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I've just received word back from a patient's mother re a teenage girl who I saw in October 2005 and gave orthoses to. Her presenting pain was tib post bilaterally and she was hypermobile and over-pronating (she was referred from a Consultant Orthopod).
10 days after wearing the Orthoses, she developed right hip pain and presented to the GP, who said that the orthoses were the cause and that she should stop wearing them.
He subsequently left her for 2 months and then sent her for x-ray and she has apparently slipped her femoral epiphysis, which now needs pinning.
GP is still adamant that the Orthoses are to blame and the war drums are sounding!
Has anyone had experience of growth plate fracture subsequent to orthoses wear?
He subsequently left her for 2 months and then sent her for x-ray and she has apparently slipped her femoral epiphysis, which now needs pinning.
The GP should be shot...SCFE is a surgical emergency. Leaving it for 2 months significantly affects the outcome.
I fail to see how the foot orthoses could have caused it.
Here is the notes I give the students:
Quote:
Most common in ages 9 - 15. 25% bilateral. M>F. Characterised by disruption of structural integrity of the proximal epiphyseal plate of femur --> displacement of head relative to neck of femur --> potential for vascular disruption. Similar to Salter Harris type 1 fracture.
Rarely due to trauma
Most are obese. Present with limp and pain over anterior aspect of hip (may be acute or insidious) – gait is often antalgic and externally rotated; usually unable to bear weight on affected side. Joint is tender and internal rotation is restricted. May get referred pain to knee. On examination leg appears shorter, hip abduction and internal rotation is restricted.
Immediate non-weightbearing (bed rest if severe, otherwise wheelchair or crutches)
Surgical intervention is almost always needed (pinning and maybe osteotomy).
Early recognition and prompt surgical intervention is associated with better outcomes.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Admin : 5th January 2006 at 05:26 PM.
I've just received word back from a patient's mother re a teenage girl who I saw in October 2005 and gave orthoses to. Her presenting pain was tib post bilaterally and she was hypermobile and over-pronating (she was referred from a Consultant Orthopod).
10 days after wearing the Orthoses, she developed right hip pain and presented to the GP, who said that the orthoses were the cause and that she should stop wearing them.
He subsequently left her for 2 months and then sent her for x-ray and she has apparently slipped her femoral epiphysis, which now needs pinning.
GP is still adamant that the Orthoses are to blame and the war drums are sounding!
Has anyone had experience of growth plate fracture subsequent to orthoses wear?
Thanks!
I have never seen foot orthoses cause a slipped capital femoral epiphysis and have never heard of this. The GP is wrong on this one, like they are wrong on so many other foot and lower extremity biomechanical problems.
The epiphysis was going to slip regardless of whether the patient was wearing orthoses or not.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Whilst I can understand that the claim from the GP can cause alarm, and whilst not wishing to discuss the situation here too openly, I would want to reassure you that, from an expert witness point of view (which is part of my work), there would be a lot of difficulty backing up the GP statement. If possible put the concerns on the back burner for now and wait and see what the orthopod suggests.
I have experienced something similar once, but coming via a neurologists statement. It never amounted to anything and the pt eventually B****Ked the neurolgist for their attitude.
Thank you all for these comments as, although I knew deep down that my actions were not causative of these events, it's sometimes difficult when you work in isolation of other Podiatrists (mainly) and are meant to be a specialist in your field, to be supremely confident of yourself and your, hopefully, best practice.
It has demonstrated to me, though, the good that a forum such as this can achieve, as it will enable me to progress with communication with this patient's family and, potentially, GP with the knowledge that, although I may not be backed my the GP, I am backed by my peers, theoretically, which is a lot more meaningful!
Femoral epiphysis slip whilst wearing orthoses
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