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Las Amigas Luau Charity Gala

Las Amigas de Las Lomas, an auxiliary of the Charitable Children's Guild of Orthopaedic Institute for Children (OIC) in Los Angeles requests your presence on October 8th at 6 o'clock in the evening to support our worthy fundraising efforts where 100% of the proceeds raised go directly to Orthopaedic Institute for Children.

Help us, help them during an elegant evening in Rolling Hills Estates with a luau and live auction.

For event and ticket information, please visit www.lasamigas.org/luau-fundraiser-for-oic.html.

OIC Swing for Kids Golf Classic 2016

Proceeds from the OIC Swing for Kids Golf Classic will support the OICare for Kids Fund. This year’s tournament will celebrate OIC’s worldwide efforts, highlighting our International Children’s Program and OIC’s research, education and patient care globally. With your participation and support, we will continue to care for kids in need and pay for 100% of a child’s care when needed. To date, OIC has helped over 2 million patients - 150,000 of them (from over 15 countries) through ICP. For more information or to register, please visit www.swingforkidsgolf.org.

 

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Adelle's Story

Five minutes into her soccer game, Adelle Levi’s shot was intercepted by a defender, causing her to fall directly on her arm. She knew right away that it was broken. Luckily, Adelle’s family knew exactly where to take her for care, having seen Dr. Bowen for a previous injury. Dr. Scaduto examined her arm and determined that it was broken in two places. She wore a cast for 10 weeks and received multiple x-ray evaluations at OIC’s Luskin Children’s Clinic. While her injury kept her away from sports during that time, the 12 year old occupied her time by focusing on her other interests. In addition to being a member of an academic decathlon team, Adelle enjoys cooking and trying out new restaurants.

 

 

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Debra Mathias, Chief Operating Officer

Primary Area of Practice:
Specialty:
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As'ad's Story

A Journey of Faith from Patient to Ambassador for OIC

This year, through our International Children’s Program, we met a brave 10 year-old Nigerian, As’ad Kashim, who was born with Cerebral Palsy (CP), a condition marked by impaired muscle coordination and/or other impairments. His muscles were so constricted he could only squat like a baseball catcher and hobble about. His mom, Sha’awa, searched feverishly—but fruitlessly—in Africa, India, and Saudi Arabia for someone to help him walk. Without an appointment, but with a lot of hope, the Kashim family arrived in our lobby.

Following a thorough assessment and discussions with the family, Dr. Scaduto, assisted by surgical resident Dr. Allis, performed six hours of surgery on As’ad’s ankles, hamstrings, and knees. Once As’ad’s post-operative casts and braces were removed, he began extensive physical therapy, which he continues to participate in today, seeing continual improvement.

A giver himself, even at such a young age, As’ad has inspired others with his tenacity of spirit by sharing his amazing story with OIC supporters. He has continued his journey of faith and recovery by walking across a dance floor, surrounded by 170 cheering guests, and has spoken at multiple OIC events, expressing his gratitude for our donors’ “support to cover the cost of” his care.

As’ad also volunteers at an orphanage, reading to children with CP. He is the true definition of courage, determination, and selflessness – a great spirit who now has the opportunity to bring his special gifts to the world more fully and easily, thanks to our OIC family.

 

 

Plantar Fasciitis

Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the botton of the heel.  Approximately 2 million patients are treated for this condition every year.  Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed. 

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot. It is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is in ammation, which results in the heel pain and stiffness of plantar fasciitis.

In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to  the condition:

  • Tighter calf muscles that make it dif cult to ex your foot and bring your toes up toward your shin - Obesity
  • Very high arch
  • Repetitive impact activity (running/sports)
  • New or increased activity 

Treatment

Initial treatment can be remembered the acronym, RICE. 

