OKOJ, Volume 7, No. 3

Drop foot refers to a flaccid, paralytic condition involving the muscles of the anterior compartment of the leg, which results in difficulty lifting the front part of the foot. The deformity may be caused by any lesion affecting lower motor neuron innervation to the tibialis anterior muscle or by direct injuries to the musculotendinous unit of tibialis anterior. Initial diagnosis of drop foot often is made during routine physical examination. During the swing phase of gait, patients with dorsiflexion weakness may either scrape their toe or compensate for their drop foot with increased knee and hip flexion to allow the foot to clear the ground (steppage gait). For neurologic drop foot, numbness and tingling in the lower leg, particularly on the top of the foot and ankle also can be present. Treatment of drop foot is based on the underlying disorder. For example, if drop foot is caused by a lumbar radiculopathy, treatment may involve decompression of the L4 nerve root. However, if the drop foot is caused by a nerve injury, internal neurolysis, partial neurorrhaphy, complete neurorrhaphy with suture, or autogenous nerve grafting (often with the sural nerve) can be performed. The choice of technique depends on the individual clinical scenario. For drop foot secondary to musculotendinous injury, tendon transfer surgery is frequently used to restore ankle dorsiflexion.

Fractures of the proximal humerus in childhood are relatively uncommon injuries, accounting for less than 5% of all pediatric fractures. Most are Salter-Harris type I or II injuries. The combination of extensive mobility at the glenohumeral joint and the significant contribution of the proximal physis to overall humeral growth allow these injuries to be treated nonsurgically in most cases. The goal of treatment is to provide stabilization to the fracture and to comfort to the child while healing occurs. There are some limited indications for surgical intervention in the proximal humerus, which are discussed.

Scoliosis is a multiplanar spinal deformity characterized by a lateral curvature in the coronal plane, lordosis in the sagittal plane, and rotational abnormality in the axial plane. The deformity may present in pediatric patients of any age and is typically classified according to age of onset as infantile (<3 years of age), juvenile (3 to 10 years of age), or adolescent (>10 years of age). A two-part classification has been proposed that divides the population into two sets: early onset (<5 years of age) and late onset (>5 years of age) scoliosis. Although this two-part classification is simpler and likely more clinically relevant, the three-part classification is used in this review given its prevalence in the available scoliosis literature. The critical components of the evaluation of the patient with idiopathic scoliosis are discussed, and the current understanding of the etiology and pathophysiology of the disease are reviewed. The central components of the history, physical examination, and radiographic evaluation of the patient with idiopathic scoliosis are also detailed.