Bone & Joint Disorders in Children

Bone and joint disorders in children often show up in quiet ways. A pediatrician notices a click in a newborn’s hip, a grandparent points out that a toddler’s legs look curved, or a parent sees one shoulder sitting higher than the other at the pool. Usually, there is no fall or sports injury, which can make it hard to know whether the change is normal growth or something that needs care.

Our pediatric orthopedic team in Gilbert evaluates these developmental, congenital, and growth-related conditions every day, from infancy through the teen years. This page explains how pediatric bone and joint disorders are grouped, the conditions we see most often, which changes are typically normal, which signs need prompt attention, and how we match treatment to a growing child.

What Makes Pediatric Bone and Joint Disorders Different

Adult orthopedic problems usually involve wear, injury, or arthritis in a skeleton that has stopped growing. In children, the skeleton is still being built. Bones lengthen, joints take their final shape, and the spine and legs gradually settle into adult alignment over the first two decades of life. A condition that affects this process can have effects that build over time, and growth itself can either help correct a problem or make it worse.

That dynamic shapes nearly every decision we make. A mild curve in a 2-year-old’s legs may be watched because growth is expected to straighten it, while a similar curve in a 7-year-old may need closer attention. A hip that is slightly shallow at birth can often be guided into a normal shape with a soft brace in the first months, but the same problem found at age 3 is far more involved to correct. Timing, age, and remaining growth are central to pediatric orthopedics in a way they are not for adults.

Most of the conditions on this page fall into one of four groups:

• Congenital conditions are present at birth, such as clubfoot and many cases of hip dysplasia.
• Developmental conditions appear or change as a child grows, such as Perthes disease, Blount’s disease, and idiopathic scoliosis.
• Normal variations look unusual but are expected stages of growth, such as toddler bowlegs, flexible flatfoot, and most in-toeing.
• Infectious and inflammatory conditions involve swelling, infection, or irritation of a bone or joint, such as septic arthritis and transient synovitis.

Hip Conditions

The hip is a ball-and-socket joint, and in children both the ball and the socket are still forming. Hip conditions in kids tend to follow clear age patterns, which is one of the first clues we use when a child has hip pain or a limp. Hip problems can also cause pain in the thigh or knee instead of the hip itself, so a limp with knee pain and a normal knee exam still warrants a look at the hip.

Developmental Dysplasia of the Hip (DDH)

In developmental dysplasia of the hip, the socket is too shallow or the ball is loose within it. According to the American Academy of Orthopaedic Surgeons, true hip dislocation occurs in roughly 1 to 2 of every 1,000 births, while milder looseness is more common. Risk is higher for firstborn babies, girls, babies born in the breech position, and those with a family history of DDH. Tight swaddling with the legs held straight can also contribute. When caught in the first months, most cases are treated with a soft harness that holds the hips in a healthy position while the socket deepens. Our hip dysplasia page explains newborn screening, ultrasound, and harness care.

Transient Synovitis

Transient synovitis is temporary inflammation of the hip joint lining and one of the most common causes of sudden hip pain and limping in children between about 3 and 8 years old. It often follows a cold or other viral illness. The condition typically improves within one to two weeks with rest and anti-inflammatory medication. The key concern is telling it apart from a hip joint infection, which looks similar at first but is an emergency. Our transient synovitis page covers how we make that distinction.

Legg-Calve-Perthes Disease

Perthes disease occurs when the blood supply to the hip ball is temporarily interrupted. The bone softens, may lose some of its round shape, and then gradually regrows over months to years. It usually affects children between 4 and 10 years old and is several times more common in boys. Early signs include a limp and pain in the groin, thigh, or knee. Treatment aims to keep the ball well positioned in the socket while it heals so the hip remains as round as possible. Our Perthes disease page describes the stages of the condition and what families can expect.