  1. Frozen Water Bottle Roll - Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen water bottle. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done rst thing in the morning.
  2. Towel Stretch - Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot, and pull the towel toward your body. Be sure to keep your knee straight. Hold this position for thirty seconds and repeat three times.
  3. Standing Calf Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12-18 inches behind your uninjured leg.Keep your injured leg straight and your heel on the oor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.
  4. Standing Soleus Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 4-6 inches behind your uninjured leg. Keep both heels on the ground and gently bend your knees until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.
  5. Plantar Fascia Stretch - Stand with the ball of your injured foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot. 
  6. Towel Pickup - While sitting in a chair with your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel.
  7. Towel Windshield Wipers - While sitting in a chair with your heel on the ground, pick up a towel with your toes and move foot out and in 10 times. Complete 3 sets of 10 
  8. Arch Squeeze - Place a chair next to your non-injured leg and stand upright. (the chair will provide you with balance if needed.) Stand on your injured foot. Try to raise the arch of your foot while keeping your toes on the oor. Try to maintain this position and balance on your injured side for 30 seconds. This exercise can be made more dif cult by doing it on a piece of foam or a pillow, or with your eyes closed.
  9. Reaching Dynamic Balance - Place a chair next to your injured leg and stand upright. (the chair will provide you with balance if needed.) Stand on your injured leg and while maintaining your arch height reach forward in front of you with your uninjured side’s hand, and behind you with the uninjured leg. Allow your standing knee to bend slightly, then return to starting position. Repeat this 10 times while maintaining the arch height. This exercise can be made more dif cult by reaching farther in front of you. Complete 3 sets of 10. This can also be done by placing cones or small objects to reach for in a semi-circle. 
  10. Thera-Band Exercises

A. Resisted Dorsiflexion - Sitting with your leg out straight and your foot near a door, wrap the tubing around the ball of your foot. Anchor the other end of the tubing to the door by tying a knot in the tubing, slipping it between the door and the frame, and closing the door, or have a friend of family member hold the band for you. Pull your toes toward your face. Return slowly to the starting position. Repeat 10 times, and do
3 sets of 10.

B. Resisted Plantar Flexion - Sitting with your leg outstretched, loop the middle section of the tubing around the ball of your foot. Hold the ends of the tubing in both hands. Gently press the

ball of your foot down, and point your toes, stretching the THERA-BAND. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

C. Resisted Inversion - Sit with your legsstraight out and cross your uninjured leg over
your injured ankle. Wrap the tubing around theball of your injured foot and then loop it aroundyour uninjured foot so that the THERA-BAND is anchored at one end. Hold the other end of the THERA-BAND in your hand. Turn your injured foot inward and upward. This will stretch the tubing. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

D. Resisted Eversion - Sitting with both legs out stretched and the tubing looped around both feet, slowly turn your injured foot upward and outward. Hold this position for 5 seconds. Repeat 10 times, and do 3 sets of 10. 

Patella Dislocation

What is a Patella dislocation?

The patella (kneecap) contacts the femur with normal knee movement. The joint is called the “patellofemoral joint” Sometimes a twisting motion or a traumatic hit can cause the patella to pop out of place, usually towards the outside of the knee. Sometimes the kneecap will pop back in by itself, and sometimes you may need to see a healthcare provider to “reduce” the patella back in place. There are supporting structures around the patella which help prevent this motion, but these can often me stretched or damaged when the patella dislocates. 

 

Risk factors for patella dislocation

There are several risk factors which make a person more likely to have a patella dislocation:

  • Tightness, weakness or imbalance of the muscles of the thigh preventing the kneecap from sliding smoothly with knee motion
  • Flat feet, overpronation
  • Knock-knees, Malalignment of the kneecap or patella instability
  • Shallow trochlear groove, which is the groove that the patella usually slides up and down in in the knee 

Do I need an MRI?

The initial diagnosis can be made based on the history and physical exam of the patient, however if a complete ACL tear is suspected a MRI may be ordered. A MRI is a picture, almost like an xray, that uses magnets instead of radiation. This test takes 20-40 minutes. Your provider will ask that you bring a CD of the images to your return visit for review. If your provider has ordered an MRI, it is recommended that you avoid any contact sports and and movements that require twisting or pivoting. 

Do I need surgery?

For patients who would like to participate in sports or be active, surgical reconstruction of the ACL is generally recommended when there is a full tear of the ACL. For partial tears, surgery is generally not required or recommended. Patients with partial tears tend to do very well with physical therapy and home exercise programs. 

