Introduction to Podopediatrics PDF
Preview Introduction to Podopediatrics
CHURCHILLLIVINGSTONE AnimprintofElsevierLimited ©ElsevierLimited 1993.Allrightsreserved. No part ofthispublicationmay bereproduced,storedinaretrieval system,ortransmittedinanyform orbyanymeans,electronic, mechanical,photocopying,recordingorotherwise,withouteitherthe priorpermissionofthepublishersoralicencepermittingrestricted copyingintheUnitedKingdomissuedby theCopyrightLicensing Agency,90TottenhamCourtRoad, LondonWIT 4LP.Permissions may besoughtdirectlyfrom Elsevier'sHealthSciencesRights DepartmentinPhiladelphia,USA:phone:(+1)2152387869,fax:(+1) 2152382239,e-mail:[email protected] completeyourrequeston-line viatheElsevierhomepage (http://www.elsevier.com).byselecting'CustomerSupport'andthen 'ObtainingPermissions'. Firstedition1993 Secondedition2001 Reprinted2004,2005,2006 ISBN0443062080 BritishLibraryCataloguingin PublicationData Acataloguerecord forthisbook isavailablefrom theBritish Library LibraryofCongressCataloguingin PublicationData Acataloguerecordforthisbookisavailablefrom theLibraryof Congress Note Medical knowledgeisconstantlychanging.Asnewinformation becomesavailable,changesintreatment,procedures,equipmentand theuseofdrugsbecomenecessary.Theeditors,contributorand the publishershave takencaretoensurethatthe informationgiven inthis textisaccurateand up todate. However,readersarestronglyadvised toconfirmthat theinformation,especiallywithregardtodrugusage, complieswiththelatestlegislationand standardsofpractice. The Publisher _ yoursourcefor books. journalsandmultimedia inthehealthsciences www.elsevlerhealth.com Workingtogetherto grow libraries indevelopingcountries www.elsevier.corn Iwww.bcokaid.urg Iwww.sabre.org 1I\1\ II 1< "" I 'II ',.1, I III,' , The publishers policyis10use papermanufactured PrintedinChina fromsustainableforests 8/04 I Contributors Joseph c.0'Amico DPM lainW. McCallMBDhBDMRDFRCR Professor and Past Chairman, Division of ConsultantRadiologist, Robert Jones and OrthopedicSciences;Professor, Departmentof Agnes HuntOrthopaedicHospital,Oswestry, Pediatrics, NewYorkCollege ofPodiatric UK Medicine; PrivatePractitioner, New York,USA MalcolmMacnicolBSc(Hons) MBChBFRCSMCh Jill Ferrari BSc(Hons) DPodMMChS FRCPFRCSEd(Orth) Lecturer,DepartmentofPodiatry, ConsultantOrthopaedicSurgeonand London FootHospital, London, UK Senior OrthopaedicLecturer, The Royal Hospital forSickChildrenand the EdwinJ.Harris DPM Princess MargaretRoseOrthopaedicHospital, ClinicalAssociate Professor ofOrthopedics, Edinburgh, UK LayolaUniversity, Maywood, Illinois,USA Kevin MurrayMBBSFRACP Rheumatologist, DepartmentofRheumatology, Alexandra M.John BScMSc(Clin Psycholl GreatOrmondStreet Hospital, London, UK Head ofPsychologyServices,SussexWealdand Downs NHSTrust,GraylingwellHospital, Kathryn Noyes MBChB Chichester, UK StaffGradePaediatrician (DiabeticTeam), Royal Hospitalfor SickChildren, Edinburgh, ChristopherKelnarMAMD FRCPCH FRCP(Edin) UK ConsultantPaediatric Endocrinologist, Reader in Child Health, RoyalHospitalforSick Jill Pickard MScMCSPCertEdDipTp Children,Edinburgh, UK Senior Lecturer, UniversityCollege Northampton, Northampton, UK Linda Lang PhD Associate Director ofMedicine, AIDSResearch BarbaraResseque DPM Director,ElmhurstHospital Center, NewYork, AssociateProfessor, NewYorkCollege of USA PodiatricMedicine, NewYork; PrivatePractitioner, EastNorthport, NewYork, LawrenceJ.Lowy DPM USA Assistant Professor, DepartmentofPediatrics, New YorkCollege ofPodiatric Medicine, ChristopherSteerBScMBChB DCHFRCPEFRCPCH New York; PrivatePractitioner, ConsultantPaediatrician,Victoria Hospital, Bethel,Connecticut, USA Kirkcaldy,UK ix StevenSubotnickOPMNODC PeterThomson BScOPodMMChS Clinical Professor, Departmentof Biomechanics SeniorPaediatricPodiatrist, FifePrimary Care andSurgery, CaliforniaCollege ofPodiatric NHS Trust, Dunfermline; Medicine,San Francisco; PrivatePractitioner, Dunfermline, UK Adjunct Professor, DepartmentofKinesiology, Ronald L.ValmassyOPM CaliforniaState University,Hayward, Podiatrist, StFrancisMemorial Hospital, San California,USA Francisco, USA John ThomsonMO FRCP(Glas Edin}OObslRCOG Russell G. Volpe OPM Professorand Chairman, Departmentof FChS ConsultantDermatologist, The Royal Infirmary, Pediatrics,NewYorkCollegeofPodiatric Glasgow, UK Medicine, NewYork,USA Foreword Having spent over 40 years studying and prac- extremityindiseaseare outstandingandserveas tising podopediatrics, Ihave learned the import- an excellent reference for the practitioner. ance of keeping well-informed in this especially The editors have assembled a diverse team of difficult field of medicine. Very often, the pedi- authors,each bringingtheirexpertise from years atric patientcannot give the information needed of experience in their field. This team of authors for the podiatrist to perform a thorough and not only comes from different professional back- comprehensive evaluation; it isup to the skill of grounds but also from different areas of the the practitioner to know what to look for and world. It is this diversity that provides such in- how toassess this information. depth coverage ofthe subject. The field of podopediatrics has expanded Iam very honored to havebeenasked to write greatly over the past 10 years. Our knowledge the foreword for this book. Itis a welcome addi- base has broadened and the 'need to know' has tion to one's ownlibraryas it isaworkingdocu- become a priority in our everyday clinical ment, ideal not only for the