Slipped Capital Femoral Epiphysis (SCFE)

In SCFE, the ball at the top of the thighbone slips backward on the growth plate. It is the most common hip disorder in adolescents, usually appearing between about 10 and 16 years old, often during a growth spurt. Higher body weight and certain hormone conditions increase the risk, and SCFE can affect both hips. A teen with SCFE may limp, walk with the foot turned outward, or complain only of knee pain. Doctors treat SCFE with surgery to stabilize the hip and prevent further slipping, so a prompt diagnosis matters. Our SCFE page explains warning signs and treatment.

Leg Alignment and Walking Concerns

Questions about how a child walks are among the most common reasons for a referral to our office. The reassuring news is that many of these concerns are normal stages of development. The chart below shows how leg alignment typically changes during early childhood.

Most babies are born bowlegged, straighten out around age 2, become knock-kneed between about 3 and 4, and settle into adult alignment by about age 7. A child who follows this pattern, with both legs looking the same, usually needs nothing more than reassurance. A child whose curve falls outside this pattern, worsens, or is uneven between the legs needs an evaluation.

Bowlegs, Knock Knees, and Blount’s Disease

Bowlegs that persist past age 2 or 3, are severe, or affect only one leg can point to Blount’s disease, a growth disorder of the inner part of the shinbone growth plate. Blount’s disease is more common in children who walk early and in children with higher body weight. It tends to worsen without treatment, and options range from bracing in young children to guided growth procedures and surgery in older ones. Our Blount’s disease page explains how we tell it apart from normal bowing.

In-Toeing and Out-Toeing

In-toeing, sometimes called pigeon toes, is very common in toddlers and young children. It can come from a curve in the foot, a twist in the shinbone, or a twist in the thighbone, and the cause tends to change with age. Most cases improve on their own as children grow, and special shoes, braces, and exercises have not been shown to speed that process. We evaluate in-toeing that is severe, affects only one side, causes frequent falls, or does not improve by around age 8. Our in-toeing and out-toeing page covers each cause in detail.

Toe Walking

Many toddlers walk on their toes while learning to walk, and most outgrow it by about age 2 or 3. When toe walking continues past that age, the cause is often idiopathic, meaning no underlying problem is found, but it can also be related to a tight Achilles tendon or, less often, a neurological or developmental condition. Treatment may include stretching, serial casting, or bracing, and occasionally surgery to lengthen the tendon. Our toe walking page describes when to seek an evaluation.

Limb Length Discrepancy

Small differences in leg length are common and usually cause no problems. A larger difference can lead to a limp, back or hip discomfort, or an uneven gait. Leg length differences can result from a prior growth plate injury, an infection, a congenital condition, or uneven growth with no clear cause. We measure the difference and estimate how it will change with remaining growth, then match treatment to the projected difference, from a simple shoe lift to procedures that slow growth in the longer leg, or in severe cases, lengthening the shorter leg. Our limb length discrepancy page explains how those predictions are made.

Foot Conditions

Clubfoot

Clubfoot is a congenital condition in which a baby’s foot turns inward and downward. It occurs in about 1 of every 1,000 births and affects both feet in roughly half of cases. Clubfoot is sometimes seen on a prenatal ultrasound, which gives families time to plan. Today, most clubfeet are corrected without major surgery using the Ponseti method, a series of gentle stretches and weekly casts that begins in the first weeks of life, often followed by a minor tendon release procedure and a period of bracing. Our clubfoot page walks families through each stage.

Flat feet

Nearly all babies and toddlers appear flatfooted, and the arch develops gradually through early childhood. Flexible flatfoot, where the arch appears when a child stands on tiptoe or sits, is a normal variation that usually causes no pain and needs no treatment. Flat feet that are stiff, painful, or affect only one foot can signal a tarsal coalition, an abnormal bridge between foot bones that often becomes noticeable in the preteen years. Our flatfeet in children page explains the difference and when inserts or other treatment may help.

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Spine Conditions

Scoliosis

Scoliosis is a sideways curve of the spine, often with some rotation. The most common form, adolescent idiopathic scoliosis, has no known cause and affects about 2 to 3 percent of adolescents, typically appearing between ages 10 and 18. Signs include uneven shoulders, a protruding shoulder blade, an uneven waist, or one side of the back sitting higher when a child bends forward. We monitor small curves with periodic X-rays, often treat moderate curves in growing children with a brace, and may recommend surgery for large or progressive curves. Our scoliosis page covers screening, bracing, and monitoring.

