• Abstract and Figures
• Public Full-text

PM’s ROUNDTABLE Stanley Beekman, Joseph D’Amico, Mark Caselli, Louis DeCaro, Patrick DeHeer, Nicholas Pagano, Mitzi L. Williams, DPM DPM DPM DPM DPM DPM DPM Pediatrics and Podiatric Medicine Our experts discuss the latest trends in this area. BY MARC HASPEL, DPM 91 he practice of pediatrics practitioners in that field to participate Podiatric Medicine. He currently is in within the specialty of in a lively roundtable discussion on a private practice, limited to gait-related podiatric medicine could few select topics in pediatrics. They disorders, in New York, New York. be one of the best-kept have shared their insights on problem- Mark Caselli, DPM is an adjunct secrets of the profession. atic childhood pedal conditions, and professor, Department of Orthopedics, TSimply by offering a wide range of offered recommendations on growing at the New York College of Podiat- services to the youngest in the popu- a pediatric following within a practice ric Medicine; he is adjunct Professor, lation, a podiatric practice could ben- of podiatric medicine. Ramapo College of New Jersey. Dr. efit in untold ways. Once a podiat- Joining this roundtable panel are: Caselli is a fellow, American College ric physician gains the confidence of Stanley Beekman, DPM, was of Foot and Ankle Pediatrics. He is for- those seeking care for their children, first Fellow of Orthopedics and Bio- mer chair, Department of Orthopedics the rest of the family will very often trust its care with that same doctor. Savvy practitioners also recognize that Simply by offering a wide range of services the opposite is true. Often presenting pedal structural complaints of adults to the youngest in the population, a podiatric practice can also be identified in their children, giving podiatric physicians an oppor- could benefit in untold ways. tunity to treat many more patients. The result could be an exponential growth in the podiatric practice. Of mechanics at the New York College and Director of Pediatrics, at the New course, the desire to practice pediat- of Podiatric Medicine. He served as York College of Podiatric Medicine. rics in podiatric medicine demands assistant professor in the Department Louis DeCaro, DPM specializes in strong knowledge and skill in many of Clinical services at the Ohio Col- pediatrics, sports medicine, and biome- medical disciplines including biome- lege of Podiatric Medicine, where he chanics. Dr. DeCaro is president and chanics, neurologic development, der- supervised the students in the po- fellow of the American College of Foot matology, and surgery. In addition, do-pediatric department. & Ankle Pediatrics. He is board certi- a warm welcoming professional de- Joseph D’Amico, DPM is profes- fied by the American Board of Multiple meanor is usually necessary to receive sor of Orthopedics & Pediatrics, and Specialties in podiatry. In 2018, he was and treat young patients. past chairman in the Division of Or- granted fellowship in the Royal College Recognizing the potent role that thopedic Sciences at the New York of Physicians & Surgeons of Glasgow. pediatrics can play within the practice College of Podiatric Medicine. He is Dr. DeCaro is an international lecturer of podiatric medicine, Podiatry Man- past director of the Department of Bio- on the topics of podo-pediatrics and agement has invited several leading mechanics at the California College of Continued on page 92 www.podiatrym.com JUNE/JULY 2019 | PODIATRY MANAGEMENT PM’s ROUNDTABLE Pediatrics (from page 91) Treatment is based on identifica- still present so ideally an above-knee tion and neutralization of structural im- splint would be advantageous. biomechanics, and runs a specialty gait perfections to prevent progression and evaluation clinic for some of his most encourage resolution. If the deform- Williams: The earlier a deformity challenging pediatric cases. ing forces can be controlled with the presents, the more important it is for Patrick DeHeer, DPM is in private proper orthotic device, and maintained the clinician to determine why faulty practice in Indianapolis, Indiana. He during developmental years some mea- mechanics exist. There tends to be a is a trustee for the American Podiatric sure of success can be anticipated. In proximal driving force. For example, Medical Association, and serves as res- essence, this approach is similar to young children often present with idency director of St. Vincent Hospital that of orthodontics. If an improperly JHAV and co-existing hind foot val- in Indianapolis. Dr. DeHeer is board aligned skeletal segment can be held gus. Hence, early biomechanical con- certified by the American Board of Foot in its corrected position, and the forces trol of the foot either from an orthotic and Ankle Surgeons in Foot Surgery, that were responsible for its inception or SMO is important. Despite all ef- and Reconstructive Rearfoot and Ankle negated, then, according to Wolf’s Law forts, many children with JHAV at Surgery. Dr. DeHeer is a fellow of the of Bone and Davis’ Law of Soft Tissue, an early age will progress toward the American College of Foot and Ankle improvement should be achievable. development of pain and/or fatigue. Pediatrics. He lists as potential conflicts of interest that he is the owner of IQ Medical and inventor of The Equinus “Not one combination of procedures is right Brace. He is speaker for Paragon 28 and serves as consultant for Flower Ortho- for every child presenting with JHAV.”