Ankle-Foot Orthosis Devices: A Guide for Parents

Ankle-Foot Orthosis Devices: A Guide for Parents

by | Jan 1, 2024 | Clubfoot & Foot Disorders

Health conditions that limit your child’s ability to walk, run, play and just be a kid can take a lot of fun out of childhood. An ankle-foot orthosis could be the solution your child needs, particularly if he or she has muscle or joint problems in the legs, ankles or feet. These specialized orthotics can help relieve uncomfortable symptoms, allowing children to return to their daily activities. 

What Is an Ankle-Foot Orthosis?

Ankle-foot orthoses (AFOs), sometimes called AFO braces, are devices designed to support and improve the function of your child’s foot and ankle. Pediatric orthopedic specialists often prescribe them to children with conditions that cause joint instability, irregular walking patterns and muscle weakness or stiffness. 

Your child might need an AFO if he or she has: 

·       Deformities of the foot or ankle

·       Fractures

·       Neuromuscular disorders, such as cerebral palsy, muscular dystrophy and spina bifida

·       Peripheral nerve injuries 

·       Spinal cord injuries

AFOs can also treat ankle instability caused by cerebral palsy and other neuromuscular disorders, congenital abnormalities and injuries. A child with ankle instability may have a hard time maintaining balance, walking or playing. An AFO provides stability, improves gait patterns and prevents additional complications associated with ankle instability.

Three Primary Types of AFOs

Typically made from lightweight and durable materials, such as plastic or carbon fiber, an AFO holds your child’s foot and ankle in the proper position. They can be custom made to fit your child to ensure a secure fit.

Many people confuse orthotics with prosthetics, but they are not the same. A prosthetic device replaces a missing limb, whereas orthoses and orthotic devices, like AFOs, support and correct musculoskeletal problems.

There are many types of AFOs, which can range from very rigid to more flexible. The right device for your child will depend on his or her condition and the location of the issue. In general, AFOs fall into these categories: 

·       Solid AFOs: These provide maximum support and allow for very little movement of the ankle or foot. They often benefit children with neuromuscular conditions that cause severe muscle tightness.

·       Flexible AFOs: Designed to give kids more movement in the foot and ankle, these AFOs allow for a more natural walking motion and give kids more freedom to play while still supporting the muscles and joints.

·       Dynamic AFOs: These orthotics have spring-like mechanisms to assist with push-off during walking, which can be helpful for children with muscle weakness.

If your child has severe muscle weakness, joint instability or paralysis, he or she may need a knee ankle foot orthosis (KAFO). While most AFO braces come up to a child’s calf, KAFO braces extend from the ankle to the knee or even higher.

On the other hand, children with mild to moderate foot and ankle conditions, such as hypermobility or pronation (inward rolling of the foot), may need only a supramalleolar orthosis (SMO). SMO braces reach an area just above the ankle called the supramalleolar region, offering foot and ankle support without limiting a child’s overall mobility.

Life With an AFO Brace 

You can take some steps to help ensure your child’s AFO works as well as it should, no matter what type they have. Make sure your child:

·       Always wears shoes. Properly fitting shoes with good support will keep your child comfortable and prevent slips and falls while wearing the orthosis.

·       Always wears socks under the AFO. Socks can protect your child’s skin from moisture, blisters and irritation caused by the device.

·       Follows instructions for wearing the AFO. Your specialist will show you how to put the device on correctly and adjust the buckles and ankle straps. He or she will also let you know how long your child should wear the device. If your child seems resistant, have him or her start with wearing it only a few minutes a day, gradually working up to the recommended length of wear.

·       Wash your child’s foot every day. You’ll not only keep his or her skin clean, but you can also look for bruising, redness and other signs the orthosis is causing discomfort.

Does your child need an ankle-foot orthosis? Our Orthotics & Prosthetics department craft state-of-the-art, custom-made orthoses in house. To learn how we can help your child, call 214-559-7440.

Get to Know our Staff: Matt Messer, Administration

Get to Know our Staff: Matt Messer, Administration

by | Dec 27, 2023 | Spotlight

What is your job title/your role at Scottish Rite for Children? 
I am an administrative resident. My role is to learn about health care administration through projects and working with leaders to complete my master’s degree.

