February 2014

Click on image to Download the complete supplement in its original form PDF

Click on image to Download the complete supplement in its original form PDF

Editor Message


Shaping the future

One of the most rewarding aspects of pediatric lower extremity care is the knowledge that early intervention can have a positive effect on a child’s entire adult life—a theme that is repeated throughout this special publication dedicated to lower extremity pediatrics.

In some cases, the upside of early intervention is readily apparent. For example, new research demonstrates that children with clubfoot who are treated with the Ponseti method have significantly better functional outcomes as adults than those treated with surgery. Research also suggests that children with meniscal tears who are treated within three months of injury are more likely to have tears that can be repaired rather than removed, thus significantly reducing the risk of early onset knee osteoarthritis.

In other cases, the picture is less clear. Experts have yet to reach a consensus as to whether early intervention in children with flexible flatfoot might spare those children from more serious issues as adults—a debate that

becomes even more complicated when the issue of childhood obesity is added to the mix. Early intervention in a child with Charcot-Marie-Tooth (CMT) disease can positively affect that child’s gait pattern for years to come, but only if the treating clinician is aware that not all gait impairments in patients with CMT are the same.

Improving a child’s pain and function for now is a worthwhile goal. Improving a child’s pain and function for a lifetime is even better. That’s why we’ve created LER: Pediatrics, a quarterly publication dedicated to pediatric lower extremity care and filled with the type of evidence-based information you need for both short- and long-term clinical success in treating your littlest patients. Let us know what you think.

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Ponseti method surpasses surgery for long-term clubfoot outcomes

But both groups fall short of controls – Children treated for clubfoot with the Ponseti method have less pain and fewer gait impairments as adults than those treated with surgery, according to research from Shriners Hospital for Children in Chicago.

By Samantha Rosenblum

Ankle dorsiflexion patterns vary in Charcot-Marie-Tooth disease

Data support case-by-case approach – Gait patterns can vary significantly among young patients with Charcot-Marie-Tooth disease (CMT), and pathomechanics can vary even between limbs in one child, according to a recent study published in Gait & Posture.

By Larry Hand

Ankle weights improve walking in children with Down syndrome

Load may help engage plantar flexors – Adding an ankle load during treadmill walking significantly improves gait kinetics in children with Down syndrome (DS), possibly due to greater contributions from the ankle plantar flexors, according to a study from Georgia State University in Atlanta.

By Larry Hand

In youth athletes, repair after meniscal injury poses challenge

Obesity, gender affect tear complexity – Adolescents and children suffer more complex meniscus injuries that are often less repairable than previously reported, according to a study published in the December 2013 issue of the American Journal of Sports Medicine (AJSM).

By P.K. Daniel


New flatfoot data rekindle debate over role of obesity

Australian researchers found no correlation between body mass index and prevalence of pediatric flatfoot, but used a different methodology than previous studies that reached an opposite conclusion. The conflicting results have revitalized the ongoing debate on this topic.

By Cary Groner

Strength training improves function in children with CP

Research suggests strength training can improve gait and function in children with cerebral palsy. But to be successful, experts say, the training needs to be part of a multifaceted rehabilitation program that accounts for more than the physical limitations imposed by the disease.

By Shalmali Pal