specialistbutalso as experience. Both patients and parents expect an essential text for the undergraduate, post- the podiatrist to be on the cutting edge of doctoral fellow and the non-specialist seeking the latest information and technology. Intro- enlightenment. You can rest assured that this duction toPodopediatrics addresses these matters book isgoing tobe a key referencein the field. in a well-organised and comprehensive man- Peter Thomson and Russell Volpe have gen- ner. erouslyoffered theirexpertiseand extraordinary This second edition is special and unique - it talents in writing Introduction to Podopediatrics. reflects the most recent knowledge and under- They have years of experience, with solid back- standing of pediatric foot problems, considering groundsinboththe academicandclinicalarenas. not only thefootbutthe total patientaswell.The Producing a text of this magnitude is a huge addition of a chapter on normal child develop- undertaking and this effort is acknowledged ment, for example, functions as a benchmark in withappreciationfor a worthyendeavour. helping to understand the presenceofpathology JW and its significance. The sections on the lower NewYork,2001 xl Preface In the preface to the first edition of this book it The second section introduces the major was stated that the purpose of the book was to medical conditions that may involve the child's identify those lower limb problems in the lower extremity. This includes a comprehensive pediatric population that could be managed by chapter on a variety of medical problems of the podiatrist alone or as a member of a wider interest to the pediatric foot specialist, including team. Similarly, many medical conditions were diabetes, which is now included within the identified which, although they did not techni- chapter General Medicine. It also includes chap- cally fall into the domain of podiatry, would ters on three areas notably involved in child- nevertheless have aninfluence onthepodiatrist's hood foot and leg dysfunction: rheumatology, management of the child. This basic outline has neurologyandcutaneousdiseases. been followed forthis edition. Section 3 focuses on the lower extremity as a Decidingwhich subjectareas toincludeand in distinct entity covering various pathologies of what depth to cover them is one of the major the legand foot.Included here are discussionsof challenges faced in planning an introductory radiological evaluation of the child's foot and text. In this edition the reader will find new or orthopedic conditions such as congenital defor- updated chapters on subjects of great relevance mities and fractures. The very important bio- to the clinician seeking understanding of the mechanical conditions found in the child are child's leg and foot. This edition benefits con- discussed in chapters on torsional and frontal siderably by the inclusion of a co-editor, which planeabnormalitiesand developmentalflatfoot. has allowed for this increase in the number of Finally, Section 4 covers the increasingly chapters. Five new chapters have been added, important topic of the pediatric athlete, as more namely History Taking and Physical Examination; children engage in organized sports at a young Pediatric Gait; Growth and Development; Develop- and vulnerable age. The remaining chapters in mental Flatfoot and Serial Casting. The book is this section are on therapeuticsofthe child'sfoot organized bysection, each representingagroup- and leg including physical therapy. Therapies ingofrelated chapters. frequently employed for the non-operative Section1isdevoted to providingafoundation management of pediatric foot problems are dis- for approaching the child's lower extremity. It cussed in chapters devoted to serial casting and contains chapters on growth and development, orthoticmanagement. psychological considerations and fundamental Itistheeditors'hope that thisbook willanswer clinical chapters on the pediatric history and many of the reader's fundamental curiosities physical examination and the complexities of about the child's foot and leg as well as instill an beginning towalk. appreciationofthecomplexitiesofthesubject.We xiii also hope it will leave the reader questing for ized discipline in foot medicine, and under- greater depth and understanding of this special- appreciated componentofpediatricmedicine. PT,RGV, 2001 Acknowledgments Thequality ofany multi-authortextisdependent might otherwise have expected. We hope the upon the calibre of the authors contributing to final product goes some way to redress the the text. For this edition the editors were balance. fortunateinbeing abletoattract17peoplewhose Our thanks also go to all those children who qualifications in their respective fields are through their parents have allowed us to illus- without question. In addition, it may be seen trate this textbook with clinical photographs. from their contributions that as teachers they Their contribution is acknowledged as a fun- have no equal. Therefore the editors would like damental teaching aid and one without which to thank all those clinicians who managed to the book would be much the poorer. create space in their busy schedules in order to PT would like to thank Dr Lowe for his take part inthis work, some for the second time. critique on the section on fractures and also the Once more the innocents who suffer most in Medical Illustration Department, Queen such projectsare the families.Theeditors would