Children's bones are not small adult bones. They grow. They have growth plates. They heal differently. They deform differently. They need a different kind of orthopedic eye. Most pediatric orthopedic worries that bring parents to Dr. Swaroop's Ortho and Polyclinic in Wakad turn out to be completely normal developmental variants. Some need watching. A small number need active treatment. The point of the consultation is to know which is which.
Common Pediatric Orthopedic Conditions
Clubfoot (Congenital Talipes Equinovarus)
A condition present at birth where the foot is twisted inward and downward. Modern Ponseti casting started within the first few weeks of life corrects almost every case without major surgery. Treatment involves serial casting (weekly cast changes for 6 to 8 weeks), a small Achilles tendon procedure and bracing for several years.
Developmental Dysplasia of the Hip (DDH)
The hip socket is shallow at birth and the femoral head can slip out. Early diagnosis (newborn examination, ultrasound) allows treatment with a Pavlik harness - a soft brace worn for 6 to 12 weeks. Late diagnosis (after 6 months) requires more involved treatment including casting and sometimes surgery.
Flat Feet (Pes Planus)
Most flat feet in young children are normal. Arches develop gradually until age 6 to 8. Flat feet that are flexible (the arch appears when the child stands on tiptoes) usually do not need treatment. Rigid flat feet, painful flat feet, or flat feet that cause walking problems need evaluation.
Knock Knees and Bow Legs
Bow legs are normal until age 18 to 24 months. Knock knees are normal between ages 3 and 6. Beyond these age ranges, persistent or asymmetric deformity needs evaluation. Most cases resolve naturally; some need orthotics, physiotherapy or, rarely, growth modulation surgery.
In-Toeing and Out-Toeing
Most cases of toe-walking, in-toeing and out-toeing in children under 8 are normal developmental variants. Persistent severe deformity, painful walking or asymmetry needs assessment.
Scoliosis (Spinal Curvature)
Lateral curvature of the spine. Most often noticed in adolescent girls (10 to 16 years). Mild scoliosis is monitored. Moderate scoliosis (20 to 40 degree curve) is managed with bracing. Severe scoliosis (above 40 to 50 degrees) may require surgical correction. Early detection through school screening makes a big difference.
Pediatric Fractures
Children fracture differently from adults. Greenstick fractures, buckle fractures and growth-plate (Salter-Harris) fractures are common. Most pediatric fractures heal faster than adult fractures. Special care is needed for fractures involving the growth plate, as poor treatment can cause limb shortening or angular deformity over time.
Slipped Capital Femoral Epiphysis (SCFE)
A specific hip condition in adolescents (often overweight boys aged 10 to 16) where the growth plate at the top of the femur slips. Causes hip pain, knee pain or a limp. Requires urgent surgical fixation.
Perthes Disease
A condition affecting children aged 4 to 10 where the blood supply to the femoral head is temporarily disrupted. The bone softens, sometimes deforms, then reheals. Treatment varies by age and severity - observation, physiotherapy, bracing or surgery.
Growing Pains
Aching pain in the legs at night in children aged 3 to 10. Despite the name, it is not caused by growth itself. Most growing pain is benign and self-limiting. Pain that is one-sided, persistent, present in the day, or accompanied by limp or swelling needs evaluation.
Sports Injuries in Adolescents
Increasingly common in PCMC schools and academies. Common injuries include ankle sprains, knee ligament injuries (ACL tears in teenage athletes), apophyseal injuries (Osgood-Schlatter disease at the knee, Sever's disease at the heel) and stress fractures.
When Should Parents Seek a Pediatric Orthopedic Opinion?
Newborn
- Foot turned inward at birth (clubfoot)
- Asymmetric leg creases or hip click on examination (DDH)
- Birth injuries to the shoulder or arm (brachial plexus injury)
Infants and Toddlers (1 to 3 years)
- Not walking by 18 months
- Limping at any age
- Persistent toe-walking after age 2
- Asymmetric leg movement or apparent leg length difference
Pre-school and Early School (3 to 8 years)
- Persistent severe in-toeing or out-toeing affecting walking
- Persistent flat feet with pain or fatigue
- Bow legs after age 3 or knock knees after age 8
- Limp without obvious injury
- Pain at the heel or knee in active children
Older Children and Teenagers (8 to 18 years)
- Asymmetric shoulders, waist or hips on inspection (possible scoliosis)
- Hip or knee pain in adolescent athletes
- Growth-plate injuries from sports
- Persistent back pain in a teenager - never normal, always investigate
- Sudden hip or knee pain in a heavy adolescent (rule out SCFE)
How a Pediatric Orthopedic Consultation Works
The consultation is built around making the child comfortable. Children do not respond well to being rushed. Dr. Solunke takes time, watches the child walk in different patterns, plays simple games to test range of motion and explains findings to both child and parent in language each can understand.
X-rays are done only when essential. Most consultations for normal developmental variants need no imaging at all. When imaging is required, modern X-ray units use pediatric-dose protocols to minimize radiation.
Treatment Approaches
Watchful Observation
For most developmental variants. Periodic review every 3 to 6 months until the issue resolves naturally.
Physiotherapy and Exercises
For postural issues, mild deformities and recovery from injuries. Pediatric physiotherapy is gentle and game-based, focused on movement patterns rather than strength.
Casting and Bracing
For clubfoot, hip dysplasia, scoliosis and certain fractures. Modern braces are lighter and more comfortable than older designs.
Surgery
Reserved for cases where conservative treatment will not work - significant scoliosis, severe deformity, displaced growth-plate fractures, slipped capital femoral epiphysis and certain congenital conditions.
