Legs of different lengths in a child

This disease is characterized by the abnormal development of part of the hip joint. This results in a loss of the ability of the acetabulum, joint capsule, and ligaments to hold the femoral head in the anatomically correct position. The result is an outward and upward displacement of the femoral head, resulting in a subluxation. A subluxation occurs when the femoral head is not in contact with the hip socket.

Brachydactyly

Brachydactyly is a pathology in which the feet or hands develop abnormally and the fingers are shortened. It is often accompanied by symphalangism and some forms of syndactyly.

Brachydactyly clefts manifest themselves in different degrees of development and therefore are divided into the following types:

1) Type A, in which the middle fingers are shortened and curved and there is dysplasia of the nail plates;

2) Type B, when the phalanges at the ends of the feet and hands are underdeveloped, second and third fingers are fused, and there are anomalies in the formation of teeth, spinal and skull bones;

3) Type C, in which underdevelopment of the metacarpals and the middle phalanges of the fingers is observed. Children with this pathology have poor growth and mental retardation;

Currently, one of the most severe forms of brachydactyly is type B, the rarest is type E and the most common is type D.

symptoms

The disease is mainly characterized by Shortness of the leg. This defect is not only of cosmetic importance, but also significantly impairs the function of the limbs. In addition, brachydactyly can be combined with split or flattened toes, joint stiffness, muscle weakness and the absence of nail plates.

Hypophalangia is usually one of the isolated malformations, but sometimes develops against the background of these syndromes:

• Polish – Microdactyly is associated with syndactyly, absence of the pectoralis major and minor muscles, rib deformity and amastia;
• Down syndrome - Main features: shortened neck and skull, jaw abnormalities, cataracts and strabismus, heart defects, chest deformity (funnel-shaped or keeled);
• Beymond – presence of cerebellar ataxia, nystagmus;
• Aarskog-Scott – shortening of the stump associated with joint instability, syndactyly, mental retardation, presence of inguinal hernias, narrowing of the foreskin in boys.

Isolated brachydactyly cannot cause miscarriage. If comorbid syndromes are present, the decision is made on an individual basis.

Hip dysplasia in children: what is the problem?

If your child is diagnosed with hip dysplasia (abbreviated hip dysplasia), serious problems with skeletal development and walking ability may occur. Hip dysplasia in children is a pathological condition that affects the development of the hip joint. In children with this anomaly, the spherical part at the end of the femur (called the bone head) does not fit tightly into the hip socket where it attaches to the pelvic bone. The ligaments of the hip joint that hold the head of the bone in place can also become loose and weakened, leading to a hip dislocation. Sometimes the anomaly can be diagnosed early in life, shortly after birth. However, some children may not notice the problem until they start walking. As the joint grows and develops abnormally, as the body transitions to an upright position, the head slips out of the hip socket and a dislocation occurs, resulting in limping, pain, and limb deformity.

To avoid serious consequences and disabilities, doctors carry out a DTBS diagnosis in the first weeks after birth. These include visual inspection of the buttocks, hips and joint area, performing diagnostic techniques with adduction and inversion of the legs, comparing the symmetry of folds on the posterior surface of the hips. However, the crucial diagnostic procedure is joint ultrasound and x-rays. If imaging studies show abnormal bone structures and an immature hip joint, treatment should be initiated as quickly as possible. There are currently a number of treatment options for hip dysplasia, which can be divided into conservative and surgical procedures.

Hip dysplasia: treatment at a young age

In the first months of life, when the child's skeleton is still plastic and the joints are not yet fully formed, conservative measures are effective. If the dysplasia is discovered while running or later when the joints are fully formed, surgery is often the only treatment option. The main problem with dysplasia is the small number of symptoms and minimal changes, only isolated signs that are difficult for the doctor to recognize at a young age. Parents usually pay attention to the following symptoms.

• The hip joint on the affected side is 'stiff', functions poorly or cracks.
• The child's legs are of different lengths.
• The folds on the back of the thighs and buttocks are not symmetrical.
• The foot may be turned outwards on the affected side.

However, these symptoms are typical of more severe anomalies involving a dislocation or subluxation of the hip. If the joint is not yet fully formed, the changes may be minor, but the child still needs corrective treatment.

Causes of hip dysplasia in children

At birth, the hip joint is made of soft cartilage that hardens over time and develops into bone. The ball and hip socket should fit together well. If the ball is not firmly seated in the hip socket, it cannot fully form.

Shortly before birth, the space in the uterus can become so narrow that the ball of the hip is displaced from its correct position.

Factors that can reduce the space in the uterus include:

Risk factor.

