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Clinical news alert: Journal of the American Academy of Orthopaedic Surgeons May highlights

Treatments for Idiopathic Toe Walking Based on Child's Age and Severity of Gait Abnormality

Most children develop a normal walking pattern, or gait, by age 2. And while some toe walkingwhere a child primarily walks on the front of the foot or toes, never touching the heel to the groundis common, persistent toe walking beyond age 2 may indicate a neurological disorder.

A review article, "Idiopathic Toe Walking," outlines the appropriate steps for effectively diagnosing and treating pediatric toe walking when the cause of the disorder is unknown. A comprehensive physical examination should focus on the child's lower extremities and his or her gait pattern to rule out any neurodevelopmental disorders, and take into consideration the child's medical history including the details of gestation, birth, early development and other medical events. Electromyopathy (measuring the conducting function of muscles and nerves) and gait kinematics (study of human motion) can further identify abnormalities. Treatment is based on physical examination results and the age of the child. For patients under age 2, initial treatment may simply be observation as many children eventually develop a normal heel-toe gait on their own.

Non-surgical treatments often are recommended for younger children in whom the muscles have not become overly tight and may include physical therapy to stretch the posterior calf muscle, braces and night splints to stretch the heel cord and stabilize ankle movement, or a walking cast below the knee. If nonsurgical treatments are unsuccessful, surgical lengthening of the calf muscle may be recommended. All treatment decisions should have the full support of and input from the child's parents.

Strategies for Treating Patients with Continued Pain, Limited Function Following Rotator Cuff Surgery

Most patients (more than 90 percent) with rotator cuff tears experience successful outcomes following surgery, including decreased pain, increased active range of motion (ROM), and improved shoulder strength function following surgery.

A review article, "Management of Failed Arthroscopic Rotator Cuff Repair," outlines potential treatment and pain management options for the estimated small percentage of patients who continue to experience pain, weakness and limited mobility following surgery. For these patients, the study recommends a thorough physical examination to rule out any other causes for the pain, weakness and/or limited mobility, such as cervical spine disease or a subsequent, secondary trauma to the shoulder. Standard radiographs of the shoulder also should be obtained. Occasionally, advanced imaging, such as an MRI or an Ultrasound, may be warranted.

In some cases, treatment options may include repair, partial repair, partial repair with biologic or synthetic substances, or a tendon transfer. Candidates for revision surgery and repair are typically younger than age 65, without signs of arthritis, pseudoparalysis (voluntary paralysis), tendon retraction, or muscle atrophy. Tendon transfers, where the muscles and tendons of the shoulder are moved for rotator cuff deficiency, are a salvage option for younger patients, often with good results.

Read about "A Nation in Motion" and what Mary Bennett, Patricia McConaghy, Terry Dewald, and others can now do since their rotator cuff surgeries. Patient interview opportunities are available.


Contact: Kayee Ip
American Academy of Orthopaedic Surgeons

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