Bone Cysts and Benign Bone Growths

Children sometimes develop noncancerous bone lesions that are found by chance on an X-ray or after a minor fall causes an unexpected break. A unicameral bone cyst is a fluid-filled cavity, most often in the upper arm or thighbone, that can weaken the bone. An osteochondroma is a bony bump that grows near a growth plate and may be felt under the skin. Many of these lesions need only monitoring, while others are treated to strengthen the bone and prevent repeat fractures. Our bone cysts and benign tumors page explains how we evaluate each type. When a lesion causes a break, we manage the fracture through our fracture care service.

Infections and Inflammatory Joint Conditions

A bone or joint infection is one of the few true orthopedic emergencies in children. Septic arthritis is an infection inside a joint, most often the hip or knee, and osteomyelitis is an infection of the bone. Both can develop quickly and may cause fever, severe pain, refusal to walk or move a limb, and swelling or redness. Prompt diagnosis and treatment protect the joint and the growth plate from lasting damage. If your child has a fever with joint pain or suddenly will not bear weight, go to the emergency room.

Ongoing joint swelling and stiffness that lasts for weeks, especially in the morning, can signal juvenile idiopathic arthritis. We evaluate these symptoms and work closely with pediatric rheumatologists when long-term inflammatory care is needed.

Ages are typical, not absolute. Sources: AAOS OrthoInfo and POSNA OrthoKids condition overviews.

Signs That Need a Pediatric Orthopedic Evaluation

Plenty of the differences parents notice are part of normal growth. These signs, however, are worth having checked by a specialist:

• A limp with no known injury, or a limp that lasts more than a few days
• Hip, thigh, or knee pain in a child who has not been hurt
• A hip click, uneven thigh or buttock creases, or one leg that looks shorter in a baby
• Bowing or knock knees that are severe, worsening, or different between the two legs
• In-toeing or toe walking that continues beyond the expected age
• A stiff or painful flatfoot, or a foot that is turned inward at birth
• Uneven shoulders, shoulder blades, or waistline
• A firm bump on a bone, or a bone that breaks after only a minor fall
• Joint swelling or morning stiffness that lasts more than a few weeks

Go to the emergency room if your child has a fever along with joint or bone pain, refuses to walk or move an arm or leg, or has a joint that is hot, red, and very painful.

How We Evaluate and Treat Bone and Joint Disorders

Every evaluation begins with your child’s story: when you first noticed the change, whether it is getting better or worse, birth history, developmental milestones, family history, and any recent illness. For babies, details such as breech position or being a firstborn can be important. We then examine how your child stands, walks, and moves, compare both sides of the body, and check flexibility, strength, and alignment.

We choose imaging to fit the child’s age and the question being asked. Ultrasound is often best for a young baby’s hips because the bones have not yet hardened. X-rays show alignment, bone shape, growth plates, and spine curves in older children. We use MRI or other tests when we need a closer look at cartilage, blood supply, or a possible infection.

Treatment follows the guiding principle of pediatric orthopedics: do the safest treatment that is needed, at the right time. For conditions expected to correct with growth, that may mean scheduled check-ins to confirm things are on track. When treatment is needed, options include harnesses and braces, casting, physical therapy, shoe lifts, guided growth procedures that use a child’s own growth to correct alignment, and realignment surgery when other approaches will not provide a durable result.

Watching Growth Over Time

Many bone and joint disorders are managed over months or years rather than in a single visit, because growth continues to shape the result. A baby treated for hip dysplasia is typically followed into the walking years to confirm the hip is developing normally. A child with Perthes disease is monitored as the ball of the hip regrows. We check a teen with scoliosis periodically until the spine finishes growing. These visits let us confirm that progress is on track and adjust the plan early if it is not. We keep your pediatrician informed so your child’s care stays coordinated.

Frequently Asked Questions About Pediatric Bone and Joint Disorders