Treatment

Initial treatment includes reduction of the patella back into place which may happen on its own or at an emergency room or urgent care. After that depending on how bad the injury was you may be asked to wear a knee immobilizer or special cast. Follow your provider’s instructions for the brace, however most patients can take the brace off when not putting weight on their leg. It’s also helpful to remember the following acronym, RICE. 

Once you are able to walk without pain or a limp, you may begin the following exercises and your provider may recommend you work with a Physical therapist for 4-6 weeks to prevent reinjury. 

PATELLA DISLOCATION STAGE I EXERCISES

  1. Vastus Medialis Oblique Quadriceps Sets -Sit on the oor with your injured leg straight in front of you. Press the back of your knee down while tightening the muscles on the top of your thigh. Concentrate on tightening the muscles on the inner side of your kneecap. Hold this position for 5 seconds. Complete 3 sets of 10.
  2. Straight Leg Raise - Sit on the oor with the injured leg straight and the other leg bent, foot at on the oor. Pull the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on the top of your thigh. Raise your leg six to eight inches off the oor and hold for 5 seconds. Slowly lower it back to the oor. Complete 3 sets of 10.
  3. Straight Leg Stretch - Lay down in a bed or on the oor on your back and place a towel or pillow under your ankle or heel and sit for 3-5 minutes allowing for gravity to straighten your knee. You may also place a small weight over the knee.
  4. Heel Slides - Lay down in a bed or on the oor on your back, drag your heel towards your buttocks on the bed/ oor so your knee bends. Stop when you feel pain, a small stretch is normal, hold for 5 seconds, repeat 10 times. Do 3 sets of 10. 
  5. Leg Lifts: Abduction - Lie on your uninjured side and place leaning on the elbow of your uninjured side and using the arm of the injured side in front of you to stabilize your body. Slowly with the injured leg up, hold for 5 seconds then lower slowly. Be sure to keep your hips steady and don’t roll forwards or backwards. Complete 3 sets of 10.

Abduction - Lie on your injured side with your top leg bent and at foot placed in front of the injured leg, which is kept straight. Raise your injured leg as far as you can comfortably and hold it there for 5 seconds. Keep your hips still while you are lifting your leg. Hold this position for 5 seconds, and then slowly lower your leg. Complete 3 sets of 10.

Extension - Lie on your stomach. Raise your injured leg as far as you can comfortably and hold it there for 5 seconds. Keep your hips still while you are lifting your leg. Hold this position for 5 seconds, and then slowly lower your leg. Complete 3 sets of 10. 

CORE EXCERCISES

DO NOT PROGRESS WITH THESE EXERCISES UNTIL CLEARED TO DO SO!

 

  1. Abdominal Contraction - Lie on your back with knees bent and hands resting below ribs. Tighten abdominal muscles to squeeze ribs down toward back. Be sure not to hold breath. Hold 30 seconds. Relax. Repeat 3 times on each side.
  2. Pelvic Tilts - Lie on your back with both knees bent and feet planted on the oor. Gently tuck your buttocks under and front of hips slightly up and think of pulling your belly button in towards your back as you do this. Hold for 10 seconds and repeat 10 times.
  3. Abdominal Crunch - Lie on your back with both knees bent and feet planted on the oor. Tuck your buttocks under like in the pelvis tilt exercise. Gently place both hands behind your head for support and tuck your upper body in. DO NOT PULL YOUR HEAD WITH YOUR HANDS. The movement should come from squeezing your abdominal muscles. 
  4. Forearm Plank - Lie down facing the oor on y our forearms. Raise yourself up until resting on your knees and elbows. Maintain your body straight from your head to your knees. Hold for ve to ten seconds. If this is easy for you, lift your knees up off the oor. You may be able to work up to holding plank for 30 seconds to 1 minute, but only do this if you can keep your body straight like a board.
  5. Plank (Upper Pushup) - Lie down facing the oor with your hands planted on either side next to your chest. Raise yourself up until resting on your knees and hands. Maintain your body straight from your head to your knees. Hold for ve to ten seconds. If this is easy for you, lift your knees up off the oor and keep a straight line from head to toes. You may be able to work up to holding plank for 30 seconds to 1 minute, but only do this if you can keep your body straight like a board.
  6. Opposite Arm and Leg - Lie down facing the oor. You may use a rolled up towel under your forehead for comfort. Lift up the opposite arm and leg two inches above the oor. Hold this position for ve to ten seconds. Repeat 10 times on each side. Do three sets.
  7. Dead Bugs - Lie on your back and place both hands under your buttocks. Bring both legs up to point to the ceiling with knees slightly bent. Gently lower one leg towards the ground then slowly back up. Try to keep your lower back on the oor. Repeat with opposite leg. Complete 3 sets of 10. 
 