Hip dysplasia is more common in girls. The risk of developing hip dysplasia is also higher in breech babies and those who are swaddled tightly with straight hips and knees.

Later, hip dysplasia can damage the soft cartilage (labrum) that surrounds the hip socket of the hip joint. This is called a tear of the femoral neck.

Hip dysplasia can also increase the risk of developing osteoarthritis of the joint - as a result of greater pressure on the smaller surface area of the hip socket. Over time, the smooth cartilage that helps parts of the joint move smoothly during movement wears away.

What risks are associated with hip dysplasia?

Dysplasia is a pathology. It is a mistake to believe that it does not have serious consequences. It causes malformations of the entire hip joint, which is one of the largest and most important joints in the body. It ensures an upright posture and correct gait.

With dysplasia, the head of the femur is not properly aligned with the hip socket. This leads to a disturbed gait:

• He can become 'duck-like';
• excessive 'hip wobble' and glutes are 'higher';
• the unequal length of the limbs leads to lameness.

The cartilage is formed gradually; In dysplasia, this process is disrupted. Changes also occur in the pelvic bone. As a result, the joint loses some of its function, which can lead to disability.

The pathology affects the entire musculoskeletal system. The strain increases, the affected person is constantly tired and muscle weakness occurs.

In nine out of ten clinical cases, patients who are not treated in a timely manner develop a number of complications:

• coxarthrosis;
• Impairment of the motor function of the leg;
• cosmetic deformities;
• Neoarthrosis (formation of a new pathological joint).

Coxarthrosis, an inflammation of the hip joint, is particularly dangerous. In this disease, the cartilage and adjacent bones are destroyed. As a result of coxarthrosis, the patient can no longer walk properly and is in constant pain.

Treatment of hip dysplasia

The most important thing in treatment is timely diagnosis. In ladists, only modern equipment is used to accurately determine the angle of dislocation and the degree of pathology. In the early stages, dysplasia can be treated with special orthopedic constructions: Pawlik stirrups, Gniewkowski braces, free pillows and others. Such treatment is carried out until the child is 12 months old. Constantly wearing the braces is an essential part of the treatment. If there are no positive results after a year, surgical intervention is recommended.

There are numerous articles on the Internet about the treatment of dysplasia, from wide spreading to invasive procedures. Remember that if you have the slightest suspicion of congenital dysplasia, you should immediately consult a specialist instead of resorting to folk medicine. Because this can make the situation worse.

There is no time to waste with this disease. An experienced podiatrist will make an accurate and efficient diagnosis and prescribe appropriate treatment.

From the first symptoms to the diagnosis

Listen to yourself

I could see that Gordey was different from other children, but I didn't understand why. He didn't speak until he was three years old. He was a bit clumsy and couldn't jump or run. I was told that it was because of the difficult birth, that we had to wait a little longer and then he would grow out of this awkwardness. Or I was gently suggested that I was just an anxious mother worried about her first child. During the pre-school examination, all specialists once again confirmed that my son was healthy. Nobody was worried - not the doctors nor my mother, who has a doctorate in medicine.

In addition, Gordey was and is a very demanding and sensitive child, it is difficult to get in touch with him. My relatives said that this is how I raised him: he is moody and wants to be held, not because he is tired, but because he is manipulative. What do you say on this point? I really thought it was my fault. At the time, I didn't know that these characteristics were also related to his illness.

I noticed the symptoms.

I heard about Duchenne myodystrophy several years before Gordey was diagnosed with the disease. It was the story of Olga and Pyotr Sveshnikov, the founders of the Myo Foundation, who adopted a child with DMD. This act gave me endless respect and admiration. But then I just read about it and moved on with my life. Some time later I saw a report on Facebook about a father and his son with DMD. After the sentence 'I looked at his calves, they were so muscular and had no strength', the image in my head completely reshaped itself. I googled the symptoms and understood what was wrong with my child.

The main symptom of muscular dystrophy is progressive muscle weakness. specific Depending on the type of muscular dystrophy, the specific symptoms occur at different ages and in different muscle groups. The first symptoms of DMD usually appear around the age of two or three. child may be He falls over frequently, walks slowly, and walks on tiptoes or waddles. He may have difficulty getting up from the floor and climbing stairs. Often a child with DMD will have disproportionately large calves. Initially, the weakness appears more in the thigh muscles, but over time it spreads to other muscles, including those involved in breathing. The child may have delayed motor and language development as well as learning difficulties. DMD impaired Memory, communication and emotional well-being.

