People usually associate bone and joint diseases with the elderly, since most musculoskeletal problems are consequences of overuse or degeneration. Children’s bones are different from adults, since they continually grow, reshape or remodel extensively. Damaged bone is replaced by new bone tissue. But kids can also suffer from bone problems or disorders, because of heredity, infection, injury or poor development.
Congenital deformity: clubfoot
Maileen, 30, was diagnosed at birth with clubfoot. As a child, she was brought to an orthopedic surgeon who did serial casting every week for a year. Afterwards she wore leg braces for several months. Looking at her now, no one would guess she had bone problems as a child.
Clubfoot causes the feet to point inward and down. Positional clubfoot is a normal foot that has been held in a deformed position in the uterus during pregnancy. Upon examination, the foot is flexible, in contrast to congenital clubfoot which has varying severity and is typically rigid upon examination. The abnormal position of the foot leads to abnormal development of the joints and foot bones. With early management, surgery may not be needed. In severe cases, orthopedic surgery is required.
Nutritional deficiency: Rickets
Normal bone growth and mineralization requires adequate calcium and phosphate, and vitamin D to absorb them. Inadequate mineralization of bone has consequences. Nikki Cotoco-Chu, M.D., a pediatrician from St. Luke’s Medical Center in Quezon City, says rickets is a disease of growing bone due to unmineralized matrix at the growth plates causing softening and weakening of the bones.
Rickets only occurs in children, and is commonly attributed to nutritional deficiencies—although certain drugs, kidney problems or tumors can also be the cause. Bones are soft and bend easily when pulled or bearing weight. The softening leads to various deformities. Affected children may have soft cranial bones or widened junctions from rib to rib. Other manifestations include delayed dentition, back problems, fractures, or deformities of the extremities. With adequate sun exposure, vitamin D deficiency is preventable. Oral doses can be given for several weeks for vitamin-deficient rickets. Calcium intake should also be optimized during this period.
Infectious cause: Osteomyelitis
According to Dr. Cotoco-Chu, bone infections, also called osteomyelitis, are common in children especially in the school-age population. Bone infections have the potential to cause permanent disability. Early recognition and treatment are important to prevent extensive infection and permanent damage. In young infants, abnormal growth and bone or joint deformity are possible consequences.
Most of these infections are a result of localization of blood-borne bacteria in the bones. Minor closed trauma is a common precursor to cases of osteomyelitis. Bone infections can also follow open fractures or penetrating injuries. Symptoms include fever, pain, swelling, limping or refusal to walk. The long bones of the legs are often involved and require x-rays, ultrasound, CT scan or magnetic resonance imaging (MRI) to make the diagnosis.
Antibiotic treatment should be started early and adjusted when the specific bacterial cause is identified from blood cultures. Treatment may require a total of four to six weeks. Surgery may be needed after penetrating injuries, when there is a retained foreign body, or to remove pus that collected in the bone. Physical therapy is also done so the child can resume normal activity on the affected extremity.
For more on children’s bone health, grab a copy of the October issue of HealthToday, out now in bookstores and newsstands.