Patella Dislocation Stage II Exercises

DO NOT PROGRESS WITH THESE EXERCISES UNTIL CLEARED TO DO SO!

 

  1. Standing Calf Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12-18 inches behind your uninjured leg. Keep your injured leg straight and your heel on the oor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.
  2. Standing Soleus Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 4-6 inches behind your uninjured leg. Keep both heels on the ground and gently bend your knees until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.
  3. Hamstring Stretch - Lie on your back and bring affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.
  4. Quadriceps Stretch - Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside. Facing straight ahead, keep the hand nearest the wall against the wall for support. With your other hand, grasp the ankle of your injured leg and pull your heel up toward your buttocks. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times.This may also be done while laying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times. 
  5. Alternative Quadriceps Stretch - Place affected leg on a sturdy chair or low stool, and place opposite hand on a wall to the side of you. Slowly bend front leg, hold for 30 seconds, repeat 3 times.
  6. Clamshells - Lie on your side with your knees slightly bent, keeping your legs and ankles together. Open and close your knees like a clam by lifting your top knee up until its parallel with your hip. Keep your feet together throughout the exercise, move slowly and cotrolled as if someone is pushing against your knee while you are pressing it up. Complete 3 sets of 10.
  7. Sidesteps with Theraband - Place theraband around your ankles and lower down into a half squat with knees bent and toes pointing forwards. Step to the right with your right foot while staying low in your squat position, then bring your left foot in. Repeat 10 times in each direction. Do 3 sets. 

Prevention

  1. Stay in shape
  2. Stretch - before doing any strenuous activity, do a 5 minute warm up and do stretching exercises. Remembering to stretch your knee will help keep the structures around the knee exible and less likely to be irritated by activity
  3. Increase training gradually - dramatic increases in activity over a short period of time can result in overuse injuries
  4. Use proper running gear - make sure that your shoes t properly and provide good support
  5. Use proper running form
  6. Strengthening of thigh, hip and trunk muscles - Helps to “off-load” stress on the patellofemoral joint using the above mentioned exercises 

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead longer healing times. Everyone recovers at a different rate. Returning to your sport or activity will be determined by how soon your knee recovers, not by how many days or weeks it has been since pain began. Typically for patellar dislocations it will take about 3 months before returning to sporting activities. After successful completion of physical therapy and a home exercise program, it may be recommended to use a patella stabilizing or “J” brace which can be purchased at most sporting good stores, medical supply stores and online through retailers like amazon.com. 

Anterior Cruciate Ligament Sprain

What is a knee sprain?

There are several major ligaments in your knee, which provide stability to your knee. Injury to the major ligaments that are on either side of your knee is called a ligament sprain. The four major ligaments of the knee are the Anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). Here we discuss the treatment and rehabilitation of ACL injuries. There are different levels of knee sprain from a mild stretching of these ligaments to a full tearing of these ligaments. 

 

What are the symptoms of an ACL tear?

Patients with partial tears generally have swelling and pain especially with twisting movements. Patients will full ACL tears frequently describe a feeling of a “giving out” sensation even with light activities including walking. ACL injuries usually occur because of a twisting injury, where the foot is planted and the body pivots, a hyperextension where the knee straightens out too much, slowing down suddenly or a hard hit during a contact sport with a twisting motion. 

Do I need an MRI?

The initial diagnosis can be made based on the history and physical exam of the patient, however if a complete ACL tear is suspected a MRI may be ordered. A MRI is a picture, almost like an xray, that uses magnets instead of radiation. This test takes 20-40 minutes. Your provider will ask that you bring a CD of the images to your return visit for review. If your provider has ordered an MRI, it is recommended that you avoid any contact sports and and movements that require twisting or pivoting. 

