» Orthopaedics

Setting straight concerns on those issues

Orthopaedics is seldom addressed in the CdLS litrerature, and yet it is an area of extreme importance for the activities of daily living, writes Tonie Kline. I believe reviewing some orthopaedic concerns raised by families would compliment the issues discussed in Dr. Renshaw’s leading article as well as answer some additional questions.

It is not rare for children with CdLS to start walking in late childhood, even as late as 16 years. In his article, Dr. Renshaw discusses the basis for this delay in walking as well as the diagnosis and treatment of lower limb problems.


And, while many orthopaedic conditions are treated with medical and surgical remedies, various therapy techniques may be of benefit as well.

Both physical and occupational therapy may improve range of motion, coordination, balance and strength of the muscles of the extremities.

Physical therapy is important for many aspects of foot positioning. If the position of the foot is fixed in an unusual position, such as plantar-flexed (pointed), walking will likely be delayed until the feet are stable in a typical weight-bearing position.


Tight Achilles tendons (heel cords) are relatively common in CdLS and may affect an individual’s gait. With the lack of motion of the ankle, the forefoot may need to compensate with gait, thus further affecting position of the foot.

As mentioned on a previous page, a current CdLS-related clinical project involves studying the peripheral nervous system, or, the effects and reactions of the nerves as they reach the extremities and the skin.

A common finding that has been frequently noted in CdLS in changes in temperature (from warm to cold) and/or skin colouring (from red to blue) particularly on the feet, but also the hands.

This tends to recur similarly to Raynaud’s phenomenon. It may be extremely painful and has resulted in some individuals’ refusal to walk. There may be poor tolerance of shoes, although wearing socks may be welcomed and helpful.


Hips are another area of concern. Hips may migrate out of proper position over time (subluxation), particularly if the individual is nonambulatory. This migration of the hip can lead to dislocation. Unstable hips may also contribute to gait changes.

A popping or clicking noise could indicate instability. Surgery can be helpful for this and prevent recurrence. Avoiding internal rotation and hip flexion greater than 90 degrees will help stabilize the hips, as will exercises for stability, balance and trunk control. Physical therapists can provide standing balance exercises that are particularly helpful for unstable hips.