Children

For older children who have been walking on their tip toes for a long time, the calf muscles may have become so tight that they are unable to get their heels down. These children will need to be seen for an assessment. If the child can get the heels down, try some calf stretches a shown in the pictures above.

Treatment

There is no single accepted treatment for toe walking. Treatment options can vary and include monitoring only, calf stretches, wearing orthotics, wearing a cast or serial casting, lengthening the calf muscles (surgery).

Some children will habitually toe walk, even when they are able to walk with their heels down. This usually subsides and rarely persists into adulthood.

Growing pains do exist although the exact cause is unknown. Growing pains occur in the evening or at night-time in children aged between 3-12 years. The pain should be gone in the morning and it should not affect activities during the day. The pain is usually symmetrical (occurring on both sides) and most commonly affects the legs and feet. The pain is usually a dull ache and it does not typically affect the joints (ankles, knees or hips). A child with growing pains will feel well and will not have a temperature. Growing pains at night will often be worse after a busy/active day. There should not be any swelling or redness with growing pains and the way a child walks should not be affected (they will not limp).

Joint pain requires further investigation, particularly if it is present on waking.

Treatment for growing pain

Growing pain will resolve without treatment. There may be periods where the pain gets worse (during rapid growth). If growing pains are affecting sleep, a hot pack or warm bath may help. Massaging the muscles gently may also help. Occasional children’s paracetamol may be helpful, particularly after an active day.

Hypermobility is defined as having greater than expected ranges of movement in a joint. This may affect one or more joints but usually affects both sides. Typically, children are more flexible in their joints compared to adults. This is because their ligaments have more elasticity in them. We tend to get a bit stiffer in our joints as we get older. Some children who have hypermobility may not continue to have hypermobility when they reach adulthood. Hypermobility generally affects girls more than boys and it does not usually cause problems. For some, it can be advantageous such as those who do gymnastics or ballet. Hypermobility can be inherited.

Some children who have hypermobility can complain of aches and pains around the joints. If there is a lot of flexibility around the ankles, wearing good fitting supportive shoes or boots can help. In young children, taking breaks during long walks can be helpful. Distraction can also help such as playing counting or spotting games when walking. Hypermobility does not cause redness or swelling in the joints. If this occurs, your child will need to see a medical professional.

Hypermobility can be associated with other conditions. If there are concerns regarding a child’s coordination, balance or handwriting, you may want to seek an opinion from a healthcare professional. You may also need to seek advice if you feel that your child’s daily activities are affected by their increased joint mobility.

Treatment 

There is no specific treatment for hypermobility but keeping the muscles around the joints strong is helpful. Activity should be encouraged and if children get tired quickly then a little and often approach works best. Wearing good supportive footwear is also helpful. A referral to a specialist may be helpful in severe cases, for example where daily activities are affected or if there are recurrent joint dislocations.

• APCP Information - Hypermobility and Hypermobility Spectrum Disorder

Perthes disease is a condition which affects the blood supply to the hip joint. This causes the ball part of the ball-and-socket hip joint to become flattened. This can affect the movement in the joint and may, in some cases, lead to difficulties such as arthritis later in life. The cause of the condition is unknown, but it appears between the ages of 5-12 and more commonly affects boys. This is a self-limiting condition, meaning the disease process will stop, but damage to the structure of the hip is likely to remain. One hip is usually affected but there can be cases where both sides have the disease.

Symptoms 

• Hip pain or groin pain
• Thigh or knee pain (hip pain can often refer to the knee)
• Walking with a limp
• Restricted movement in the hip/stiffness in the hip.

Treatment 

Anyone with Perthes disease will need to be under the care of an orthopaedic consultant. Treatment can sometimes be just watching and monitoring the disease progress. In some cases, surgery may be required. Activity modification is likely to help limit damage to the hip joint whilst the disease is active. Some children may be advised to be non-weight bearing for a period of time. Physiotherapy exercises may be advised to keep the joint moving.

• APCP - Perthes Disease

A slipped upper femoral epiphyses can also be called a SUFE or a slipped capital epiphyses. The cause is largely unknown, but this condition occurs during growth between the ages of 10-17 (boys) and 8-15 (girls). It is more common in boys. Children have growth plates at the end of their bones and a SUFE occurs when the ball-shaped head of the thigh bone (femur) slips backwards on the femoral neck. It is essentially a fracture through the bone at the growth plate but it is not always caused by trauma.

Symptoms 

• Hip/groin pain
• Walking with a limp
• The foot may be turned outwards and the leg may appear slightly shorter on the affected side
• The hip may have a restricted range of movement compared to the other side.

Treatment 

A SUFE will need to be treated by an orthopaedic surgeon. A screw is placed into the bone to keep the femoral head in the correct place. This will also prevent any further slipping.

Scoliosis is a curvature in the spine. There are some conditions that are associated with scoliosis such as cerebral palsy or some neuromuscular conditions. In many cases however, the scoliosis is idiopathic, meaning that it just happens and there is no known cause. Idiopathic scoliosis usually occurs during early adolescence. The severity of the curvature can vary from mild to severe and in some rare cases, it may affect the respiratory system. Girls and boys are equally likely to get scoliosis but it is more frequently mild in boys.

Scoliosis is a curvature in the spine. There are some conditions that are associated with scoliosis such as cerebral palsy or some neuromuscular conditions. In many cases however, the scoliosis is idiopathic, meaning that it just happens and there is no known cause. Idiopathic scoliosis usually occurs during early adolescence. The severity of the curvature can vary from mild to severe and in some rare cases, it may affect the respiratory system. Girls and boys are equally likely to get scoliosis but it is more frequently mild in boys.

Mild forms of scoliosis often don’t require treatment, however yearly monitoring may be required until growth is complete. Those who have a more significant curve may require brace treatment, surgery to control growth of the spine or even surgical correction. Treatment choice will depend on the age of the child, severity of the curve and the likelihood of the curve progressing.

It is important that where possible children/adolescents with scoliosis remain active to maintain flexibility and muscle strength and health of the heart and lungs.

• Scoliosis Association
• Scoliosis Research Society