Do I need surgery?

For patients who would like to participate in sports or be active, surgical reconstruction of the ACL is generally recommended when there is a full tear of the ACL. For partial tears, surgery is generally not required or recommended. Patients with partial tears tend to do very well with physical therapy and home exercise programs. 

Treatment

1. Standing Calf Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12-18 inches behind your uninjured leg.
Keep your injured leg straight and your heel on the oor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.

2. Standing Soleus Stretch - Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 4-6 inches behind your uninjured leg. Keep both heels on the ground and gently bend your knees until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.

3. Hamstring Stretch - Lie on your back and bring affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.

4. Quadriceps Stretch - Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside. Facing
straight ahead, keep the hand nearest the wall against the wall for support. With your other hand, grasp the ankle of your injured leg and pull your
heel up toward your buttocks. Do not arch or twist your back. Hold this position for 30 seconds.

Repeat three times.

This may also be done while laying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times.

Alternative Quadriceps Stretch - Place affected leg on a sturdy chair or low stool, and place opposite hand on a wall to the side of you. Slowly bend front leg, hold for 30 seconds, repeat 3 times.

5. Vastus Medialis Oblique Quadriceps Sets - Sit on the oor with your injured leg straight in front of you. Press the back of your knee down while tightening the muscles on the top of your thigh. Concentrate on tightening the muscles on the inner side of your kneecap. Hold this position for
5 seconds. Complete 3 sets of 10.

6. Straight Leg Raise - Sit on the oor with theinjured leg straight and the other leg bent, foot aton the oor. Pull the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on thetop of your thigh. Raise your leg six toeight inches
off the oor and hold for 5 seconds. Slowly lower it back to the oor. Complete 3 sets of 10. 

7. Leg Lifts - Abduction - Lie on your uninjured side and place leaning on the elbow of your uninjured side and using the arm of the injured side in front of you to stabilize your body. Slowly with the injured leg up, hold for 5 seconds then lower slowly. Be sure to keep your hips steady and don’t roll forwards or backwards. Complete 3 sets of 10.

8. Abduction - Lie on your injured side with your top leg bent and at foot placed in front of the injured leg, which is kept straight. Raise your injured leg
as far as you can comfortably and hold it there for 5 seconds. Keep your hips still while you are lifting your leg. Hold this position for 5 seconds, and then slowly lower your leg. Complete 3 sets of 10.

9. Prone Hip Extension - Lie on your stomach. Squeeze your buttocks together and raise your injured leg 5-8 inches off the oor. Keep your back straight. And the hip of the leg you are lifting on the ground. Hold your leg up for 5 seconds, and then lower it. Repeat 10 times. Do 3 sets of 10.

Do not let your hip roll open as you lift your leg. 

10. Clamshells - Lie on your side with your knees slightly bent, keeping your legs and ankles together. Open and close your knees like a clam by lifting your top knee up until its parallel with your hip. Keep your feet together throughout the exercise, move slowly and controlled as if someone is pushing against your knee while you are pressing it up. Complete 3 sets of 10. 

11. Sidesteps with Theraband - Place theraband around your ankles and lower down into a
half squat with knees bent and toes pointing forwards. Step to the right with your right foot while staying low in your squat position, then bring your left foot in. Repeat 10 times in each direction. Do 3 sets. 

 

When can I return to my sport or activity?

This depends on whether or not you have a complete tear of your ACL which requires surgery, or a partial tear of the ACL. If surgery is recommended, please refer to the surgical recovery guidelines.

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead longer healing times. Everyone recovers at a different rate. Returning to your sport or activity will be determined by how soon your knee recovers,
not by how many days or weeks it has been since pain began. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

  • You have full range of motion in the injured knee, compared to the uninjured knee
  • You have full strength of the injured knee and hip compared to the uninjured knee and hip and are able to complete the above exercises without pain
  • You can jog straight ahead without pain or limping
  • You can sprint straight ahead without pain or limping
  • You can jump on both legs without pain, and you can jump on the injured leg without pain

 

Return to your sport at about 50% effort, and increase by about 10% each week. Patients should progress slowly with cutting movements. If there is a feeling of your knee giving out on you during these movements, you should make an appointment with your provider. If you begin with pain, you may need to rest for a few days before returning to activities. 

