Treatments
Children’s bones, joints and growth, from a newborn’s foot to a teenager’s knee: what can go wrong, and how it is put right, gentlest treatment first.
General information based on AAOS OrthoInfo and NHS guidance, not a diagnosis. Sources
In clubfoot, a baby is born with one or both feet turned in and down. It is not caused by anything the parents did, and with early treatment most clubfeet become strong, flexible feet.
In DDH the ball of the hip sits loosely in a shallow socket, or slips out of it. Found early, it is usually treated with a soft harness; found later, it may need a cast or an operation.
Most young children go through bow legs and then knock knees as they grow. Legs that stay bent, bend on one side only, or grow to different lengths are checked and, if needed, straightened or evened out.
Children often break the wrist, forearm or elbow. Most heal well in a cast, but some need setting or fixing, and an elbow fracture that heals crooked can leave a bent elbow (cubitus varus) that can be corrected later.
In babies, a tight neck muscle can make the head tilt to one side and turn to the other. Most improve with gentle stretching exercises in the first year; a few need a small operation to release the muscle.
Some problems involve the whole growing skeleton: an infection in a bone or joint, which is urgent; the tight muscles and hip and foot problems of cerebral palsy; and deformities present from birth.
See it treated
Clubfoot casting, a baby’s hip finding its socket, and a broken forearm healing, on the bones of the 3D child.
The Ponseti method
Keep scrolling. Watch the bones of a clubfoot turn straight, cast by cast.
Walking.
Treated early, most clubfeet become strong, flexible feet. Wearing the brace as advised is what keeps them straight.
Book a visitStep by step
Scroll through the steps; the bones of the see-through 3D child follow. The left hip is the loose one.
Babies’ hips are checked soon after birth and at early baby check-ups. The doctor gently moves each leg to feel whether the ball is loose or slips out of the socket. Uneven skin creases or one leg looking shorter are other clues.
Before about 4 to 6 months, a baby’s hip is mostly soft cartilage that doesn’t show on X-ray, so an ultrasound is used to see the ball and the shape of the socket. Older babies have an X-ray instead.
A Pavlik harness holds the legs bent up and apart, which guides the ball deep into the socket. It is usually worn day and night for several weeks, with regular checks and scans. Parents are shown how to care for the baby in it.
With the ball held in the right place, the socket grows deeper around it. If a harness doesn’t work, or the hip is found later, the hip may be set under anaesthesia and held in a cast, or placed with an operation.
Most babies treated early walk at the usual age. X-ray check-ups continue for some years to make sure the hip keeps growing well.
Remodelling
A time-lapse of a young forearm healing. It plays once; drag along the timeline to go back and forth.
Day 0
Many problems in growing bones correct with casts, splints, braces and exercises, or simply with time.
Cast
Support
Relax
Watch
When an operation is the better option, it is planned around your child’s growth, often using that growth to do the work.
A small plate is fixed across one side of a growth plate through a small cut. That side grows more slowly, so the other side catches up and the leg straightens over months; the plate then comes out.
Usually for knock knees or bow legs that remain in a growing child, and some leg-length differences.
A tiny cut through the tight heel cord, under local anaesthetic, at the end of Ponseti casting, so the foot can come up. A last cast is worn while it heals.
Usually for most clubfeet treated with the Ponseti method.
Under anaesthesia the ball of the hip is guided into its socket and held there in a hip cast while the socket deepens around it.
Usually for hip dysplasia found after the age when a soft harness works, or when a harness has not held the hip.
The bone is cut and realigned, then held with plates, screws or a frame while it heals in the new position.
Usually for a bone that has grown or healed bent, such as cubitus varus after an elbow fracture.
The bone is cut and held with a frame outside the leg or a nail inside it; the ends are drawn apart about a millimetre a day and new bone forms in the gap.
Usually for larger differences in leg length.
The broken bone is lined up and held with wires, nails or plates while it heals, chosen so they protect the growth plates.
Usually for displaced or unstable fractures, and breaks near a joint or a growth plate.
Lengthening tight tendons and releasing tight muscles, and bone surgery to place a slipping hip or correct a foot, often several in one planned operation, followed by physiotherapy.
Usually for tightness and deformity that limit walking, sitting, care or comfort.
Having an operation?
How a typical planned operation goes for a child, from the first visit to being back at school. Every operation is a little different; Dr. Kayal will go through your child’s own plan with you.
Weeks before
Dr. Kayal examines your child, goes through the X-rays and scans, and explains every option, including treatment without surgery. If an operation is the better choice, you go home with a written plan and time to ask questions.
1 to 2 weeks before
Your child is weighed and examined, with blood tests if they are needed. The anaesthetist checks that your child is well enough for the anaesthetic and asks about allergies, medicines and any past anaesthetics.
In the days before
Explain simply and honestly what will happen, in words that fit their age. Let them pack a favourite toy or blanket. A child with a cough, cold or fever on the day may need a new date, so tell the hospital.
The night before
Follow the eating and drinking times the hospital gives you exactly. For children they are often shorter than for adults, and babies have their own times for milk. Not following them can mean the operation is put off, for your child’s safety.
On arrival
Check in with your child’s papers and any X-rays. Nurses check your child’s weight, temperature and fasting, and put on an ID band. You’ll be asked your child’s name, allergies and which side is being operated on more than once: that is a safety check.
