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Does my child need surgery to fix an ACL tear?

Does my child need surgery to fix an ACL tear?

by | Jul 30, 2024 | Sports Medicine

Anterior cruciate ligament (ACL) injuries, continue to challenge young athletes, many calling it an epidemic. Because of the high cost of care and loss of playing time, Scottish Rite for Children’s Sports Medicine team is actively looking for answers to prevent these injuries. As we study the conditions that may contribute to the risk with programs like the Sports-specific Assessment and Functional Evaluation (SAFE) program, we also continue to evaluate and contribute to the available evidence for caring for ACL injuries in young athletes.

Medical director of clinical research and pediatric orthopedic surgeon Henry B. Ellis, M.D., led a multicenter team including others from the Scottish Rite Sports Medicine team just published a critical analysis of the literature pertaining to the management of pediatric ACL injuries. The article is available on the Journal of Bone and Joint Surgeries (JBJS) Reviews site.

Here are some key messages you should know when considering surgery for an ACL tear:

» Even though these are happening at a high rate, there is very little published evidence for managing ACL injury in a pediatric or skeletally immature case.

Studies suggest that as many as 3 out of 4 athletes return to play after completing a nonoperative plan of care after ACL injury, but there are times that surgery is necessary. A physical therapist or athletic trainer can guide rehabilitation with a comprehensive exercise program to prepare an athlete to return to competitive sports with an ACL tear.

» This review suggests that surgery for an ACL reconstruction is recommended when another condition is present. These include:

  • Repairable injury to the cartilage, soft tissue that covers the surface of the bone.
  • Repairable injury to the meniscus, a disc between the two major bones in the knee joint.
  • Symptoms of instability even after high quality rehabilitation.

Since both paths for care can be successful and come with some risk, a decision for surgical or nonsurgical approaches to care for a pediatric ACL reconstruction should include a broad team considering many aspects of the circumstances.

Learn more about individualized care for ACL injuries at Scottish Rite for Children.
 

Ellis, H. B., Jr, Zak, T. K., Jamnik, A., Lind, D. R. G., Dabis, J., Losito, M., Wilson, P., & Moatshe, G. (2023). Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS reviews, 11(8), 10.2106/JBJS.RVW.22.00223. https://doi.org/10.2106/JBJS.RVW.22.00223
What to Do When Your Child Has Pigeon Toes

What to Do When Your Child Has Pigeon Toes

by | May 31, 2024 | Clubfoot & Foot Disorders

Most feet point forward, aiming at their destination — but not all. Although this condition can cause concern for parents, intoeing, or pigeon toes, is common. Intoeing occurs when children have feet turned inward toward one another. Here’s what you should know to help your child manage this condition and enjoy an active and healthy life.

Why Children Experience Pigeon Toes

Pigeon toes can exist at birth but often become noticeable later in childhood. There are three main causes of intoeing, all of which usually resolve without treatment at different times in a child’s growth. These causes include: 

  • Metatarsus adductus. While in the womb, your baby’s position may force the front of the foot to turn inward. This position can result in metatarsus adductus, a condition in which the toes point inward while the outer edge of the foot is curved outward. Metatarsus adductus is a common cause of pigeon toes in newborns and infants. In rare cases, the condition can cause the foot to look like clubfoot. This condition usually resolves spontaneously by age 2.
  • Internal tibial torsion. In this condition, your child’s tibia, or shinbone, twists and turns the leg inward. This is also related to “packaging” of the legs in an inwardly twisted direction while in the womb. This condition usually resolves spontaneously by age 6.
  • Femoral Anteversion. With femoral anteversion, your child’s thigh bone, the femur, turns inward, causing the feet and toes to point inward as well. This condition usually resolves spontaneously by age 9. 

Intoeing often runs in families. Because of its genetic root, preventing pigeon toes is not possible. 

When to See a Provider

Thankfully, being pigeon-toed does not cause pain, and most infants and children grow out of the condition without requiring treatment. The bones correct themselves as the child grows older. However, some cases of intoeing do not resolve on their own and require medical care. 

