Osgood-schlatter condition

Many terms have been applied to the Osgood-Schlaiter condition; the most prevalent are apophysitis, osteochondritis, and epiphysitis of the tibial tubercle. It is not considered a disease entity, but rather the re­sult of a separation of the tibial tubercle at the epiphyseal junction.

The cause of this condition is unknown, but direct injury and long-term irritation are thought to be the main inciting factors. Direct trauma (as in a blow), osteochondritis, or an excessive strain of the patellar tendon as it attaches to the tibial tubercle may result in evulsion at the epiphyseal cartilage junction.

Disruption of the blood supply to the epiphysis re­sults in enlargement of the tibial tubercle, joint ten­derness, and pain upon contraction of the quadriceps muscle. The physical educator may be the one to de­tect this condition from the complaints of the stu­dent, who should be immediately referred to a phy­sician.

Local inflammation is accentuated by leg activity and ameliorated by rest. The individual may be unable to kneel or engage in flexion and extension movements without pain. The knee joint must be kept completely immobilized when the inflammatory state persists. Forced inactivity, provided by a plaster cast, may be the only answer to keeping the overactive adolescent from using the affected leg.

Therapeutic Treatment. Early detection may reveal a slight condition in which the individual can continue a normal activity routine, excluding overexposure to strenuous running, jump­ing, and falling on the affected leg. All physical edu­cation activities must be modified to avoid quadri­ceps muscle strain while preparing for general physical fitness.

While the limb is immobilized in a cast, the indi­vidual is greatly restricted; weight bearing may be held to a minimum, with signs of pain at the affected part closely watched by the physician. Although Osgood-Schlatter condition is self-limiting and tempo­rary, exercise is an important factor in full recovery. Physical education activities should emphasize the ca­pabilities of the upper body and nonaffected leg to prevent their deconditioning.

After arrest of the condition and removal of the cast (or relief from immobilization), the patient is given a graduated reconditioning program. The ma­jor objectives at this time are reeducation in proper walking patterns and restoration of normal strength and flexibility of the knee joint. Strenuous knee movement is avoided for at least 5 weeks, and the demanding requirements of regular physical educa­tion classes may be postponed for extended periods depending on the physician's recommendations. Al­though during the period of rehabilitation emphasis is placed on the affected leg, a program must also be provided for the entire body.

The criteria for the individual to return to a regu­lar physical education program would be as follows:

1. Normal range of movement of the knee

2. Quadriceps muscle strength equal to that of the unaffected leg

3. Evidence that the Osgood-Schlatter condition has become asymptomatic

4. Ability to move freely without favoring the af­fected part

Following recovery, the student should avoid all activities that would tend to contuse, or in any way irritate again, the tibial ruberosity.

CLUBFOOT

One of the most common deformities of the lower extremity is clubfoot. This deformity is characterized by plantar flexion or dorsiflexion and inversion or eversion of the foot. The clubfoot deformity, if not corrected, would force the individual to walk on the side of the foot or on the ankle rather than on the sole of the foot.

This defect can be acquired or congenital. The ac­quired type of clubfoot can develop from a spastic paralysis, as in cerebral palsy or other neuromuscular diseases, which may eventuate in bone and soft tissue changes.

Medical Treatment. If the deformity is recognized soon after birth, a plas­ter cast is employed to retain the foot in an overcorrected position. Special clubfoot shoes with a rigid steel pole may be employed for the prewalker to help maintain the proper position of the foot. Various corrective shoes may be worn and splints applied to continue the development of proper foot alignment until amelioration is achieved.

The pupils limitations and capabilities will depend on the extent of residual derangement and deformity. A handicapped child with a severe malformation may be restricted from standing for long periods or may be unable to walk without fatigue. Activities requiring running and jumping must be modified. Team and individual sports activities are beneficial for the pupil with clubfoot, but they have to be adapted to prevent the deleterious effects of extensive running, jumping, and kicking.

Therapeutic Treatment. Exercise cannot be considered a means for correct­ing a clubfoot. However, a graded program should be given to the pupil that will maintain or improve muscle tone, ambulation, body mechanics, posture and physical and motor fitness.

Дата добавления: 2015-11-16