Still the #1 injury in kids, ankle sprains commonly occur during sports. The ankle “twists,” (usually inward) and the bottom of the foot faces the other ankle. Pain occurs rather immediately
Identifying the etiology for hip pain in a child can be tricky. The reason, hip pathology often presents as knee pain. The bodies wiring is such that there are various “referred pain” patterns. Entities in the neck may present as arm pain. Low back ailments may first be recognized as lower limb pain. In a child, there is a strong predilection for knee pain to originate from the hip. Usually the first sign of hip pathology in a child is an altered gait pattern. A limp notes this. Once direct trauma has been ruled out, the most common diagnosis in a child with a limp is Transient Synovitis. This is one of the most common hip disorders of childhood. The typical presentation is in a child (4-10 years of age) who awakens and suddenly refuses to bear weight on a lower limb. There is pain in the limb but no history of injury is noted. Its etiology is unclear and typically resolution is noted within a few weeks. It is usually a diagnosis of exclusion in that the work-up for a painful hip, which includes X-ray, and laboratory studies (Lyme disease, Rheumatoid arthritis, infection) are all normal. Treatment is symptomatic.
Another entity affecting the hip is Legg-Calve’-Perthes Disease. The child presents with a limp and upon further evaluation, atrophy may be noted of the involved lower limb. This disease is diagnosed with radiographs, which reveal disruption of the top of the thigh (femur) bone. Treatment includes a protracted course of bracing and/or or surgical correction. Another disorder, seen around the time of puberty, is Slipped Capital Femoral Epiphysis. In this disorder, the top of the thigh (femur) bone undergoes a shearing effect and the very top (the “ball”) slides upon itself. Of major concern to me, one of the suspected risk factors for the development of a Slipped Capital Femoral Epiphysis is excessive weight. In an era of increasing childhood obesity, this is a significant concern. Surgery is the treatment of choice since stabilization of the slipped bone is necessary.
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