Orthopedic conditions can cause pain and dysfunction, causing aches and pains in bones and joints. Mobility and activity may be limited by these conditions.
Polly Wimer, CPNP, APRN discusses common orthopedic conditions and their treatment.
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Common Orthopedic Conditions and How to Treat Them
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Polly Wimer, CPNP, APRN
Polly Wimer received her NNP from St. Luke’s/Children's Mercy, she helped begin NICU coverage at St. Joseph Hospital, St. Luke's South and Shawnee Mission. She then pursued her MSN through UMKC and worked as a primary care PNP a year later she decided she wanted more of a challenge. In 1999, Polly joined the Orthopedic Surgery team at Children's Mercy as a pediatric nurse practitioner. Dale Jarka, MD has been Polly's mentor for the last 20+ years, working hand-in-hand with Dr. Jarka is where she gained a majority of her expertise in Orthopedic conditions and treatment. Polly was able to start the first independent advanced practice screening and fracture clinic over 15 years ago. She is a great resource to the department as well as families. Having a strong working relationship with the orthopedic surgeons, Polly can refer a patient if she knows they need surgery or require more complex treatment. Currently, she is focused on caring for patients with non-surgical pediatric orthopedic diagnosis, non-operative fractures and fractures requiring reduction and casting. She provides her services in scheduled Clinic and in the ED at Children’s Mercy Kansas Hospital. In her spare time she teaches pediatric orthopedics to graduate NP students at UMKC and Research, as well as, speaking at conferences. Transcription:
Common Orthopedic Conditions and How to Treat Them
Dr. Michael Smith: Our topic today is common orthopedic conditions and how to treat them. My guest today is Polly Wimer. Polly is a pediatric nurse practitioner working with the orthopedic surgery team at Children’s Mercy. Polly and the other specialty trained, orthopedic specific APRNs see approximately 60-80 patients a week in clinic. Polly, welcome to the show.
Polly, Wimer, CPNP, APRN: Thanks for having me.
Dr. Smith: I find this topic to be very interesting and I just want to have you teach me and the audience. What's the first orthopedic condition you'd like to teach us about?
Polly: I’d like to talk about in-toeing because that’s my job and I've been doing it for 20 years and things have changed. Our parents used to think that we had to have special shoes and braces, but we've done a lot more studies now and found out that kids actually grow out of a lot of the alignment conditions that we see. The only thing that we actually treat with casting or bracing is club feet. We see kids of all ages from infants to 10 year old’s because parents are concerned about their feet turning in or out. There are common conditions like metatarsus adductus where their foot is curved and we only treat those now if it's severe, if it's not flexible. There's bowlegged, which is a normal phase that kids go through and there's some teaching that their legs should be straight by the time their two, but it's actually more like three. They then go through a phase from three to five to where they have knock knees, and then by the ages of six to eight, they should have their normal adult gait.
Dr. Smith: Help me to understand a little bit. As a primary care physician or as a general pediatrician working in the community, when they see this type of presentation, what's your advice to them? Are there things they can do right there in the office to help the parents feel better? What do you think?
Polly: It's mostly reassurance and educating the parents about what's normal and usually there are some relatives or sometimes grandparents that are actually more concerned than the parents. It's just educating them that the kids are actually going to grow out of it on their own. A red flag or a condition that we would want you to refer to us is if there's asymmetry because as they grow, they should be symmetrical, but if there's asymmetry in one foot or one leg that's different than the other leg, that would be something that you would want to refer to our clinics.
Dr. Smith: When you see something like that in the community, what does that usually mean when there's asymmetry?
Polly: There are conditions that can be caused by birth injuries or Blount’s disease, which is a pathologic type of bowlegs but it’s really rare. There's usually family history in the patients of other family members that had to have surgery on their legs if it’s caused by Blount's disease, but it shows us as asymmetry.
Dr. Smith: You’ve been working with Children’s Mercy for many years now working with the orthopedic surgery team. In your experience, what are some of the common conditions that you see? What are some of those things that we’re learning new things about and new treatments? Tell us a little bit more about your overall experience in the clinic you work in.
