Causes and Treatment of Orthopedic Problems in Newborns

While orthopedic problems in newborns can be distressing to parents, most can be treated without surgery if identified early. Some occur during fetal development while others happen during the delivery itself.

According to research, around one percent of babies born in the U.S. will have an orthopedic defect at birth. Birth injuries are even rarer with three-quarters occurring during a vaginal breech delivery (where the baby's head is turned away from the opening of the womb). As with orthopedic defects, most birth injuries can be treated without surgery due to the malleability of the baby's still-developing bones.

Hip Dysplasia

Hip dysplasia is the medical term for a hip socket that doesn't fully cover the ball portion of the upper thigh bone (femur). When the ball-and-socket of the hip joint is not in proper alignment, the joint will not develop normally.

Unless treated in a timely manner, hip dysplasia can severely impair the child's mobility in later years and lead to the premature development of hip osteoarthritis.

Fortunately, because the baby's bones are still developing at the time of birth, early diagnosis allows for more effective treatment. Diagnosis is typically made by performing a simple hip click test which involves moving and rotating the infant's leg.

Hip dysplasia in newborns is usually treating by securing the hip in proper position with a brace called a Pavlik harness.

If hip dysplasia is identified in later development, more invasive treatments may be needed. Surgery is usually indicated in babies over the age of one.

Newborn with Club Foot — CDC Public Health Image Library

Clubfoot is a birth defect which causes the feet to point down and inward. When a child is born with this condition, the tendons on the inside and the back of the feet are too short and essentially wrench the feet into an unnatural position.

Because babies have greater bone and joint flexibility, doctors can usually treat the condition without surgery using a manipulation technique called the Ponseti Method.

Introduced in the 1990s, the Ponseti Method involves the gradual softening of the ligaments, tendons, and joint capsules. After each treatment, the feet are held in place with a plaster cast until the bones and joints are finally in proper alignment (usually within two months). As with hip dysplasia, early treatment is associated with better outcomes.

Metatarsus adductus is a common foot deformity that causes the front half of the foot (the forefoot) to turn inward. In newborns, the condition is characterized by the bean-shaped appearance of the foot.

Luckily, most babies born with metatarsus adductus rarely need treatment with over 90 percent resolving on their own.

Some children, however, may be at an increased risk of developmental hip dysplasia if the condition doesn't fully correct itself. In cases like these, the abnormal foot position places chronic stress on the hip joint. This can cause the top of the thigh bone to slip in and out of the hip socket, leading to mobility problems and premature arthritis.

If diagnosed early, your doctor will be able to show you on how to perform passive manipulation exercises to correct the misalignment. In severe cases, surgery may be needed to release the forefoot joints, followed by casting to keep the foot in the correct position.

Sources:

Fishco, W.; Ellis, M.; and Cornwall, M. "Influence of a Metatarsus Adductus Foot Type on Plantar Pressures During Walking in Adults Using a Pedobarograph." J Foot Ank Surg. 2015; 54(3):449-453. DOI: 10.1053/j.jfas.2014.11.007.

Loder, R. and Skopelja, A. "The Epidemiology and Demographics of Hip Dysplasia." SRN Orthop. 2011; 2011: 238607. DOI: 10.5402/2011/238607.

Ponsetti, I. and Smoley, E. "The Classic: Congenital Club Foot: The Results of Treatment." Clin Orthop Relat Res. 2009; 467(5):1133-1145. DOI: 10.1007/s11999-099-0720-2.