February 2015

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


Sizing up the evidence

Evidence-based medicine, defined literally, depends on the existence of studies that justify treatment decisions. But, too often, practitioners who specialize in pediatric lower extremity care find that the only evidence they have to draw on involves studies done in adults, not children.

In some cases, the same concepts seem to apply to both patient populations. Research from the University of Wisconsin in Madison, for example, suggests that balance training and prophylactic ankle bracing can be just as effective for preventing ankle sprains in high school athletes as in their adult counterparts (see “Treating and preventing ankle sprains in children,” page 9).

But other examples serve as a reminder that children are not just small adults. Researchers from Cincinnati Children’s Hospital have found that the Balance Error Scoring System, a popular test for identifying and monitoring postcon­cussion balance deficits, is not as clinically useful in children as it is in adults (see “Study questions utility of adult balance test in concussed kids,” page 6).

The problem is that studies like those mentioned above are rare. That means pediatric clinicians often must decide on their own whether to base treatment for children on research done in adults. This requires practitioners to rely on their clinical experience and knowledge of key differences between adults and children with regard to such factors as anatomy, biomechanics, lifestyle priorities, and ability to follow instructions.

In the real world, evidence-based medicine isn’t just about blindly following the literature. It can also be about using published studies as a starting point, and then making educated decisions about the extent to which those studies apply to your patients—no matter how old they are.

Jordana Bieze Foster, Editor


  • Soft tissues may help determine response to Ponseti treatment

    Children with idiopathic clubfoot who have relapses after treatment with the Ponseti method demonstrate different soft tissue abnormalities than children whose clubfoot is permanently corrected, according to research published in the August issue of the Journal of Bone & Joint Surgery.

    By Erin Boutwell

  • Study questions utility of adult balance test in concussed kids

    With head trauma becoming increasingly worrisome in sports these days, a significant concern is whether the same protocols for clearing an athlete to return to sports should be used in both adults and children. Research from Cincinnati Children’s Hospital Medical Center suggests that the…

    By Chris Klingenberg

  • Shoe flexibility influences gait characteristics in early walkers

    A recent study published in the winter issue of Pediatric Physical Therapy found that children just learning to walk may have altered gait characteristics when wearing flexible shoes.

    By Erin Boutwell


  • Treating and preventing ankle sprains in children

    High rates of chronic ankle instability in children suggest a need for better prevention and treatment of ankle sprains in young patients, but researchers are just starting to explore whether clinical approaches designed for adults will also be effective in their younger counterparts.

    By P.K. Daniel

  • Cerebral palsy and knee pain: management tips

    Knee pain is common in children with CP, but given the many health challenges facing this patient population, knee symptoms may not be given high priority. Proper diagnosis and treatment of knee pain, however, can be key to maximizing a childʼs mobility and quality of life.

    By Shalmali Pal

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