Lower extremity physiological bony development and its clinical ramification in the pediatric and adult patient.

Course Outline:

The lower extremity of a child goes through bony ontogey changes through the first decade of life.  If these physiological developmental changes do not transpire during the first decade of life, will this predispose the adult to specific pathologies in their lower extremities?

There is scientific evidence to show that the lower extremity pathologies we see daily in our adult patients can stem from incomplete physiological bony ontogeny during childhood. For example, the literature states that patellofemoral issues can result from a lack of complete femoral torsional development. In addition to patellofemoral issues such as osteoarthritis (OA) and chondromalacia patella, some other common adult pathologies include but are not limited to hip osteoarthritis, hip labral tears, and adult acquired flatfoot. 

As such, the aim of this course is to help the manual practitioner :

(1) understand the physiological  progression of lower extremity bony ontogeny  especially in the first decade of life

(2) learn to assess whether the presenting pathology stems from lack of physiological bony ontogeny

 (3) Understand how bone concepts and bony ontogeny can be implemented into clinical practice for both the pediatric and adult population

Course goals:

•  Review the bony ontogeny of the lower extremity (i.e. femur, tibia, calcaneus, talus) and present what is “normal”(physiological)

• Learn to assess and differentiate between femoral and tibial torsions and femoral version and how these conditions can influence pathology in the adult population

• Learn  clinical assessment of the pediatric patient including  angular and rotational issues, gait development which will also benefit your specific/appropriate  assessment of the adult population

• Gain knowledge of how to assess the child as well as how to use these assessment tools when considering the adult pathologies of the lower extremity.

• Provide clinical assessment tools that will allow the practitioner to gain understanding of how to differentiate lower extremity conditions and be more specific in your treatments.

• Learn about different foot types and how to assess them  including their  biomechanical effects , and how they can contribute to pediatric and adult lower extremity pathologies

• Review various pediatric hip, knee, tibial, and foot conditions that can be precursors  to adult pathology and  eventually present themselves clinically  in the adult population 

• Learn manual therapeutic normalizations of the lower extremity bones that can be beneficial in your approach when treating both the pediatric  (with growth plates) or the adult population.

• Review clinical conditions acquired during childhood and its continuation into adulthood such as pediatric flatfoot and adult acquired flatfoot and developmental dysplasia of the hip (DDH) and its relationship to labral tears and OA of the hip