Polly: Our job is just to screen patients to see if they have a more complicated condition that might need to be treated by a surgeon. Even kids that have in-toeing that are older because they're turning in is actually coming from their hip. That’s what we used to treat with braces and bowlegs, but then we did studies and found out we had kids that did braces and kids that weren't in braces and over time we found out they were both getting better on their own, so the braces weren't even helping. That's when we stopped treating kids with braces or bowlegs and in-toeing. Kids that have flat feet, we see a lot of kids because parents are concerned, but if the kids are going to develop an arch in their foot, they do it in the first decade of their life. One of the newer things is that shoe inserts and special shoes don't have any effect on the development of the foot. Sometimes we see parents that think their child needs a shoe insert so they won't have flat feet, but the shoe inserts don't change the structural development of their foot, so we don't recommend that. The only time we recommend a shoe insert is if when kids are older, if they're having foot pain, a shoe insert can sometimes help with that.
Dr. Smith: How many patients do you see in your clinic every week?
Polly: We see fractures too in our clinics, so we have about 50% screening patients and 50% fractures.
Dr. Smith: When you're looking at the screening of patients, how many of them actually go on to needing surgery?
Polly: Maybe 3-5%. Not necessarily surgery, but maybe serial casting or things like that.
Dr. Smith: What else would you like to teach us about? I know you have vast experience, so we’ve talked a little bit about the bowlegs, but is there anything else, any other common condition that you'd like to teach us about?
Polly: One of the other things that go a long way is in-towing or femoral anteversion. Kids will sit in the W position and parents are always taught to not let their kids sit like that, but actually, sitting in the W position is comfortable for the kids and it doesn't make the in-toeing worse. It doesn't affect their hips, but what I teach is to have the kids sit both ways so that they learn to sit criss cross, but they can sit in the W position so it doesn't turn into a struggle with their parents. By the time they're school age, they know they're still flexible and they can sit both ways. That’s something that’s out on the Internet that W sitting is harmful to kids, but it’s not really.
Dr. Smith: Are there any other myths like that that are floating around that parents believe you see on the Internet you have to correct?
Polly: Kids don’t need special shoes or high-top shoes or just to protect their feet. It doesn't affect the way they walk. Actually, learning to walk barefoot has more benefits for kids than wearing shoes, that’s another common thing that we hear from parents that they have questions about.
Dr. Smith: Just to summarize all this, I know you work at a very busy orthopedic surgery clinical at Children’s Mercy, you have vast experience, I’d like to end just by asking what is it you want people and general practitioners to know about common orthopedic conditions?
Polly: In-toeing and bowlegs are normal conditions of childhood that don't need to be treated with bracing or surgery, but we're always happy to see kids just to help reassure parents so parents can sleep at night and know they didn't need to have special shoes or braces on their child as they grow and go through their normal developmental stages.
Dr. Smith: I want to thank you for the work that you do at Children’s Mercy and definitely thank you for coming on the show today. You're listening to Transformational Pediatrics with Children’s Mercy – Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I'm Dr.
Common Orthopedic Conditions and How to Treat Them
Dr. Michael Smith: Our topic today is common orthopedic conditions and how to treat them. My guest today is Polly Wimer. Polly is a pediatric nurse practitioner working with the orthopedic surgery team at Children’s Mercy. Polly and the other specialty trained, orthopedic specific APRNs see approximately 60-80 patients a week in clinic. Polly, welcome to the show.
Polly, Wimer, CPNP, APRN: Thanks for having me.
Dr. Smith: I find this topic to be very interesting and I just want to have you teach me and the audience. What's the first orthopedic condition you'd like to teach us about?
Polly: I’d like to talk about in-toeing because that’s my job and I've been doing it for 20 years and things have changed. Our parents used to think that we had to have special shoes and braces, but we've done a lot more studies now and found out that kids actually grow out of a lot of the alignment conditions that we see. The only thing that we actually treat with casting or bracing is club feet. We see kids of all ages from infants to 10 year old’s because parents are concerned about their feet turning in or out. There are common conditions like metatarsus adductus where their foot is curved and we only treat those now if it's severe, if it's not flexible. There's bowlegged, which is a normal phase that kids go through and there's some teaching that their legs should be straight by the time their two, but it's actually more like three. They then go through a phase from three to five to where they have knock knees, and then by the ages of six to eight, they should have their normal adult gait.