From lack of understanding to mutual support

Improving the system

Over time, we learned how the treatment of Duchenne myodystrophy is organized. In addition to small subsidies, the government offers sanatorium treatment for the boys. But so far the system hasn't fully understood what children with DMD need. In Gordeja's experience, they usually offer the wrong thing in the wrong place - even if they try hard. Twice a year, boys and young men with myodystrophy are entitled to rehabilitation - not massages and mud. Of course it exists, but it does not meet international standards everywhere. In addition, it is not humane everywhere. Sometimes mothers run away from rehabilitation with their sons because the food is bad, the treatment is even worse, there is no exercise.

Then there is the IPRA – the individual rehabilitation plan (habilitation plan). It includes technical aids provided by the state, such as wheelchairs or strollers. However, often these devices are not suitable for the child, so parents are forced to purchase other devices at their own expense, and these costs are not always reimbursed. This is a very sensitive issue for the family and the greatest difficulties arise with mobility assistance for able-bodied boys.

It seems that the state is helping, but the mechanisms themselves are inflexible and need to be changed. According to international rehabilitation standards, children with DMD need a warm swimming pool, appropriate stretching exercises, comprehensive medical care and a strong multidisciplinary team. Until a year ago, there were no centers in Russia that could offer all this. The most modern option is now rehabilitation in the Central Hospital, the program of which was developed by experts from the Central Hospital in collaboration with our foundation. It corresponds to international best practice and in this sense is unique to Russia.

But there is only one such center, and boys with DMD are born all over the country. There are about four thousand of them, of which no more than one and a half thousand are visible to the health system. In any case, we have too many boys to send them all to Moscow. The boys need to be rehabilitated in regional centers because many of them have difficulty moving around. Our task is therefore to create such centers and train specialists on site. To do this, we need a strong patient community and nonprofit organizations to influence and improve the sluggish state system.

Recognize the disease

A doctor can immediately express suspicion of an underdeveloped hip joint during the first external examination of the child. The examination is carried out after feeding, when the newborn is calm and relaxed. A provisional diagnosis is made when one or more specific signs of dysplasia are detected, such as: B. limited hip abduction.

Instrumental examinations, usually an ultrasound scan (ultrasound of the hip), are used to confirm the diagnosis. X-rays are also used, but only in older children. Until the age of 3 months, there is still a lot of cartilage in the hip joint that cannot be seen on x-rays.

Which doctor should be consulted?

In most cases, congenital hip dysplasia is diagnosed immediately by a pediatric orthopedist or pediatrician during the next routine examination. Sometimes parents themselves notice their child's unphysiological gait when it takes its first steps. In this case, a pediatrician should be consulted, who, after a short examination, will issue a referral to a pediatric orthopedist.

The earlier the treatment begins, the sooner the hip joint can form properly. Various methods and techniques are used to fix the child's legs in flexion and adduction positions. This includes a special wide wrap, stirrups, splints and other aids. The younger the child, the softer and more flexible the orthoses should be.

Even 'neglected' joint problems can be treated at home! Just remember to rub them in once a day.

Wide swaddling

This is more of a preventive measure than a therapeutic one. Swaddling is recommended for parents of children who are at risk or who have been diagnosed with hip underdevelopment that has not yet caused predisposition, subluxation or dislocation. It is only used to treat hip dysplasia when there is no other more effective treatment.

When swaddling, the baby is placed on its back and two slings are placed between the legs. These are loosely wrapped around each leg that is bent in the abduction position. A third garment is fastened at the waist with a third garment. This helps keep the legs in a 60-80° upright position.

Orthopedic constructions

The Frekeh pillow is often used to treat hip dysplasia in very young children. It looks like a thick roll between the knees. In order to keep the legs in a physiological position for the 'maturation' of the hip joint, the construction is equipped with straps.

diagnosis

In the maternity ward, the pediatrician must carefully examine your baby for abnormalities in the hip joint. Your baby's joints will also be carefully monitored by the pediatrician who will care for your baby from birth. If the doctor has suspicions, your child will be referred for an additional examination - an ultrasound scan of the hip joints or a conversation with a pediatric orthopedist.

A routine visit to the pediatric orthopedist is mandatory at 1 month of age, then at 3, 6, and 12 months (or when your baby begins to walk).

The orthopedist will conduct a clinical examination and, if necessary, refer the child for an ultrasound examination (USG) of the hip joints. This is a harmless examination, but it does not provide a complete picture of the pathological changes in the joint. Ultrasound is more suitable for screening, that is, examining all newborns for hip joint pathology (unfortunately, this is not yet practiced in our country). In addition, ultrasound can be useful for monitoring the effectiveness of treatment.