Your child’s provider may refer you to a pediatric orthopedic specialist if:

  • Your child’s intoeing is accompanied by other foot abnormalities.
  • The foot cannot straighten out easily and feels stiff.
  • The intoeing causes pain, limping, swelling or difficulty walking.

How to Treat Pigeon Toes

The vast majority of children with intoeing due to any of the above causes will correct their rotational differences without any treatment whatsoever. When intoeing is severe and has persisted beyond the expected age at which the condition causing the intoeing should have resolved, treatment may be considered.

Your child’s provider will consider several factors when determining the most appropriate treatment. These include the cause and severity of the intoeing, your child’s age and how the problem affects your child’s daily life.

Based on this information, your provider may recommend one or more of the following pigeon toe treatments:

  • Serial Casting. A cast on your child’s leg and foot can, over time, correct metatarsus adductus. Your provider may use a series of casts as your child’s treatment progresses to continue straightening the foot.
  • Stretching. Babies with metatarsus adductus may benefit from gentle stretching. Parents can perform this physical therapy technique at home. If appropriate, your provider will show you how to stretch the foot in a way that encourages it to straighten out. 
  • Surgery. Older children with severe symptoms that don’t respond to other treatments may require surgery. During surgery, an orthopedic surgeon cuts the twisted bone and resets it in the proper position. Surgery is typically for children older than 9 who have difficulty walking due to intoeing.

You may see advertisements for special shoes or exercise programs designed to address the conditions that cause intoeing. However, the American Academy of Orthopedic Surgeons has stated these are not effective. Your best resource for help with pigeon toes is your child’s provider or orthopedic specialist. 

If you are concerned about intoeing, schedule an appointment with a foot conditions specialist at Scottish Rite for Children.

What Is Turf Toe? 7 FAQs About This Common Sports Injury

What Is Turf Toe? 7 FAQs About This Common Sports Injury

by | Nov 6, 2023 | Sports Medicine

A serious condition with a funny-sounding name, turf toe can sideline aspiring and professional athletes alike. It’s a condition that targets one of an athlete’s most important tools — their feet. Learn how you can identify turf toe in your child and the steps you can take to keep it from ruining their season.

What Is Turf Toe?

In very basic terms, a turf toe injury is a sprain that impacts the big toe’s main joint — the metatarsophalangeal joint. It occurs when the joint gets bent beyond its normal range of motion, leading to stretches or tears in the ligaments, tendons and tissues that hold the joint in place.

What Causes Turf Toe?

Turf toe got its name because it was first seen in football players who play on artificial turf. The firm and less forgiving surface can contribute to strains on the big toe during play.

Nowadays, doctors see this injury in athletes who play any sport that involves running, jumping and other activities that place a lot of strain on the foot and big toe. Those sports include basketball, dance, gymnastics, soccer and wrestling.

In those sports, as with football, footwear can play a role in causing turf toe. Wearing shoes with flexible soles that do not adequately support the big toe joint can increase the risk, whereas stiff-soled shoes offer better protection.

What Are Common Symptoms of Turf Toe?

Common symptoms include:

  • A feeling of instability or weakness in the big toe
  • Bruising
  • Difficulty walking or bearing weight on the affected foot
  • Limited range of motion in the big toe
  • Pain, tenderness, and swelling at the base of the big toe

If your child experiences discomfort or pain in the big toe joint after activity or playing sports, schedule an appointment with a sports medicine specialist. It can take time to recover from turf toe, so treating the condition at the first signs of pain can reduce your child’s time on the sidelines.

Diagnosing turf toe begins with a physical exam. Your child’s doctor will measure the toe’s range of motion and look for signs of tenderness and instability. Your child may have an X-ray to rule out any fractures, but sometimes the doctor will order an MRI scan. This type of imaging provides detailed views of the foot’s soft tissues, helping to confirm the extent of the injury.

How Long Does Turf Toe Take to Heal?

