AANDOENINGEN BIJ KINDEREN
INHOUD
Foot and lower limb disorders ................................................................................................................................ 3
Part 1: pain in the foot ........................................................................................................................................ 3
Pes planus ....................................................................................................................................................... 3
Pes cavus ......................................................................................................................................................... 4
Part 2: congenital footdisorders ......................................................................................................................... 5
Calcaneovalgus ................................................................................................................................................ 5
Metatarsus adductus ...................................................................................................................................... 5
Clubfoot/ klompvoet ....................................................................................................................................... 6
Part 3: gait disorders – bowlegs-length inequality.............................................................................................. 7
Inwendige rotatie – toeing in – walks with feeth inwards .............................................................................. 7
Toeing out ....................................................................................................................................................... 7
X-en O-benen .................................................................................................................................................. 7
Len length difference ...................................................................................................................................... 8
Hipdisorders ............................................................................................................................................................ 9
Developmental dysplasia of the hip (DDH) ......................................................................................................... 9
Transiente synovitis .......................................................................................................................................... 12
Epifysiolysis van de heupkop/ slipped capital femoral epiphysis...................................................................... 14
Manken ............................................................................................................................................................. 15
Spinal disorders ..................................................................................................................................................... 16
Rugpijn .............................................................................................................................................................. 16
thoracala hyperkyfosis ...................................................................................................................................... 16
Scoliosis ............................................................................................................................................................. 16
Structural scoliosis ........................................................................................................................................ 16
Idiopatische scoliose ..................................................................................................................................... 17
Infantiele scoliose ......................................................................................................................................... 17
Juvenile scoliose ............................................................................................................................................ 17
Adolescente scoliose ..................................................................................................................................... 17
Torticollis ........................................................................................................................................................... 19
Knee ...................................................................................................................................................................... 20
Apophysitis: Osgood -Schlatter ......................................................................................................................... 20
Apophysitis: Sinding-Larsen-Johansson ............................................................................................................ 21
Osteochondritis dissecans ................................................................................................................................. 21
Discoide meniscus ............................................................................................................................................. 21
1
, Anterieure kniepijn bij de adolescent ............................................................................................................... 22
Groeipijn ............................................................................................................................................................ 23
Orthopaedic treatment of cerebral palsy ............................................................................................................. 24
what is cp .......................................................................................................................................................... 24
primary .............................................................................................................................................................. 24
secondary .......................................................................................................................................................... 24
tertiary .............................................................................................................................................................. 24
management of secondary problems ............................................................................................................... 25
secondary problems .......................................................................................................................................... 25
3 principles for transfers ............................................................................................................................... 25
bony deformities ........................................................................................................................................... 26
Sportletsels bij kinderen ....................................................................................................................................... 27
The shoulder ..................................................................................................................................................... 27
Luxation and instability ................................................................................................................................. 27
osteochondrosis proximal humerus .............................................................................................................. 27
Impingement ................................................................................................................................................. 27
Elleboog............................................................................................................................................................. 27
little league elbow ......................................................................................................................................... 27
Pols .................................................................................................................................................................... 28
gymnast wrist ................................................................................................................................................ 28
Cervical level: .................................................................................................................................................... 28
Lumbar level: ..................................................................................................................................................... 28
Hip and pelvis: ................................................................................................................................................... 28
Thigh lesions:..................................................................................................................................................... 28
Knee injuries:..................................................................................................................................................... 29
2
,FOOT AND LOWER LIMB DISORDERS
PART 1: PAIN IN THE FOOT
PES PLANUS
Typisch is de doorzakking van de mediale voetboog En de valgus van de hiel
De soepele platvoet:
- Meest frequent
- Physiologisch tot 3 à 4 jaar
- Geeft meestal geen klachten
- Soms pijn of vermoeidheid bij wat oudere kinderen
- Corrigeert bij op de tenen staan
Behandeling:
- Meestal geen
- Steunzolen bij: pijn, vermoeidheid, misvormen van de schoenen
- De steunzolen beinvloeden de natuurlijke evolutie van de platvoet niet
- Meestal spontane correctie, echter niet altijd!