What do you do on a daily basis or what sort of duties do you have at work?
I work on projects, attend meetings and participate in rotations.

What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My first job was working as a lifeguard. I attended Trinity University, which led me to complete my residency at Scottish Rite.

What do you enjoy most about Scottish Rite?
I enjoy the mission the most! It is such an incredible mission that everyone works toward, which is really special and something you don’t find everywhere.

Tell us something about your job that others might not already know?
I am working toward my master’s degree, which will be completed after I finish my residency!

Where is the most interesting place you’ve been?
Copenhagen.

What is your favorite game or sport to watch and play?
As a graduate of the University of Alabama, it would have to be Alabama football – roll tide!

If you could go back in time, what year would you travel to?
1980

What’s one fun fact about yourself?
Fun fact: I love running on the Katy Trail!

Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

by | Dec 11, 2023 | Sports Medicine

Following surgery, the body experiences increased energy demands due to inflammation and tissue healing. Some patients may eat less due to reduced activity, an increased need for sleep and the use of medications. Not eating enough, when nutrition needs are highest, can prolong recovery time and cause muscle loss.

For young athletes planning to return to sports, the demands can go beyond the early phase of surgery recovery. After knee surgeries to reconstruct ligaments, such as the anterior cruciate ligament (ACL) or after extensive activity restrictions for healing of osteochondritis dissecans (OCD), these nutrition tips should be used throughout physical therapy and return to sports training. These phases can last months and have high energy demands.

Certified sports dietitian Taylor Morrison, M.S., R.D.N., CSSD, L.D., says, “Athletes have unique needs when there are healthy, but these needs change and continue to be unique as they are recovering from significant surgeries.” Morrison cares for young athletes in Scottish Rite’s sports medicine clinic and teaches principles of healing and muscle recovery that can help an athlete well beyond their care.

Morrison offers these nutrition guidelines to help preserve and promote muscle health and support recovery in all phases:

Eat regular meals and snacks to maintain energy levels and promote wound healing immediately after surgery. Eat a meal or a snack every three to four hours and around physical therapy sessions.

Include quality protein to help with tissue repair and wound healing. Include foods rich in leucine, an amino acid that helps build and repair muscle, such as chicken, milk, yogurt, eggs and cheese, at each meal and some snacks and especially after physical therapy sessions.

Include quality carbohydrates to provide energy. Carbs keeps protein available for healing and fiber, which can help with normal digestive function. Carbohydrates with fiber include whole grains, fruits and starchy vegetables. Other carbohydrates include milk and yogurt.

Include healthy fats that are high in omega 3s to fight long-term inflammation. Healthy fats with Omega 3s include salmon and tuna. Other healthy fats include avocado, nuts, seeds, peanut butter, almond butter and vegetable oil.

Include a bedtime snack that contains casein to support muscle protein synthesis throughout the night. Casein is a slow-to-digest protein found in milk, yogurt and cottage cheese.
When you head to the store to stock up on recovery-friendly foods to have on hand, take this list with you for ideas.

  • Eggs
  • Greek yogurt
  • Protein bars
  • Peanut Butter, Almond Butter, SunButter®
  • Starkist® Tuna packs + crackers
  • String Cheese
  • Balanced nutritional supplements such as Boost®, Pediasure®, Carnation Breakfast Essentials®, Kate Farms® or Orgain®

Nutrition after surgery is important for all patients to preserve muscle and provide the increased energy and nutrients the body needs to heal. Some patients will need a specific nutrition plan due to additional medical conditions. If you would like help with an after-surgery nutrition plan, ask your care team about a certified sports dietitian consult.

To learn more from Morrison, visit the sports nutrition page on our website.

Shouldering an Injury: What AC Joint Separation Recovery Looks Like

Shouldering an Injury: What AC Joint Separation Recovery Looks Like

by | Dec 6, 2023 | Sports Medicine

Young athletes can experience many shoulder injuries while playing sports, one of which being AC joint separation. Sometimes called shoulder separation, this injury affects the acromioclavicular joint, which rests where a part of the shoulder blade called the acromion connects to the clavicle, or collarbone.

