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What Causes Tightening Of Muscles In Hip, Calf And Heels While Moving?
Question: hi my 4 year old boys runs ackward and very slow he cant jump hop skip pedal bike or alternate stairs with each foot he has knock knees which he has custom insoles for he goes to physio cause his hip calf and heel muscles keep tighting dosent seem to make a differnce he had hip scanned and are fine doctor and physio think there a problem but wont dignose him to hes seen a specialist we have been on his waiting list for over a year now still no opointment starting school soon would like to find out what it is and how it can be fixed he has no other problems just his legs
Brief Answer:
Proper physiotherapy is needed
Detailed Answer:
Hello
Thanks for the query
Usually knock knee is normal as a part of growth in this age. It does not need any treatment as it does not causes any gait abnormality and subside on its own as the child grows (usually by 7-8 years of age). But this is not in your case, as your son has associated difficult walking.
The important causes of stiff lower limb with difficult walking are spastic diplegia (a form of cerebral palsy with normal intellect), rickets, injury or infection of the bone and exaggerated physiological knock knee. Some uncommon causes are also there which can mimic knock knee but usually there is generalized involvement of bones in those conditions. As you have not mentioned, I assume there is no history of injury or infection.
I would like to rule out any vitamin D deficiency causing rickets and then to rule out exaggerated physiological knock knee or pathological knock knee by examination (the space between two ankles will be more than 10 cm).
In both these case specific treatment is needed like Vit D supplement in case of rickets and braces or corrective surgery in exaggerated physiological knock knee or other causes of pathological knock knee.
If these two conditions have been ruled out then physiotherapy is the only choice.
I would suggest you to consult a pediatrician to rule out these causes and if these are not there then to continue the physiotherapy as advised.
I would be glad to answer if you have any further query.
Regards
Proper physiotherapy is needed
Detailed Answer:
Hello
Thanks for the query
Usually knock knee is normal as a part of growth in this age. It does not need any treatment as it does not causes any gait abnormality and subside on its own as the child grows (usually by 7-8 years of age). But this is not in your case, as your son has associated difficult walking.
The important causes of stiff lower limb with difficult walking are spastic diplegia (a form of cerebral palsy with normal intellect), rickets, injury or infection of the bone and exaggerated physiological knock knee. Some uncommon causes are also there which can mimic knock knee but usually there is generalized involvement of bones in those conditions. As you have not mentioned, I assume there is no history of injury or infection.
I would like to rule out any vitamin D deficiency causing rickets and then to rule out exaggerated physiological knock knee or pathological knock knee by examination (the space between two ankles will be more than 10 cm).
In both these case specific treatment is needed like Vit D supplement in case of rickets and braces or corrective surgery in exaggerated physiological knock knee or other causes of pathological knock knee.
If these two conditions have been ruled out then physiotherapy is the only choice.
I would suggest you to consult a pediatrician to rule out these causes and if these are not there then to continue the physiotherapy as advised.
I would be glad to answer if you have any further query.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
will get his vitamin d checked with doctor how do they test for spastic diplegia he only see the physio once every 2 months i do it at home myself would u recomend i take him to physio weekly
Brief Answer:
As physiotherapy is the mainstay it should be done properly
Detailed Answer:
Hello
Welcome again
Spastic diplegia is a clinical diagnosis.Brain imaging with MR should be done(positive in >70% cases of spastic diplegia).It is more common in preterm babies.
As physiotherapy is the mainstay of treatment it should be done properly.I don't know how perfect you are in doing physiotherapy. If you are confident enough continue it by yourself,but from my point of view it will be better if you increase the frequency by professional physiotherapist.
Continue the home physiotherapy as usual.
Regards
As physiotherapy is the mainstay it should be done properly
Detailed Answer:
Hello
Welcome again
Spastic diplegia is a clinical diagnosis.Brain imaging with MR should be done(positive in >70% cases of spastic diplegia).It is more common in preterm babies.
As physiotherapy is the mainstay of treatment it should be done properly.I don't know how perfect you are in doing physiotherapy. If you are confident enough continue it by yourself,but from my point of view it will be better if you increase the frequency by professional physiotherapist.
Continue the home physiotherapy as usual.
Regards
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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