- Zo rond 8 jaar geen verbetering, waarschijnlijk best een steunzool om pijn later te voorkomen?
Natuurlijke evolutie:
- Incidentie: 14% ( canadese soldiers)
- Normale voetboog wordt gevormd tss 1 en 6 jaar
Rigide platvoet (stijve platvoet)
- Vrij zelden
- Meestal pijn klachten
- Oorzaken : congenitale synostoses, infectie, reuma, post-traumatisch…
- Vergen dikwijls een heelkundige behandeling
Tarsale coalities: Talo-calcaneaire synostose:zeldzamer en moeilijker te behandelen
Pedes plani: operatieve behandeling
Freiberg: avasculair necrosis metatarsal 2 (or 3)
Kohler: = necrose van het os naviculare, kleuters
Behandeling: symptomatisch (ev. steunzool)
vaak verward met infectie (dike gezwollen voet, pijnlijk -> eig necrose)
3
, Calcaneaire apophysitis Sever’s disease:
- Hielpijn jonge sporters
- Inflammatie thv de apophyseale groeiplaat van het os calcaneum
- 9 - 14 jaar
- Bilat. 60% - 80%
- zeker met spierverkorting geeft pijn, posterieur hiel groeischijf -> altijd gevoelig, constante tractie
groeischijf geeft ontsteknig -> stertching en hielcups voor schokabsorptie -> enkele jaren tot groeischijf
volgroeid is
PES CAVUS
Gekenmerkt door een toename van de mediale voetboog en een hogere wreef
- Meestal geen probleem
- Soms familiaal
- Kan overdruk op hiel en voorvoet geven met soms pijn…..steunzool
- Oppassen voor de progressieve holvoet,vooral met varus van de hiel
Progressieve holvoet:
- Meestal een neurologische oorzaak (Charcot-Marie Tooth(fib.spieratr.), Polio, Spinaal dysraphisme,
Gekluisterde konus)
- Heelkundige correctie vaak aangewezen
- als holvoet steeds holler wordt -> kan een neurologische aandoening
4
INHOUD
Foot and lower limb disorders ................................................................................................................................ 3
Part 1: pain in the foot ........................................................................................................................................ 3
Pes planus ....................................................................................................................................................... 3
Pes cavus ......................................................................................................................................................... 4
Part 2: congenital footdisorders ......................................................................................................................... 5
Calcaneovalgus ................................................................................................................................................ 5
Metatarsus adductus ...................................................................................................................................... 5
Clubfoot/ klompvoet ....................................................................................................................................... 6
Part 3: gait disorders – bowlegs-length inequality.............................................................................................. 7
Inwendige rotatie – toeing in – walks with feeth inwards .............................................................................. 7
Toeing out ....................................................................................................................................................... 7
X-en O-benen .................................................................................................................................................. 7
Len length difference ...................................................................................................................................... 8
Hipdisorders ............................................................................................................................................................ 9
Developmental dysplasia of the hip (DDH) ......................................................................................................... 9
Transiente synovitis .......................................................................................................................................... 12
Epifysiolysis van de heupkop/ slipped capital femoral epiphysis...................................................................... 14
Manken ............................................................................................................................................................. 15
Spinal disorders ..................................................................................................................................................... 16
Rugpijn .............................................................................................................................................................. 16
thoracala hyperkyfosis ...................................................................................................................................... 16
Scoliosis ............................................................................................................................................................. 16
Structural scoliosis ........................................................................................................................................ 16
Idiopatische scoliose ..................................................................................................................................... 17
Infantiele scoliose ......................................................................................................................................... 17
Juvenile scoliose ............................................................................................................................................ 17
Adolescente scoliose ..................................................................................................................................... 17
Torticollis ........................................................................................................................................................... 19
Knee ...................................................................................................................................................................... 20
Apophysitis: Osgood -Schlatter ......................................................................................................................... 20
Apophysitis: Sinding-Larsen-Johansson ............................................................................................................ 21