The recovery time for turf toe can vary depending on the severity of the injury and how well it is managed. In general, mild cases of turf toe may heal in a few weeks, while more severe cases can take several months for full recovery. To help your child heal as quickly as possible, follow their treatment plan and doctor’s recommendations.

Treating turf toe typically involves a combination of the following:

  • Rest, ice, compression and elevation, a.k.a. “RICE.” The RICE method starts with letting the joint rest and allowing it to heal. Your child should avoid activities that put strain on the big toe joint. Applying ice, compressing the affected area with a bandage, and elevating the foot can help reduce pain and swelling.
  • Anti-inflammatory medications. Over-the-counter anti-inflammatory medications can help manage pain and reduce inflammation, but ask your child’s doctor which medications to use. Aspirin and adult-strength medications may not be safe for your child.
  • Custom orthotics. Depending on your child’s injury and sport, their doctor may recommend custom orthotic inserts to support and protect the big toe.
  • Physical therapy. Physical therapy can restore strength and range of motion in the big toe. A physical therapist can provide exercises and techniques to promote healing and prevent future injuries.

Is It Safe to Walk on Turf Toe?

In mild cases of turf toe, it may be possible to walk with some discomfort, although rest is still recommended. Your child should listen to their body and avoid activities that worsen their pain or discomfort.

What Happens to Untreated Turf Toe?

If left untreated, turf toe can lead to complications and chronic issues, including:

  • Increased pain and discomfort
  • Limited range of motion in the big toe
  • Reduced athletic performance
  • Risk of future injuries or damage to the joint

Can You Prevent Turf Toe From Coming Back?

You can reduce your child’s risk of getting turf toe again by helping them take some simple preventive measures:

  • Wear proper footwear with stiff soles that adequately support the big toe joint.
  • Use orthotic inserts if your child’s doctor recommends them.
  • Practice exercises that strengthen the muscles around the big toe joint to provide additional support.
  • Learn proper running and movement techniques to limit strain on the big toe.

Scottish Rite for Children has the experience necessary to help your child overcome (or prevent) turf toe. Call 469-515-7100 to schedule an appointment with one of our experts.

Ellen’s Healing Process is Going Swimmingly

Ellen’s Healing Process is Going Swimmingly

by | Jul 30, 2020 | Sports Medicine

Ellen has always been a competitive person, especially in the pool. “Even when I first started swimming competitively in sixth grade, I would tell myself that no matter who was in the lane next to me, I was racing against them,” says Ellen. That fierce competitive spirit has always pushed her to be the best she can be in all that she does. When an injury forced her out of the pool and into surgery, Ellen competed with herself to be her best at physical therapy to get back to doing what she loves.

Ellen-swimming-2-(1).jpg

When Ellen was 9, her favorite sport was soccer. After an injury on the field, she began swimming for physical therapy. She returned to soccer once she had recovered, but Ellen quickly went back to the pool because she realized how much she loved swimming. “I could tell Ellen was a natural swimmer from the second she hopped into the pool,” says Ellen’s mother, Bonnie. Ellen swam with a local club team in Southlake, the North Texas Nadadores, for a couple of years until pain began to slow her down. She spent about a year in and out of the pool, visiting different doctors, but there wasn’t a definite diagnosis until they visited Scottish Rite for Children.
Pediatric orthopedic surgeon Henry B. Ellis, M.D., diagnosed Ellen with labral tears in her hips. “Labral tears are not commonly associated with swimmers, but we are seeing more and more of this, and they may be underreported,” says Ellis. In addition, Ellis explains that hip impingement and labral tears like Ellen’s primarily occur in adults, but our team is seeing it more in young athletes. “We initially treated Ellen’s injury with physical therapy while trying to balance in-water training with cross-training and dryland exercises. Eventually, she took a break from swimming for a short time to help with the pain.” 

In some kids, like Ellen, non-operative treatment doesn’t allow the labral tears to heal. Because of this, Ellis and his team proceeded with surgery to fix the labrum and address the bone around the hip to prevent it from happening again. 

