Pediatric Orthopedic Surgeons - Correcting Developmental Problems

The field of orthopedic surgery began in 1741, when Nicholas Andry, an early predecessor to today's pediatric orthopedic surgeons, coined the word "orthopaedics," combining the Greek words for "straight" and "child" for the title of his Orthopaedia: or the Art of Correcting and Preventing Deformities in Children. This early publication made correcting spinal and bone deformities in children the foundation on which today's training of orthopedic surgeons is still based: more than 6 months of medical training is devoted to pediatric applications, even for those who do not wish to specialize in that branch of the field.

One pediatric application of orthopedics is for treating scoliosis, a genetic condition leading to exaggerated curvature of the spine. Treatments include exercises, physical therapy, and braces. If those remedial treatments are not heeded or are unsuccessful in children, minimally invasive surgery may be required. Braces are recommended for those less severe cases in both children and teenagers in which a 20-30% curvature is involved. By wearing a brace for 16-23 hours a day, the progression of the curvature can be thwarted. In young people whose bodies are growing rapidly, failure to reduce the increased deformity will likely result in a need for surgical intervention. When surgery is needed, it includes the implantation of rods into the spinal column.

Two other related pediatric applications are intoeing and clubfoot. Those with the less common condition of the two, intoeing, can also be referred to as being "pigeon-toed." Basically, it refers to a child whose toes point inward, toward one another, rather than pointing straight ahead, when the child is walking or running. While no pain or permanent disabilities result, tripping can be hazardous. While most children under the age of eight will see the condition self-correct, others do not. This condition is caused by genetic deformities, such as metatarsus adductus, tibial torsion, or femoral anteversion and cannot be corrected by exercises or special shoes or braces. Surgery includes the process cutting bones and properly aligning them.

Another congenital deformity that affects some children's walking is club foot, or CTEV (congenital talipes equinovarus). This disability can affect one or both feet, rotated inwardly at the ankle, making the person appear to be walking on his or her ankle or side of the foot. This birth defect occurs once out of every 1,000 births. Sometimes CTEV is associated with spina bifida cystic or other syndromes or disorders. Treatment options include the non-surgical Ponseti method, in which braces hold the feet in correct positions. Foot manipulations begin within a month of birth in order to provide the best possible results. Still, sometimes surgical clipping of the Achilles tendon is required. This minor surgery, requiring only local anesthesia, is usually not required.

Genetic birth defects such as scoliosis, intoeing, and clubfoot provide more than the basis for the term "orthopedics"; many of today's orthopedic surgeons specialize in helping correct these childhood deformities to enable affected children to lead healthy, normal lives.