Before theatre
Dr. Kayal and the anaesthetist see you both. In many hospitals a parent can stay with the child until they are asleep. Numbing cream on the hand can make the drip painless.
The operation
Your child sleeps through the operation under a general anaesthetic. Its length depends on the operation; the team will tell you roughly how long to expect.
Afterwards
Nurses watch your child closely as the anaesthetic wears off, with pain relief as needed. Children can be sleepy, tearful or confused for a while; this settles. You are usually called to be with them as soon as possible.
Same day or a few days later
When your child is comfortable, eating and drinking, you go home with pain medicine, cast or wound care instructions and the date of the next check.
The first days
Give pain medicine on time rather than waiting for the pain. Keep a cast dry and the leg or arm raised. Check the fingers or toes often: they should stay pink, warm and moving.
At the follow-up
Dr. Kayal checks the wound or cast, often with an X-ray, and explains what was done and the next steps: a new cast, removing a cast, or starting physiotherapy.
Weeks to months
Most children are back at school within days to weeks, depending on the operation. Sport and rough play wait until Dr. Kayal says the bone or tissue is ready. Check-ups continue while your child grows.
Call the clinic the same day if your child has a fever, pain that keeps getting worse, or fingers or toes that are pale, blue, swollen or numb. In an emergency, go to the nearest hospital emergency department.
With or without an operation, recovery runs in phases, and a child’s growth keeps being checked.
A closer look
Bone and joint infection, which is urgent; orthopaedic care in cerebral palsy; and evening out legs of different lengths.
Same day: a child with fever who limps or won’t use a limb should be seen today. Go to the nearest emergency department.
Blood tests and scans (ultrasound, X-ray, sometimes MRI) confirm the infection and show where it is. Treatment is antibiotics, usually started in hospital through a drip and then continued by mouth for some weeks. If pus has collected in a joint or bone, a small operation washes it out. Follow-up checks make sure the bone and its growth plate recover.
Orthopaedic care works alongside your child’s physiotherapists and doctors, with goals agreed with the family.
In cerebral palsy, tight muscles can pull joints into bent positions as a child grows, and hips can slowly slip out of their sockets. Treatment aims to keep muscles long, joints moving and hips in place, so that walking, sitting, care and comfort are easier.
Lengthening tight tendons and releasing tight muscles (soft-tissue surgery), and bone surgery to place a slipping hip or correct a foot. Several problems are often treated in one planned operation, followed by physiotherapy.
Standing on measured blocks, and X-rays of both legs, show how big the difference is today. Your child’s age and growth are used to predict how big it will be when growth ends.
The bone is carefully cut and held with a frame outside the leg or a nail inside the bone. After a few days the two ends are drawn apart very slowly, about a millimetre a day in small steps, and new bone forms in the gap. Physiotherapy keeps the joints moving. The bone then hardens before the frame or nail comes out.
Questions
Common questions about treatment for children’s bones.
Ideally in the first few weeks of life, while the baby’s foot is at its most flexible. Older babies and children can still be treated.
The stretching is gentle, and babies are often fed during casting. The heel-cord release is a tiny procedure, usually done with local anaesthetic.
Most children treated with the Ponseti method walk at the usual age and lead active lives. Wearing the boots and bar as advised is what keeps the correction.
Not always. Many babies’ hips make harmless clicks. What matters is whether the ball moves out of the socket, which a doctor checks by examination and, if needed, ultrasound.
Usually day and night for several weeks, then sometimes part-time, depending on how the hip responds on check-ups and scans.
Most fractures, including most growth plate injuries, heal without affecting growth. A few growth plate injuries can slow or tilt growth, so these are followed up with check-ups and X-rays.
In young children a small bend often straightens as the bone grows, so setting it perfectly may not be needed. How much it can straighten depends on age, the bone and the direction of the bend.
From newborn babies to teenagers, and adults whose problem began while their bones were growing.
Often not. Many problems in children’s bones are treated with casts, splints, braces or exercises, or simply watched as the child grows. Surgery is advised when it is the better option, and the reasons are explained first.
A small plate is fixed on one side of a growth plate near the knee. That side grows more slowly, so the other side catches up and the leg straightens over months. The plate is removed once the leg is straight. It only works while a child is still growing.
Putting a cast on doesn’t hurt; babies are often fed during it. A cast should never be painful afterwards: if your child is in pain, or the toes or fingers look pale, blue or swollen, contact the clinic the same day.
Yes. A child with fever who limps, won’t use a limb, or has a red, hot or swollen joint should be seen the same day. Early antibiotics protect the bone, the joint and its growth plate.
For some children, yes. Botox injections relax a tight muscle for a few months, which gives a window for stretching, casting and physiotherapy to work. They are planned with your child’s therapy team.
About a millimetre a day, in several small steps, after the bone has been cut and a frame or nail fitted. The new bone then needs time to harden before the frame or nail is removed.
At Marwari Hospitals (Tuesday, Thursday, Friday) and Apollo Clinic, Ulubari (Monday, Wednesday and Saturday, except the 2nd and 4th Saturday) in Guwahati, and at HM Hospital, Dibrugarh, on the 2nd and 4th Saturday and Sunday of the month. Days and numbers are on the Clinics page.