Identifying babies who are most at risk can be as simple as asking parents “Does your baby have a preferred head position while lying down?”  If the answer is yes, then it can be a sign of CMT.  Infants with clinical flattening, who are younger than 4 months, parents may opt to treat their baby with a molding helmet.

BRACHYCEPHALY:  This occurs when the back of the head is flattened, producing a wider portion of the skull in the back than the front.  This can be caused by craniosynostosis, a rare closure of the skull sutures before a baby has fully developed.

SCAPHOCEPHALY:  This is a condition in which the middle sutures of the skull are closed.  This causes a high midline of the skull and the brain grows upward.  The brain grows from back to front, producing an elongated head that could require a helmet for correction.

Find out about the reasons why foot orthotics can be beneficial.

Corns, like calluses, develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas.  They contain a cone-shaped core with a point that can press on a nerve below, causing pain.  A corn is a very common ailment that usually forms on the top, side or tip of the toes.  Corns can become inflamed due to constant friction and pressure from footwear.  Corns that form between the toes are sometimes referred to as soft corns. 

“How did I get them?”

Some of the common causes of corn development are tight fitting footwear, tight fitting stockings and socks, deformed toes, or the foot sliding forward in a shoe that fits too loosely.  Soft corns result from bony prominences and are located between the toes.  They become soft due to perspiration in the forefoot area.  Complications that can arise from corns include bursitis and the development of an ulcer.

“What can I doto relieve them?”

There are very simple ways to prevent and treat the corns.  You should wear properly fitted footwear with extra room in the toe box (toe area).  Avoid shoes that are too tight or too loose.  Use an orthotic or shoe insert made with materials that will absorb shock and shear forces.  Also avoid tight socks and stockings to provide a healthier environment for the foot.

Try to steer away from corn removing solutions and medicated pads.  These solutions can sometimes increase irritation and discomfort.  Diabetics and all other individuals with poor circulation should never use chemical agents to remove corns.

If the problem persists, consult your foot doctor.

Tel: (516) 256-9306
Fax: (718) 865-0895
Email: ortho4kids@yahoo.com

Website: www.kidisplint.com

Blog: www.kidisplints.com

Brooklyn & Long Island

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Brooklyn, NY 11218

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Brooklyn, NY 11205

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Brooklyn, NY 11213

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Call for appointment and address

How to prevent it:

Make sure your baby has plenty of “tummy time.”  Even though she should be put to sleep on her back, put her on her stomach or upright in an infant play area, like an Exer-saucer, when eating and playing. 

What to look for:

*Baby faces same exact way when he sleeps

*Flat spots – even minimal ones – in the back or side of the head

*Slight bulges in the forehead

*Ears not even

What to do if your baby’s head looks misshapen:

*Don’t panic – most cases are easily treatable

*Make an appointment with a pediatrician and explain your concerns

*Get your baby fitted for a helmet

Follow through is essential for optimal results:

 *Your baby should wear the helmet 23 hours a day (it should be removed for bathing)

*The helmet should be refitted as your baby grows, approximately every 7-14 days

For more information, contact Kidi Splints at (516) 256-9306

Rochelle B. Silberman, Orthotist

Congenital muscular torticollis or Sternomastoid torticollis is a condition that occurs at birth or up to 2 months of age, where the child’s head is tilted to one side. The layman’s term for this condition is wry-neck.

What causes congenital muscular torticollis?

It is traditionally thought to be due to trauma at birth that causes bleeding in the muscles of the neck, usually the Sternomastoid muscle. The hematoma (blood clot) within the muscle scars down over time, causing the muscle to shorten, thus pulling the head to the typical tilted position. Sometimes, there is an associated mass that can be seen or felt within the Sternomastoid muscle, and usually thought to be a hematoma that is in the process of forming scar tissue. This mass usually disappears by 3 months of age.

More recently, it has been postulated that the sternomastoid muscle shortens as a result of scarring due to an intrauterine vascular disturbance. However, the most common incidence is thought to be due to intrauterine position of the head causing fibrosis or shortening of the muscle (common with babies having higher birth weight).

What are the symptoms?

The condition does not cause pain, but it becomes apparent to the observant mother, as the child persists in holding the head in the tilted position. The right side is involved in 75% of cases, and the child holds his head tilted to the right, with his face and chin rotated to the left. This occurs within the first 2 months of life, and may or may not be associated with a sternomastoid mass. This mass, however, tends to resolve spontaneously after about 3 months.

If uncorrected, as the child grows, the face on the side affected may stay “flattened”, so that facial asymmetry is common. This is reversible if the torticollis is corrected before age 1. Beyond that, some facial asymmetry may remain permanent.

What does your doctor do about it?

After a thorough history and examination, your doctor should be able to tell if the torticollis is muscular. There are other causes of torticollis. If the torticollis is due to vertebral abnomalities like atlanto-axial subluxation or hemivertebra, the deformity is quite rigid, and resists any attempt at correcting it passively. Muscular torticollis, even in the more severe cases, can be corrected passively to some extent. In cases where the torticollis is due to spinal cord abnormalities, there are usually other symptoms or signs that suggest the underlying problem. In these cases, X-rays or even MRI exams may be required.