If dysplasia is present or suspected, the doctor may recommend an X-ray examination of the hip joints. X-rays allow an objective assessment of the condition of the joints.

Treatment

If the pediatric orthopedist confirms the diagnosis of hip dislocation (and subluxation or preluxation), treatment begins immediately. If the child does not receive adequate treatment as it grows, a mild dysplasia can become a subluxation and a subluxation can become a dislocation. It is important to remember that treatment for a congenital hip dislocation is lengthy (usually between a month and a year) and complex. Parents must be patient: the treatment of hip dysplasia is long, continuous and initially difficult for the child.

In the first month after birth Wide swaddling of the baby. The principle of wide swaddling is as follows: a simple flannel diaper is folded 15-17 cm wide and placed between the baby's legs, bent at the hips and knees, tilted to the sides at 60-80 °. The edges of the folded diaper should reach the knees. If you are not rocking the baby, you can place the diaper on top of the diaper or onesie and secure it to the baby's shoulders using the onesie's straps. The baby quickly gets used to the wide swaddling, tolerates it well and keeps his legs upright during diaper changes.

Furthermore, it is necessary that therapeutic exercises – Stretch the hips every time you change a diaper or change the baby. Swimming on your stomach is helpful.

If wide swings and gymnastics are not enough, the orthopedist will prescribe one of the orthopedic aids :

• Pavlik straps – these are gentlest on the hip joint and most comfortable for the baby and parents. They are suitable for infants aged three weeks to nine months.
• Freck Pillow – a pair of plastic pants that support the legs in the frog position. Suitable for babies from 1 month to 9 months, with support changing as the baby grows.
• Splinting (hip orthoses, gait orthoses, hamstring orthoses).

WHY and how a child's feet are deformed

Foot deformities can be congenital or acquired. In the first case, the cause is rickets, diseases of the mother or a lack of minerals and vitamins in her diet during pregnancy, hypoxia during fetal development or after birth and genetic predisposition.

Acquired leg curvature in children aged 2 and over is the result of inflammation of the leg bones, vitamin D and calcium deficiency, low physical activity, hypothyroidism and diabetes.

There are two types of changes in the shape of the legs - real and false. In the first case, there is actually a problem that caused the deformation. In the second case, the distribution of fat and muscle on the lower limbs is uneven, so their contours are not symmetrical.

The real curvatures of a child's legs have a name that reflects the external signs:

X-shaped

X-shaped curvature of children's legs or valgus. When both feet are next to each other, the distance between the ankles is greater than 5 cm.

O-curvature

Have you noticed that your child has a curvature of the legs? See a doctor immediately!

WHO TREATS CROOKED LEGS IN CHILDREN?

The treatment with Dr. OST is done at the highest level. The admission is led by orthopedists and trauma surgeons with many years of experience. For patients who do not live in the city, Dr. OST free online consultations. This type of appointment helps you get to know the doctor in advance, ask questions and prepare for your personal visit to the clinic. You can find out more about the online consultation here.

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Let it run itself!

Crooked legs in a baby of 1 year old are completely normal. You should wait until the age of 3-4, when the problem usually goes away on its own, and only then sound the alarm. Regular check-ups with a podiatrist help to get the situation under control.

Crooked feet in a one-year-old child are often a result of being overweight. Don't put him on his feet too early if he doesn't show any interest in walking upright yet. The heavy weight puts pressure on the immature leg bones and deforms them.

Prevention and correction

1. Don't forget to prevent rickets with vitamin D. Talk to your child's pediatrician about the dose your child needs.
2. Promote your child's physical development. If special training is required, it is prescribed by the orthopedist and shown by the doctor in the sports clinic.
3. Control your child's weight: Excess weight puts a strain on a weak skeleton.
4. Surgery may be necessary if, for example, one leg is shorter than the other. Due to hereditary defects or severe fractures.

1. _{Maidannik VG Pediatrics: a textbook for medical students of admission levels III-IV. 3rd ed. – Kh: Folio, 2006 – С. 6-7.}
2. _{Pediatrics. The textbook. General questions: development, nutrition, child care / Per.s Eng. – 2nd revised and expanded edition. – Moscow: Medycyna, 1991.}
3. _{E. V. Tush. Rakhit and rydzik-like diseases, N. Novgorod, 2007 – С.3-97.}

• shortening of the hip.
• The child has a shorter leg than the other.
• Leg splint for newborns.
• external rotation of the hip.
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• outward rotation of the leg.
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• Child with Komarovsky clubfoot.