If your child recently sustained an AC joint separation, you both are likely wondering how long it will take to recover and get back in the game. Athletes can usually return to sports and physical activities after 12 weeks. However, each child’s experience with AC joint separation is different. Your child’s recovery will depend on several factors, including how severe the injury is and the treatment your child receives. 

Understanding AC Joint Separation 

To understand the recovery process, it helps to understand what an AC joint separation is and how it impacts your child’s activities. 

AC joint separation typically occurs when your child experiences a strong blow to the shoulder during a game or falls on his or her arm. The impact can strain or tear the ligaments attached to the underside of the clavicle — the AC and coracoclavicular (CC) ligaments — separating the collarbone and shoulder blade (scapula). Your child may have intense pain, swelling, bruising and limited range of motion in the shoulder and arm. Your child may also develop a bump above his or her shoulder.

Sports medicine specialists categorize AC joint injuries into several types, including: 

·       Type I injuries: These injuries are generally mild. The AC ligament is sprained, and the CC ligament is still intact.

·       Type II injuries: These occur with a complete tear to the AC ligament, a sprain in the CC ligament and slight separation between the clavicle and acromion.

·       Type III injuries: Both the AC and CC ligaments are torn, and the separation between the clavicle and acromion is more pronounced.

·       Type IV, V and VI injuries: These involve tears in the AC and CC ligaments, and the clavicle is pushed further into the shoulder and neck.

Recovering From AC Joint Separation With R&R

An AC joint separation can often heal naturally using nonsurgical treatments, such as rest and temporary activity restrictions. Your child’s sports medicine specialist may recommend:

·       Cold packs to reduce pain and swelling 

·       Immobilizing your child’s arm with a sling for resting the shoulder as it heals 

·       Medication for pain relief 

Kids can often heal without surgery, even with severe AC joint injuries. Your child’s provider may start with conservative remedies before moving to surgery. 

Surgery for AC Joint Separation 

Surgery is generally used only with more severe AC joint injuries, and it may help if your athlete continues to experience pain despite nonsurgical treatment. Surgery can also help address bumps (deformities) that form after AC separation. 

Surgical procedures involve removing a small portion of the collarbone to prevent it from rubbing against the acromion. Minimally invasive or open reconstructive surgery on the AC and CC ligaments may allow your child’s surgeon to reattach them to the collarbone. These procedures may involve plates or other materials to hold the ligaments in place. 

Children who have nonsurgical treatments typically regain shoulder function within six weeks, while those who have surgery will have a longer recovery. Your child may need rehabilitation before returning to sports. Surgical recovery can take about six months.

Many children recover well from AC joint separation, and very few have complications.  

AC Joint Separation or Clavicle Fracture?

Although older children and teenagers can experience AC joint separation, a more common shoulder injury in children is clavicle fracture.

Like AC joint separation, a clavicle fracture can occur after a hard fall or an impact from an accident. The two injuries cause similar symptoms, as well, including:

·       A bump near the break

·       A drooping shoulder

·       Pain, swelling or bruising around the collarbone

·       Pain that occurs when your child tries to move the shoulder or arm and that causes them to not use the arm as much as they normally might

Your child’s provider may recommend imaging to determine whether your child broke a bone or experienced an AC joint separation. Fortunately, clavicle fractures, like AC joint separation, can often be treated without surgery.

Whether your child has AC joint separation or a clavicle fracture, it’s essential to follow the provider’s recovery instructions and ensure your child fully recovers before getting back to the field or playground. 

At Scottish Rite for Children Orthopedic and Sports Medicine Center, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work collaboratively to develop personalized treatment plans for each young athlete. Call 469-515-7100 to learn about our sports medicine program. 

Recognizing Developmental Dysplasia of the Hip in Your Baby

Recognizing Developmental Dysplasia of the Hip in Your Baby

by | Nov 27, 2023 | Hip Disorders

Developmental dysplasia of the hip (DDH) occurs when a baby’s hip joint doesn’t form properly. In most cases, the problem is present at birth, but DDH can also develop as a child grows. It’s essential for parents to know the signs of DDH. The earlier a specialist treats the condition, the better a child’s chances of appropriate development and living without hip problems later in life. DDH occurs in about one in 100 infants.