Torticollis

Torticollis means "twisted neck."  It is typically noticed the first six to eight weeks of a newborn's life.  Due to a tight muscle in the neck, the baby holds his or her head tilted to one side. 

A bump or mass may be felt over the tight muscle of the neck. It is soft and not tender. The mass is attached to the tight muscle on the side of the neck that the child holds his/her head tilted to. The bump decreases over the next several months, by ve months of age the mass is almost undetectable.

If your child has been diagnosed with congenital muscular torticollis, there may be other conditions that need to be evaluated, such as dysplasia of the hip which your provider should look for. There are other common cause of torticollis such as hearing or vision problems and bone malformations in the neck. 

What symptoms would I see?

A child with torticollis will present with a head tilt and the chin pointing to the opposite shoulder. The majority of the time, the right side is involved, 75%. There is also decreased motion of the neck. One side of the head may be more at then the other side. The bump or mass is found on the affected, short, neck muscle, but disappears after four to six months of age. 

Why does my child have torticollis?

Children who are rst born are more likely to have torticollis. The cause may be from an injury to the neck muscle from positioning in utero. As the mass resolves, the scar that is left on the affected neck muscle will determine how tight or how much torticollis the child will have later on. 

How is torticollis treated?

Stretching and range of motion exercises are treatment for torticollis. This includes turning the head so the chin touches each shoulder and the ear touches each shoulder. Other ways to have the child exercise the affected side is to place toys or his or her bottle so the child must turn his/her head using the affected side. Placing the child’s crib/ bed against the wall, so he/she will have to use the affected side to look out. In only 10% of cases, surgery is needed to lengthen the short muscle. 

Toe Walking

Children learn to walk any itme between 9 and 18 months of age.  As they practice, they try different foot positions such as walking on their tiptoes.  Usually by age 2, children will have learned to walk steadily with feet flat on the ground.  Persistent toe walking after 2 years old should be evaluated. 

What causes Idiopathic Toe Walking?

Idiopathic toe walking or habitual toe walking typically means children tend to walk on their toes for an unknown reason or cause. Children who demonstrate idiopathic toe walking are often able to stand or walk with feet at when asked, but prefer to walk on their toes or the balls of the feet. 

How is it diagnosed?

 

If your child has persistent toe walking, he/she should be evaluated by an orthopedic specialist. A diagnosis of idiopathic toe walking is made after a thorough history and clinical exam, evaluating the child to rule out any neuromuscular or orthopedic causes such as cerebral palsy, muscular dystrophy or tight heel cords. Toe walking may also be seen in children with autism, asthma, and speech and language or developmental delays. 

Can toe walking cause problems with my child?

Persistent toe walking can lead to muscle tightness or can be associated with a tight or short Achilles tendon that can make it hard to wear shoes, stand with a at foot, maintain balance, or hop on one foot. With continued toe walking, callus may form on the balls of the feet due to unbalanced distribution of weight on the feet. 

What are treatment options?

Typically, your child will be monitored and observed. If toe walking is related to other disorders, such as cerebral palsy or autism, the underlying condition will need to be addressed rst. If idiopathic toe walking persists after the age of 4 or 5 years of age, there are several treatment options. The most common include:

Physical Therapy/ Exercises - This includes Achilles stretching exercises to help improve the dorsi exion or exibility of the ankle to move up and down.

Serial Casting - Your child can be placed into short leg casts, just below the knee down to the toes to help stretch the Achilles tendon. Casts will be changed every two weeks, stretching the heel cord to improve the motion of the ankle up and down. This is more of a continued stretching over a two week period rather than an intermittent stretching with physi- cal therapy and exercises.

Bracing or Splinting - This is another option to help stretch the Achilles tendon and achieve a more normal gait. Typically this is done after casting or physical therapy has stretched Achilles enough to allow for walking with heels down.

Surgery - To lengthen the Achilles tendon is only required when conservative measures fail