Inherited disorders

Friedreich’s ataxia

This is hereditary autosomal recessive. The child presents in early childhood with both a motor and a sensory loss pre­senting as clumsiness and difficulty walking. From an orthopaedic point of view the main problem is a cavovarus deformity of the foot, which in the young child can be corrected with soft-tissue release but in the older adolescent may require a wedge osteotomy.

Duchenne muscular dystrophy

This is cross-link recessive and again presents in early childhood with difficulty walking and classically with difficulty rising from a sitting position and climbing stairs. There are high levels of serum creatinine kinase and the muscle biopsy is diagnostic. In their early teens patients are wheelchair bound and they normally die in their early twenties. The main input from orthopaedics is correction of scoliosis to improve breathing.

Multiple sclerosis

This is a patchy demyelination of the central nervous system which develops later in life. The patient develops spasticity in the lower limbs with gross deformities. Splintage should avoid these causing too much trouble but tenomities are frequently required round the hip and knee to help the patient to sit.