Dr. Smith: Help me to understand a little bit. As a primary care physician or as a general pediatrician working in the community, when they see this type of presentation, what's your advice to them? Are there things they can do right there in the office to help the parents feel better? What do you think?
Polly: It's mostly reassurance and educating the parents about what's normal and usually there are some relatives or sometimes grandparents that are actually more concerned than the parents. It's just educating them that the kids are actually going to grow out of it on their own. A red flag or a condition that we would want you to refer to us is if there's asymmetry because as they grow, they should be symmetrical, but if there's asymmetry in one foot or one leg that's different than the other leg, that would be something that you would want to refer to our clinics.
Dr. Smith: When you see something like that in the community, what does that usually mean when there's asymmetry?
Polly: There are conditions that can be caused by birth injuries or Blount’s disease, which is a pathologic type of bowlegs but it’s really rare. There's usually family history in the patients of other family members that had to have surgery on their legs if it’s caused by Blount's disease, but it shows us as asymmetry.
Dr. Smith: You’ve been working with Children’s Mercy for many years now working with the orthopedic surgery team. In your experience, what are some of the common conditions that you see? What are some of those things that we’re learning new things about and new treatments? Tell us a little bit more about your overall experience in the clinic you work in.
Polly: Our job is just to screen patients to see if they have a more complicated condition that might need to be treated by a surgeon. Even kids that have in-toeing that are older because they're turning in is actually coming from their hip. That’s what we used to treat with braces and bowlegs, but then we did studies and found out we had kids that did braces and kids that weren't in braces and over time we found out they were both getting better on their own, so the braces weren't even helping. That's when we stopped treating kids with braces or bowlegs and in-toeing. Kids that have flat feet, we see a lot of kids because parents are concerned, but if the kids are going to develop an arch in their foot, they do it in the first decade of their life. One of the newer things is that shoe inserts and special shoes don't have any effect on the development of the foot. Sometimes we see parents that think their child needs a shoe insert so they won't have flat feet, but the shoe inserts don't change the structural development of their foot, so we don't recommend that. The only time we recommend a shoe insert is if when kids are older, if they're having foot pain, a shoe insert can sometimes help with that.
Dr. Smith: How many patients do you see in your clinic every week?
Polly: We see fractures too in our clinics, so we have about 50% screening patients and 50% fractures.
Dr. Smith: When you're looking at the screening of patients, how many of them actually go on to needing surgery?
Polly: Maybe 3-5%. Not necessarily surgery, but maybe serial casting or things like that.
Dr. Smith: What else would you like to teach us about? I know you have vast experience, so we’ve talked a little bit about the bowlegs, but is there anything else, any other common condition that you'd like to teach us about?
Polly: One of the other things that go a long way is in-towing or femoral anteversion. Kids will sit in the W position and parents are always taught to not let their kids sit like that, but actually, sitting in the W position is comfortable for the kids and it doesn't make the in-toeing worse. It doesn't affect their hips, but what I teach is to have the kids sit both ways so that they learn to sit criss cross, but they can sit in the W position so it doesn't turn into a struggle with their parents. By the time they're school age, they know they're still flexible and they can sit both ways. That’s something that’s out on the Internet that W sitting is harmful to kids, but it’s not really.
Dr. Smith: Are there any other myths like that that are floating around that parents believe you see on the Internet you have to correct?
Polly: Kids don’t need special shoes or high-top shoes or just to protect their feet. It doesn't affect the way they walk. Actually, learning to walk barefoot has more benefits for kids than wearing shoes, that’s another common thing that we hear from parents that they have questions about.
Dr. Smith: Just to summarize all this, I know you work at a very busy orthopedic surgery clinical at Children’s Mercy, you have vast experience, I’d like to end just by asking what is it you want people and general practitioners to know about common orthopedic conditions?
Polly: In-toeing and bowlegs are normal conditions of childhood that don't need to be treated with bracing or surgery, but we're always happy to see kids just to help reassure parents so parents can sleep at night and know they didn't need to have special shoes or braces on their child as they grow and go through their normal developmental stages.
Dr. Smith: I want to thank you for the work that you do at Children’s Mercy and definitely thank you for coming on the show today. You're listening to Transformational Pediatrics with Children’s Mercy – Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I'm Dr.