MargaretHospital, Dunfermline. like torecord theirappreciationfor the tolerance Finally, the editors would like to thank the afforded by their long-suffering partners and to team at Harcourt Health Sciences for their their children who, despite their young ages, support and guidance, especially Dinah Thorn stoically accepted the principle of distracted and Derek Robertson. Special thanks also to fathers and the subsequentlackofattention they Mary Law. PT,RGV, 2001 xv CHAPTER CONTENTS Parent-professional relationship 3 Psychological Communication 4 considerations in the Preparation 6 child patient Diagnosis 7 Impactofthediagnosis 7 Alexandra M. John Treatment 10 Conceptsof illness 10 Attachment 11 The knowledge that a child requires hospital Dependency 13 treatment whetherfor an acute or chronic illness can have a profound impact on both the child Illnessremission 14 and thechild'sparents. Thepreviouslyheldbeliefs Discharge 14 concerning the wellbeing of the child are chal- lenged and this raises concerns for both parents Terminalillness 14 and childrenas to whether the child's health can Conclusion 15 be restored. The initialsecurityand familiarity of the family doctor are exchanged for unfamiliar individuals and environments and the disruption of the daily routine such as attending school and carrying out housework or paid employ- ment. The research into the prevalence of child- hood chronic illness has revealed a rate of 10-15% and therefore indicates that this is not a rare occurrence in our society. It is important that health care professionals are aware of the physical and psychological issues that arise for boththe family and the affected individual. Inthischaptera numberofpsychological issues are outlined and discussed in order to provide healthcare professionals with a framework which will aid them in their understanding of the impact that a chronic illness has on the individualand the family. PARENT-PROFESSIONAL RELATIONSHIP This relationship is a key concept in the process of communication between healthcare staff and the patient as the quality of the relationship will facilitate both the parents' and the child's under- standingofthe illness andasaresultenhancethe compliancewith the treatmentproposed. 3 4 INTRODUCTIONTOPODOPEDIATRICS When meeting parents and their children, interpersonal perspective. The choice ofapproach healthcareprofessionalshave choicesinregard to will inevitably be dependent on the service how they interact with the family. Cunningham context and the professional's own personal &Davis! proposed three modelsofinteraction: style. • professional as expert • transplant COMMUNICATION • the consumer. The initial concern for parents and children is The first model considers the professional as their need for clarification concerning the mean- theexpert. In such circumstances, the healthcare ing associated with the presenting symptomol- professional will hold all the expertise and ogy.In order to ensure an appropriate diagnosis willdetermine treatmentand managementofthe is made, patients and their families have to com- case. There will be no attempt to involve the municate the signs and symptomsto the medical parentsotherthantoinformthemofthe sequence and therapy staff. Their ability to communicate of events. This model has some advantages to with professional staff regarding the problem healthcare professionals as they are given a maybe more difficult than one mightimagine. It status and are rarely challenged. However, there isrecognizedthatany anxietyexperiencedby the coexists the potential for parents and children to parents will affect their ability to listen and to become highly dependent on the professional as providecomplete,coherent answers to questions well as to be demanding. They consider them- posed by the professionals. From the children's selves unable to make decisionsand their parent- perspective, they will be in an environment ingskills have been undermined. where they will have little influence in ensuring In the transplant model, the expertrole remains that their voices are heard. Their own develop- withthe professionalbutthisapproachperceives mental level will impact on their ability to com- the importance of transferring some of the skills municate their thoughts and feelings associated to the parents in order to facilitate treatment. with the illness owing toalack ofexpressivelan- Physiotherapy and Portage home visiting are two guage skills. However, if children are not given good examples of this method of working. In the opportunity to express themselves verbally order to facilitate this model, the healthcare pro- or non-verbally through facial and bodily ges- fessional needs to be able to instruct and teach ture, they may become reliant on their parents the parents with sensitivity, to have good listen- to communicate on their behalf which can lead ing skills in order to record any feedback of to a sense of helplessness and of not being the home treatment, and to have the ability to understood. maintainapositiverelationshipwith the parents. Little research has been carried out on how Finally,theconsumer model views the parents as accurately staff can identify the concerns of having the right to choose between treatment parents, let alone children. In the adult field, options and tobe given the necessary information there are numerous studies that have explored to make informed decisions. Within the parent- how hospital staff diagnose emotional and