Blount’s Disease
In many cases, a bow-legged appearance in very small children is normal and should resolve by the age of 2.
Treatment
If left untreated, Blount’s disease can quickly cause inward rotation of the lower leg, causing frequent falling. Long-term lack of treatment can lead to arthritis and pain in the knee joint, as well as difficulty walking.
For patients with infantile Blount’s disease, bracing is the standard of care to help avoid surgery and should be started under the age of 3.
Lower limb bracing is used to align the legs into a straighter position as your child grows. A difference in the angle of the lower legs is usually seen within 12 months of the start of bracing; however, bracing may be used until the desired bone angle is reached. If the bowing remains after the child turns 4, surgery may be required.
The goal of bracing in Blount’s disease is to unload the inside of the lower leg and allow the bone to grow straight. The effectiveness of bracing will depend on what age the brace is started and how often the brace is used.
Toe Walking
In very rare cases, continuing to toe walk after age 2 may be a sign of an underlying medical condition. In the vast majority of cases, persistent toe walking is “idiopathic,” which means that the exact cause is not known. Older children who continue to toe walk may do so simply out of habit or because of contractures, which are the tightening of muscles and tendons in their calves over time.
Treatment
The consequences of toe walking can be severe; after months and/or years of toe walking, an acquired contracture of the calf muscles can occur. Children with excessive toe walking also have excessive external rotation and external tibial torsion to accommodate for their plantar flexion contracture.
Toe walkers require orthotic intervention (bracing) to help with contractures and prevent them from developing into a long-term pattern. Toe walking treatment varies based on the percentage of time your child is on their toes, the length of the calf muscle, and the child’s age. The length of treatment time depends on how long the child has been walking on their toes, associated contributing factors, and compliance with the orthotic and therapy programs.
With correct biomechanical alignment, it is possible to facilitate a new movement pattern. Ankle-foot orthoses and other orthotic interventions are therapeutic tools to help re-establish the heel-to-toe pattern, control, and create proper ground reaction forces in front of the hip and behind the knee, and provide sensory input through the heel.
Clubfoot
Associated Foot Conditions
Metatarsus adductus, also known as metatarsus varus, causes the front half of the foot, or forefoot, to turn inward.
Vertical talus, also known as congenital vertical talus (CVT), is a rare foot condition that presents as an extreme case of flatfoot.
Talar coalition is the fusion of two or more bones in the mid and hindfoot. It is usually diagnosed in older children or adolescents and may cause painful flatfoot.
Treatment
Treatment for clubfoot and other many other associated foot conditions typically begins shortly after birth. It is usually successfully treated without surgery, using a combination of stretching, casting, and bracing, though sometimes children may need follow-up surgery later on.
More specifically, your doctor may decide to use a casting procedure called the Ponseti Method that gently increases corrective positioning.
Following both non-surgical and/or surgical correction, your physician may choose to prescribe lower limb braces to correct foot position, shape, and functional use.
1. Ponseti IV, Smoley EN. Congenital Club Foot: The results of treatment/ J Bone Joint Surg [1963:45-A:261-344 | 2. Cooper DM, Dietz FR, Treatment of Idiopathic Club foot. 1995 | 3. Laaveg SJ, Ponseti IV Long Term results of treatment of congenital Club foot. 19804. | 4. Ponseti IV. Congenital Club Foot: Fundamentals of treatment. 1996 | 5. Zhao D, Liu J. Zhao L, Wu Z. Relapse of Club foot after treatment with the Ponseti method and the Function of the foot abduction orthosis | 6. https://www.ncbi.nlm.nih.gov/pmc/journals/