—Williams pedics and Wishbone Orthopedics. Nicholas Pagano, DPM is in pri- 92 vate practice at Barking Dogs Foot As far as the use of HAV night Upon failure of conservative modali- and Ankle Care in Plymouth Meeting, splints in younger children, I have ties, taking available growth into ac- PA. He is course director of Pediat- found them to be of little value. count, surgery may be suggested. ric Foot and Ankle Orthopedics at This is due to the fact that most Surgery is specific to the child and Temple University School of Podiatric of these patients have ligamentous the individual deformity. This is im- Medicine. He is the Vice President laxity, which makes the benefit of portant to understand. No one combi- of ACFAP and an on-air expert For a hallux-abducting splint less likely. nation of procedures is right for every Spenco Medical Corporation on QVC. In older children, or in those cases child presenting with JHAV. The hind- Mitzi L. Williams, DPM is an at- with normal joint motion, I do aug- foot position followed by 1st ray po- tending surgeon at Kaiser Permanente ment treatment with splints. sition needs to be evaluated. Medial Foundation Hospitals in Oakland, CA. In individuals with metatarsus ad- column instability is generally noted. She is an attending surgeon at the San ductus, I find that there is a predisposi- It is the exception that the child does Francisco Bay Area Foot and Ankle tion to hallux abductovalgus formation not have some component of equinus Residency Program. She is a member because of footwear. Therefore, along if hind foot valgus is present. of the Podiatry Institute and fellow of with the appropriate conservative man- In the presence of equinus, a both the American College of Foot and agement, counseling on the appropriate gastrocnemius recession may be per- Ankle Surgeons and the American Col- straight last type footwear is essential formed. With open growth plates in lege of Foot and Ankle Pediatrics. She in preventing further hallux abduction the presence of hind foot valgus often is an instructor for the American Acad- forces. Of course, any accompanying a lateral calcaneal osteotomy is per- emy of Foot and Ankle Osteosynthesis. pathomechanical deficiencies must be formed followed by evaluation of any identified and neutralized as well. forefoot supinatus. If this exists with PM: How do you handle Posterior group contractures that open growth plates, then an opening juvenile hallux valgus? have contributed to hallux valgus medial cuneiform osteotomy remains production should be given both an option followed by evaluation of the D’Amico: I believe that passive and, depending on the age JHAV deformity. At times, a proximal Q no child is born with hal- of the child, active stretching ex- 1st metatarsal osteotomy with or with- lux abductovalgus. The deformity ercises. If this is ineffective, or im- out a distal 1st metatarsal osteotomy is is primarily acquired through me- practical, physical therapy referral an option. It is always easier when the chanical dysfunction of the foot and is warranted. The use of a posterior growth plates are near closure, as the limb. Factors contributing to its age night splint with the foot and leg Lapidus arthrodesis becomes a viable of appearance, severity, and progres- held at least at 90 degrees to pre- option for medial column correction. sion include: the degree of congenital vent perpetuation of the deformity Hence, it is important to attempt structural imperfections present, lig- due to sleep-induced plantarflexion conservative biomechanical control amentous laxity, equinus influences, is often indicated and beneficial. for JHAV until the child nears growth family history, improper footwear, While a below-knee splint prevents plate closure, as recurrence rates re- presence of metatarsus adductus, plantarflexion of the foot on the leg, main high. Unilateral JHAV without obesity, et al. the opportunity for knee flexion is Continued on page 94 JUNE/JULY 2019 | PODIATRY MANAGEMENT www.podiatrym.com PM’s ROUNDTABLE Pediatrics (from page 92) deformity and the patient’s activities. port this paradigm shift. This means Although surgery is often a good op- translational osteotomies do not fully familial history should prompt evalu- tion for a severe deformity, it should correct the deformity, and recurrence ation for other causes. Physical ther- be carefully considered in high func- is almost inevitable. If one takes a deep apy is very helpful with transitioning tioning athletes, such as dancers.

Load more

  15

Copy Link