Osteochondritis dissecans ................................................................................................................................. 21
Discoide meniscus ............................................................................................................................................. 21
1
, Anterieure kniepijn bij de adolescent ............................................................................................................... 22
Groeipijn ............................................................................................................................................................ 23
Orthopaedic treatment of cerebral palsy ............................................................................................................. 24
what is cp .......................................................................................................................................................... 24
primary .............................................................................................................................................................. 24
secondary .......................................................................................................................................................... 24
tertiary .............................................................................................................................................................. 24
management of secondary problems ............................................................................................................... 25
secondary problems .......................................................................................................................................... 25
3 principles for transfers ............................................................................................................................... 25
bony deformities ........................................................................................................................................... 26
Sportletsels bij kinderen ....................................................................................................................................... 27
The shoulder ..................................................................................................................................................... 27
Luxation and instability ................................................................................................................................. 27
osteochondrosis proximal humerus .............................................................................................................. 27
Impingement ................................................................................................................................................. 27
Elleboog............................................................................................................................................................. 27
little league elbow ......................................................................................................................................... 27
Pols .................................................................................................................................................................... 28
gymnast wrist ................................................................................................................................................ 28
Cervical level: .................................................................................................................................................... 28
Lumbar level: ..................................................................................................................................................... 28
Hip and pelvis: ................................................................................................................................................... 28
Thigh lesions:..................................................................................................................................................... 28
Knee injuries:..................................................................................................................................................... 29
2
,FOOT AND LOWER LIMB DISORDERS
PART 1: PAIN IN THE FOOT
PES PLANUS
Typisch is de doorzakking van de mediale voetboog En de valgus van de hiel
De soepele platvoet:
- Meest frequent
- Physiologisch tot 3 à 4 jaar
- Geeft meestal geen klachten
- Soms pijn of vermoeidheid bij wat oudere kinderen
- Corrigeert bij op de tenen staan
Behandeling:
- Meestal geen
- Steunzolen bij: pijn, vermoeidheid, misvormen van de schoenen
- De steunzolen beinvloeden de natuurlijke evolutie van de platvoet niet
- Meestal spontane correctie, echter niet altijd!
- Zo rond 8 jaar geen verbetering, waarschijnlijk best een steunzool om pijn later te voorkomen?
Natuurlijke evolutie:
- Incidentie: 14% ( canadese soldiers)
- Normale voetboog wordt gevormd tss 1 en 6 jaar
Rigide platvoet (stijve platvoet)
- Vrij zelden
- Meestal pijn klachten
- Oorzaken : congenitale synostoses, infectie, reuma, post-traumatisch…
- Vergen dikwijls een heelkundige behandeling
Tarsale coalities: Talo-calcaneaire synostose:zeldzamer en moeilijker te behandelen
Pedes plani: operatieve behandeling
Freiberg: avasculair necrosis metatarsal 2 (or 3)
Kohler: = necrose van het os naviculare, kleuters
Behandeling: symptomatisch (ev. steunzool)
vaak verward met infectie (dike gezwollen voet, pijnlijk -> eig necrose)
3
, Calcaneaire apophysitis Sever’s disease:
- Hielpijn jonge sporters
- Inflammatie thv de apophyseale groeiplaat van het os calcaneum
- 9 - 14 jaar
- Bilat. 60% - 80%
- zeker met spierverkorting geeft pijn, posterieur hiel groeischijf -> altijd gevoelig, constante tractie
groeischijf geeft ontsteknig -> stertching en hielcups voor schokabsorptie -> enkele jaren tot groeischijf
volgroeid is
PES CAVUS
Gekenmerkt door een toename van de mediale voetboog en een hogere wreef
- Meestal geen probleem
- Soms familiaal
- Kan overdruk op hiel en voorvoet geven met soms pijn…..steunzool
- Oppassen voor de progressieve holvoet,vooral met varus van de hiel
Progressieve holvoet:
- Meestal een neurologische oorzaak (Charcot-Marie Tooth(fib.spieratr.), Polio, Spinaal dysraphisme,
Gekluisterde konus)
- Heelkundige correctie vaak aangewezen
- als holvoet steeds holler wordt -> kan een neurologische aandoening
4