professional relationship, it is the parents who psychiatric problems associated with physical have the power and influence. Inthismodel, there health problems, with most studies significantly isanacceptance that itisthe parentswho have the underrepresenting the difficulties.i-'The effectof most knowledge and competence regarding their this lack of appreciation of the concomitant child's entirecircumstances.Thehealthcare profes- difficulties experienced by parents and children sional's roleisto be a consultant and advisor and resultsin those individualsnot receivingthe help decision-making is through negotiation and is they need. It has been proposed that the reason based on amutuallyrespectful relationship. for poorcommunicationfrom the hospitalstaffis These three models provide potentially chal- due to a number of factors, e.g. limited time," lenging methods of delivering services from an poor interviewing skills," the assumption that PSYCHOLOGICALCONSIDERATIONSINTHECHILDPATIENT 5 the patient will disclose the problem without professional has to ensure that both parents and probing," and the professionals' avoidance of child are kept updated with emerging informa- strong emotions together with a wish to escape tion and of the implications that such informa- from awkward questions." In addition, the tion may have for them. In a number of studies, environmentin which the discussion takes place parents have indicated that they wished to be is important - open wards and clinical offices told the truthearly.Theresearchalso highlighted provide very different atmospheres for parents the importance of being told the truth in a and children to raise concerns. For parents the sensitivemanner rather than simplybeing given office may provide the privacy to raise issues reassurance. whereas for young to middle school-aged chil- In hospitals, there are many potential barriers drentheroughandtumbleofthewardmay seem to communicating with children. The white coat a preferableplace to raise theirconcerns. is one of these and for many children prior to Bradford & Singer"undertookastudyin order having to attend hospital on a regular basis the toconsiderthe medicaland nursingstaff'sability white coat will have been associated with pain to predict accurately the concerns and anxieties and discomfortand authority wherechildrenare ofparentswho had achild withachronic illness. seenand perhapsnot heard. In orderto facilitate Their findings were salutary to those who work compliance with medical regimens, it is impor- in the health context. They established that the tant that children have an age-appropriate staff were only able to predict 15-30% of the understanding of their condition and what they parents' concerns with regard to the amount of can expect inordertopreventunnecessaryworry information that they received. Interestingly, the and anxiety. The process of knowing to whom staffgroupsdidnotagree on whatthese concerns they can address their concerns will help chil- might be. Such evidence confirms that despite dren to be able to find ways to cope with their the knowledge that communication may be situation. This process may include talking to problematic and despite the wealth of literature other children in the clinic, to parents or to hos- available in order to facilitate improvements, pital staff. Interestingly, it has been established healthcare staff still have difficulty in this area. that the process of worrying in anticipation There needs to be further attention given at the enhancesadjustment following the procedure. outset of a professional-patient relationship in When children are old enough to be aware of order to ensure clarification and to derive open, the illness and of the consequences to theirdaily direct communication between the two parties. life, it is necessary for the professional to speak Therefore, onseeingachild for the first time, itis with children at the appropriate cognitive level. important not to make assumptions regarding This isimportantboth at the timeofinitial diag- thechild's response topodiatry. Forchildrenwho nosis (when age appropriate) and at follow-up may already have endured numerous hospital and review. However, to assess the children's visits and medical!surgical procedures, to have cognitive level by their use of language alone their feetexamined may bethe last strawas they may be misleading. Any mismatch between the may associate previous examinations inappro- manner in which children speak and their real priately with podiatry and as a result behave in abilities may be attributable to several factors, an unexpected manner. e.g. the unfamiliar setting or their own anxieties The impactof the diagnosis can be moderated aboutwhatishappening. When childrenare very and adjustment to it enhanced by the way in anxious they may regress both in the way in which parents and children are provided with which they talk and how they behave. Another the information,i.e.whatthey are told andwhen factor may be a child's own physical limitations. they are told. Occasionally, diagnosis may be Certain children with cerebral palsy have great made at birth but for others it isan evolving sit- difficulty expressing their thoughts verbally uation when there is no definitive time that the because of their motor difficulties but they may parents can be given a diagnosis. Therefore, the well understand everything that is being said.
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