The vast majoriry of orthopedic problems in childhood are seen in the lower extremities: the feet, legs, knees and hips. When one considers the vast changes that a small body must make as it grows from its cramped in utero position through crawling to walking, it is not surprising to find problems in the lower extremities. The orthopedic condition routinely evaluated for at birth is "congenital hip," where the head of the femur (upper leg bone) cannot seat itself in the too shallow depression present in the ilium (hip bone). Though it must be treated with bracing, osteopathic treatment helps to normalize the joint functions which were inevitably disturbed by the bracing. Osteopathic manipulative treatment, which looks to improve body function through addressing body structure, assists in the resolution of many common orthopedic conditions of childhood.

Tibial torsion, the outward bowing of the lower leg, is caused by the cramped folding of the baby's legs in utero, and often resolves spontaneously in the first year of life. However, if the torsion is accompanied by a distortion between the knee cap and the tibial bone, or between the tibia and the nearby fibula, these should be treated osteopathically, preferably before the baby begins to walk. When babies first stand, they often place their feet far apart for stability, thereby standing on the inside edges of their feet. If the stance remains wide beyond the first few months of walking, osteopathic treatment is recommended. Falling down hard on one's bottom is another normal component of learning to stand but is hard on the relationship between the sacrum (at the base of the spine) and the vertebrae of the lower back. This common insult, left untreated, is probably one of the underlying causes of low back pain suffered by adults.

Between l0 and 14 months of age, most children begin to walk. As more balance is gained, the distance between the feet should become the same as the distance between the hips, and the feet should point straight forward when the child stands, walks or runs. If this normalization of postural stance is not gained spontaneously, osteopathic evaluation and treatment should be pursued. The causes may be found in disturbed relationships of the bones of the pelvis or legs or in abnormal tensions of the connective tissues or muscles. Correcting these osteopathically early in life will foster healthy structural growth throughout childhood and adolescence. Although standard medical counsel advises waiting, with an expectation that gait abnormalities will resolve themselves, we all have seen school children and adults plagued with gait problems and the frequently associated back pain.

Do not be alarmed by "flat feet" in your toddler, since the instep is slow to develop. One should not be alarmed either by the development of "knock knees" in a three-year-old whose knees looked normal prior to this time. As the child develops arches and the bones change with growth, the knee alignment will, in most cases, become normal by age five. Osteopathic treatment addressing the alignment of the bones of the ankle and foot and knee can help in correcting both of these clinical problems at an appropriate time. Sometimes home-based exercises, sturdy shoes with arch supports or custom made orthotics are needed.

Many children in this age group are stretching their limits in gross motor skills. To jump from locations too high for the size of the child may result in compression of one or both ankle joints. If the child lands harder on one foot than the other, this can create a hip height discrepancy. This discrepancy is usually easy to correct with osteopathic treatment, but, if left uncorrected, can be a factor in the development of childhood and adolescent scoliosis and low back pain.

Sports injuries are the cause of the vast majority of structural problems in this age group. Though they may not result in "skeletal deformity" (the common definition of an orthopedic problem), they are worthy osteopathic consideration. Children are a physically active lot, and unless there are good reasons why not, they should be encouraged and enabled to engage in the physical challenges that interest them. But they and their parents must be prepared to accept the periodic injuries that accompany physical activity. Knee injuries are common in basketball due to the necessity of rotating one's body over a foot planted on the court. Running sports, such as track and soccer, are ideally done only by children whose hip, knee and ankle line up vertically. Poor alignment fosters more frequent and more severe injuries. All activities played with balls involve the risk of impact from the ball, the most serious location being the head. The intentional "headers" of soccer are less damaging to the normal motion mechanics of skull joints than are accidental impacts. Football, gymnastics and snow or ice-based sports are fraught with potential injury. Osteopathic treatment to release the sprains, strains and bony misalignments as they occur is good insurance toward a healthy and pain-free adulthood.

Some skeletal problems of childhood affecting the hips and/or knees, such as slipped epiphysis, Perthes' disease, Osgood Schlatter disease and synovitis, require cessation of sports activities for variable periods of time. Though they each have their appropriate orthopedic treatment, the recovery of full and pain-free joint function can be aided by osteopathic treatment, both during and after the disease process.

Scoliotic curves of the spine are most commonly, though not exclusively, seen in girls between the ages of 10 and 14. The curves vary widely in their severity. The more severe fixed curves require bracing or surgical treatment. In scoliosis, the vertebrae are both sidebent and rotated. Ribs are displaced, and muscle groups are stretched or shortened. There is often a hip height discrepancy. Although discomfort is rare during adolescence, both pain and disability are likely to be experienced later in life if left untreated. Osteopathic manipulative treatment can be beneficial for both the more mild functional curves and for curves requiring more invasive measures. Osteopathic treatment can improve both spinal mobility and degree of curve.

A Doctor of Osteopathy (DO) is a fully licensed physician whose training includes, beyond the normal medical curriculum, extensive training in manual manipulation as a treatment to improve body function through addressing body structure. Although many osteopathic physicians are in family practice or providing specialty care, some have chosen to focus their practices on the hands-on approach which makes osteopathy unique. Of these, some have pursued additional training in cranial osteopathy, which is essential in the osteopathic treatment of children.