PFFD

Therapy

The treatment of PFFD is very complex. Depending on the difference in leg length, knee instability and hip mobility, it must be arranged in a completely individualized way. Concomitant anomalies must also be taken into account.

In early childhood, it should be attempted to achieve and preserve good mobility in hip, knee and ankle. In addition to physiotherapy, correcting casts can be put on in childhood, in order to hold a joint in flexion or extension - depending upon extent and kind of the malformation and the desired correction.

Approximately at the age of one year, the young patient can be supplied with an ortho-prosthesis, in order to learn how to walk at an age-appropriate time, despite the existing leg length discrepancy and the joint contractures in hip and knee.

At the same time, the possibility of later surgical treatment should be considered. If a femoral head is present and shows mobility, then there are surgical possibilities to correct the malposition. At the same time, a correction of the malformed acetabulum is possible. At a later time, the leg may be lengthened by means of an external ring fixator or a unilateral fixator.

This procedure may have to be repeated several times, depending on the difference in leg length. Also the knee instability should be addressed as early as possible, preferably still before the repeated lengthenings. If the femoral head is not mobile and leg lengthening is out of the question, the optimization of providing a prosthesis is at the centre of attention. This can be achieved by different methods. One possibility is to stop growth of the affected side, in order to have the foot at the level of the healthy knee. Another possibility is performing a rotationplasty. However, this may be psychologically disturbing both for the child and family members.

The newer surgical lengthening methods for this type of PFFD are already available, but long-term results are still missing.

Physiotherapy with PFFD

A generally applicable treatment schedule is not possible for PFFD. The manifestations of this malformation are too different. The support by an experienced and accordingly trained therapist is indispensable.  If physiotherapy is carried out inappropriately it can actually even be harmful.

Physiotherapy should be started already shortly after birth. Different treatment methods are available.

Manual therapy

Manual therapy (the Kaltenborn/Evijent or Maitland approach) is essential in order to maintain or improve the joint mobility in hip, knee and foot.

In the first months, it is recommended it to perform traction at the hip. At the knee, likewise traction, as well as - depending on the existing knee instability - sliding to ventral should be performed, in order to improve the extension.

If the foot is additionally affected by a fibular defect, the lateral instability should be treated as well. Here, traction of the calcaneus (heel) is recommended.

All techniques are to be supported by soft tissue techniques (hip stretching into extension, stretching the knee flexors and stretching the calf muscles, as well as the Achilles tendon).

Vojta therapy

The Vojta therapy is an excellent method to prevent damage to the spine by asymmetries and to optimally prepare the child's muscles for standing upright.

Due to unequal weight distribution (legs), kicking, crawling, being on all fours or standing and walking cause an asymmetrical stress to the spine and thus, lead to considerable problems and damage.   These secondary damages can already cause back pain and problems for the children at the age of 10-12 years.

In order to prevent this, the Vojta therapy should be performed by parents on their own and several times a day - after appropriate instruction by a therapist.

Bobath therapy

By this therapy form, the affected child obtains development-promoting and supportive assistance. This can be of advantage in particular with the first ortho-prosthesis. It should be noted that forcing physical strain before a possibly necessary hip surgery or in case of a child without an ortho-prosthesis is not appropriate. The hip situation does not permit this, and the axis of the leg is not sufficiently stabilized without orthosis. For this reason, the children come for the first treatment once they stand upright.

Physiotherapeutic treatment focuses on

In the first year of life until the first lengthening:

  • manual therapy to improve hip and knee mobility
  • in case of an additional fibular defect: Manual therapy to improve foot mobility
  • traction at hip and knee
  • translation of the knee (sliding to ventral) to improve knee extension (as agreed with the treating physician - knee instability)
  • soft tissue techniques for stretching the hip flexors and for improving hip extension, as well as stretching the knee flexors to improve of knee extension
  • preventing and improving an asymmetry of the spine
  • Vojta therapy
  • Development-supporting therapy after Bobath by assistance with the tasks of everyday life (e.g. playing with ortho-prosthesis, providing therapeutic appliances and much more)

Erfahrungsberichte