Note: There is a 20% incidence of hip dysplasia in children with muscular torticollis. So it is important that your doctor does an ultrasound exam of the hips in the first 4 to 6 weeks of life to rule that out.

The mainstay of treatment is stretching exercises to stretch the contracted sternomastoid muscle 15 to 20 times, 4 to 6 times a day.  Additionally, it is highly advisable to seek out the expertise of a pediatric physical therapist that specializes in torticollis.

In a child with right torticollis, the head is tilted to the right and the face is rotated to the left. You will want to tilt his head to the left (left ear towards left shoulder), and rotate his face to the right (chin to right shoulder).

In a child with left torticollis, the head is tilted to the left and the face is rotated to the right. You will want to tilt his head to the right (right ear towards right shoulder), and rotate his face to the left (chin to left shoulder).

If you have help with the exercises, your assistant can stabilize the shoulders while you do the stretching exercises with the child lying on his back. Doing these exercises at each diaper change is a great way to start.

Exercise should be consistent, and generally continued till the child is one year of age. Your doctor or therapist will advise you as to the frequency and duration of the exercises.

What can be expected of the future?

When discovered early, and stretching exercises and positioning followed consistently, 80% recover completely with no long-term effects. In some cases that do not respond to exercises by age 1, surgical release of the sternomastoid muscle may be required.

NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. Neither the author nor the publisher will be responsible for any harm or injury resulting from interpretations of the materials in this article.

also potentially three separate orthotic modifications! The primary misunderstanding stems from the fact that two esteemed doctors applied their names to unique foot pathologies.

Morton’s Neuroma

Thomas G. Morton studied neuralgia of the forefoot, and bequeathed his name to the entrapment neuropathy of interdigital nerves. Morton’s neuroma is a painful condition that occurs most frequently at the distal end of the third intermetatarsal space, but it can be also found in the other interspaces. The entrapped and damaged nerve causes aching and burning of the forefoot. The symptoms of Morton’s neuroma are aggravated by wearing shoes that are too tight or narrow in the forefoot.

The most conservative treatment is to apply a metatarsal pad beneath the affected webspace. By supporting the transverse arch and spreading the metatarsal heads, the pinching on the nerve will be reduced. Alternatively providing a drop or relief under the met head may be sufficient to reduce the pressure. Torpedo-shaped “Neuroma Plugs” are also sometimes used, but their placement needs to be very accurate in order to get results.

It is important that the patient wear wider shoes if a met pad or foot orthotic is provided; otherwise, the pain will only worsen as you have added bulk to an already tight fit. Other medical treatments include local injection of sclerosing solutions or surgical excision of the neoplasm.

Morton’s Syndrome

Meanwhile another physician was busy inspecting short first toes. Dudley Morton lent his name to Morton’s syndrome. This is characterized by a short first metatarsal bone causing excessive weight to be borne by the second metatarsal head. It is usually a hereditary condition and will result in callus formation under the second and third metatarsals. Pain and tenderness are usually felt at the base of the first two metatarsal bones and at the head of the second.

Conservative treatment of Morton’s syndrome consists of building a flexible platform under the first met and toe. By bringing the ground up to the first met and toe, it is assuming extra weight, and thereby relieving the second met. This addition of material to the distal end of a foot orthotic is called a flexible Morton’s extension. It can be made out of cork, EVA, or other suitable materials, and is usually 1/8″ to 1/4″ thick

Morton’s Extension

The goal of a flexible Morton’s extension, as discussed above, is to increase the range of motion (ROM) and weight bearing along the first metatarsophalangeal joint (MPJ) and hallux. However, there are other conditions that require decreasing the ROM at the first MPJ.

Hallux limitus and hallux rigidus occur due to the inflexibility of the first MPJ. The great toe is unable to dorsiflex, which may cause pain and will interfere with toe-off during gait. Patients will often shift weight to the outer border of the foot in order to prevent motion in the big toe. There are several techniques available to limit ROM in the forefoot. A rigid Morton’s extension is a foot orthotic where the rigid orthotic material extends under the first to the distal tip of the hallux. It is usually made out of a rigid thermoplastic or carbon graphite material.

This device may impede the gait cycle, and if the extension is not fully rigid, it may even exacerbate the condition! If the goal is to decrease ROM, then it is preferable to either add a sole stiffener to the shoe, or place a full-length carbon footplate under the insole of the shoe. Full-length footplates have the added advantage of being transferable between shoes. In addition, putting a rocker sole or rocker bar on the shoe will help reduce flexion.

A more conservative approach is to create a reversed Morton’s extension, which will also help decrease ROM along the first. A reversed Morton’s is a channel that allows the first MPJ and hallux to “float” while transferring weight laterally to the second, third, and fourth mets. Typically, this is an accommodative-type orthotic. It will also include a sesamoid pad (a broad met pad with a deep drop for the first met head). Other conditions such as turf toe and sesamoiditis will benefit from this style of device.

Séamus Kennedy, BEng (Mech), CPed, is president and co-owner of Hersco Orthotic Labs, New York City, New York.