Defining DDH

The hip is a ball-and-socket joint. The ball, called the femoral head, sits at the upper end of the thighbone and fits snugly into a socket in the large pelvis bone. This ball moves around but always stays inside the hip socket, allowing the hip to move backward, forward and side-to-side while supporting body weight.

When a child has DDH, the ball is not fully covered in the socket or the socket is shallow, which can easily lead to a dislocated hip. Or the hip may already be dislocated or completely or partially out of the socket. Without treatment, the hip joint will not grow properly. As a child gets older, he or she might have pain when walking or develop arthritis at a young age.

Babies at Higher Risk of DDH

While any baby can have DDH, the risk is higher in babies who:

  • Are female
  • Are the first-born child
  • Have a family history of DDH
  • Were born in the breech position (buttocks first instead of head first)

In rare cases, babies can develop DDH after birth. For example, swaddling a baby with the legs straight and tight together can increase the risk of DDH. To help prevent this, talk to your provider about how to use sleep sacks and how to swaddle your infant correctly.

“There’s a lot of importance in how we take care of our babies’ hips after they’re born,” said hip specialist and pediatric orthopedic surgeon William Z. Morris, M.D. “Swaddling the legs in a forced extension can cause the hips to develop incorrectly. The ball and the socket are almost like moldable pieces of clay when you are young, so letting the hips and legs move into a flexed and separated position helps keep the ball tucked up in the socket and makes the socket deeper and the ball rounder.”

When swaddling your baby, focus on wrapping the arms and upper torso only, allowing the hips and legs to move without constriction.

Know the Signs

Babies with DDH do not have pain from the condition. However, parents may notice:

  • A clicking or popping in the hip that you can hear or feel
  • Differences in leg length (one leg being shorter than the other)
  • One leg or hip is not moving the same as the other
  • Skin folds under the buttocks do not line up
  • A limp when the child starts to walk

If you notice your baby has any of these symptoms, immediately make an appointment with your pediatrician.

Navigating a DDH Diagnosis

Doctors usually find signs of DDH during a child’s annual checkup. If symptoms are present or the child has risk factors, the doctor will likely order tests to confirm a diagnosis. These might include:

  • Ultrasound: This imaging test uses sound waves to create pictures of the hip joint. Ultrasound works best with babies younger than 6 months old because the hip joint is mostly cartilage at this age and doesn’t show up on an X-ray.
  • X-ray: In babies older than 6 months, bones have formed well enough to appear on X-ray images.

If your child has DDH, your pediatrician will refer you to a pediatric orthopedic surgeon. The surgeon will choose the best treatment to hold the hip in place and help the ball stay in the socket so the hip joint will grow normally and not cause problems as your child gets older. Early intervention with DDH is important.

“Parents should know that DDH caught early is treated very successfully,” Morris said. “And the vast majority of the time we can do so without surgery.”

Treatment options for developmental dysplasia of the hip include:

  • Bracing: This is the most common treatment for babies younger than 6 months old. The soft fabric brace, called a Pavlik harness, is a shoulder harness with attached foot stirrups. The brace puts the baby’s legs in a “frog-like” position that allows the ball of the hip joint to fit into the socket properly. This treatment usually lasts about six to 12 weeks. Many babies don’t need additional treatment. Even severe cases, where the hip is fully dislocated, are treatable with a harness or brace more than 80% of the time.
  • Closed reduction and spica casting: If bracing does not correct the problem or the child is older than 6 months at the time of diagnosis, the surgeon might do a closed reduction procedure. The surgeon will inject contrast dye into the hip joint to see the cartilage and gently move the thighbone, guiding the ball of the joint into the socket. The baby will then wear a special cast, called a hip spica cast, for two to four months. The cast will hold the hip joint in place.
  • Open reduction: This is a type of surgery done if a closed reduction is unsuccessful or when the child is older than 18 months at the start of treatment. During the surgery, the surgeon moves muscles to see the hip joint and puts the ball properly in place. An open reduction also requires a hip spica cast to hold the hip joint in place.

When doctors find DDH early, your child will likely benefit more from nonsurgical treatment and may not need surgery. If you have any concerns about your child’s hips, talk to your pediatrician about a referral to a pediatric orthopedic specialist.

Is your baby showing signs of developmental dysplasia of the hip? Schedule an appointment with a specialist at the Scottish Rite for Children.