Ellen returned to physical therapy the day after her surgery. It was tough at first, but her competitiveness kept her motivated. “There was another kid about her age that was doing physical therapy at the same time, and Ellen was quietly competing with her in her head,” says Bonnie. “We worked with several physical therapists. We found that God provides what you need at the right time. We had perfect people for the different stages of healing that she was going through.” As physical therapy continued, Ellen joined the Grapevine Faith Christian School swim team. Just 13 months after her second surgery, she qualified for the Texas Association of Private and Parochial Schools (TAPPS) State Swim meet. She swam in the medley relay and individually in the 200 breaststroke.

Ellen says that she has learned a lot from her experiences. “I think, most of all, I learned that God has a plan for my life. Even when I didn’t understand why I was in so much pain, I grew in other areas and realized I could do more than sports,” she says. Ellen also loves art, and this experience has helped her to figure out her art style. “She’s being pretty humble when she says she loves art. She was at the VASE (Visual Arts Scholastic Event) regional art competition and qualified for state. She ended up winning a Gold Seal at the state competition, which is the highest ranking!” says Bonnie joyfully.

Ellen is now training with her team, and she is excited to swim in her junior year, but she also wants to continue with her art. “It’s been good to do something different since I used to just swim all the time,” she says. “That balance is good.” Ellen encourages other young athletes to find that balance and not to rush their physical therapy. “Be determined, but don’t hurt yourself from trying too hard, because that’s kind of what I did. I tried pushing through it, and it just made it worse. I’m not back to swimming as many hours a week as I used to yet, but I’m definitely healed.”

Bonnie shares that they loved their time at Scottish Rite. “The care and the love shown by everyone was amazing. As a mom, when the doctor looks straight at your child and really talks to them and takes the time to get to know them as a whole person, it makes the experience incredible.” Ellen adds, “Dr. Ellis was really good about telling me what was going on instead of just telling my parents. He helped me understand why we were doing all the things like injections and physical therapy, and why everything needed to happen, and he told me about how my surgery was going to be.”

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Get to Know our Staff: Jessica Dabis, Therapy Services

Get to Know our Staff: Jessica Dabis, Therapy Services

by | Jul 6, 2020 | Sports Medicine

What is your role at Scottish Rite for Children? 
I work in the Sports Physical Therapy department in Frisco. I evaluate and treat non-operative and post-op sports injuries, spanning all joints. I typically see patients one-on-one throughout the day in 45-minute blocks, implementing activities such as manual therapy, therapeutic strengthening, dynamic movement mobility and speed/deceleration/landing mechanics training. We focus on coordination and motor control development for our young, skeletally immature population. The goal for our athletes is to foster long-term athletic development and equip them with the tools needed to minimize future injury risk factors by building durability for once they return to sport.
What do you enjoy most about Scottish Rite?
I love the people –  my coworkers, the collaborating physicians and nurses, social workers, psychologists and leadership. Everyone seems to truly share a vision of compassion and patient-centered care that I feel contributes to our strong patient outcomes.

Why did you decide to do the work you are doing now?
Scottish Rite for Children was my first job out of physical therapy school. I have worked here for four years now. I was drawn to sports physical therapy because it is a way to use my passion for learning about and understanding the human body – from injury to healing. It is great to know that my work can help to get an athlete back to doing what fulfills them.
 
What’s the coolest or most interesting thing you’re working on right now?
From a rehab to performance standpoint, I have been working on some sport-specific programming resources. I also work on the Keeping Up With the Count dance project, where we have created a variety of resources for the dance community.
 
What are you currently watching on Netflix/Hulu/TV/etc.? 
I watched Money Heist during quarantine and am about to start the Japanese anime series, Demon Slayer.
 
What would be the most amazing adventure to go on?
I would love to make it to Thailand and Bali in the next few years – explore their culture, architecture and tropical landscape!

Keeping Up With the Count – Among other clinical and injury prevention interests, Dabis works closely with a multi-disciplinary team providing patient care and content for young dancers.​