Orthopedic Alterations Research Articles

Onychomycosis in Foot and Toe Malformations.

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

The Diagnostic Capacity of Physical Examinations in Diagnosing Musculoskeletal Disorders of the Lower Limbs in Children with Down Syndrome.

Background and Objectives: although musculoskeletal alterations are common in patients with Down syndrome (DS), studies investigating this association are scarce, and proposals for diagnostic standardization are limited. We aimed to evaluate the prevalence of musculoskeletal disorders in the lower limbs in a sample of children and adolescents with DS and to investigate the diagnostic capacity of orthopedic clinical examinations performed by orthopedists and pediatricians to diagnose these alterations. Materials and Methods: Twenty-two patients aged between three and ten years with DS were included. Patients and guardians answered a simple questionnaire regarding orthopedic complaints and underwent a systematic orthopedic physical examination, performed twice: once by an orthopedist and again by a pediatrician. Patients underwent a series of radiographs to diagnose anisomelia, hip dysplasia, epiphysiolysis, flatfoot valgus, mechanical axis varus, and mechanical axis valgus. The radiological diagnosis was considered the gold standard, and the diagnostic capacity of the physical examination performed by each physician was determined. Results: The median age was 6.50 years. Only four patients (18.2%) presented with orthopedic complaints. All patients were diagnosed with at least one musculoskeletal disorder. The only musculoskeletal disorder with a good diagnostic capacity was flatfoot valgus. Limited sensitivity values were found for hip dysplasia, mechanical axis varus, and mechanical axis valgus. The agreement between the orthopedic physical examinations performed by the two examiners was weak, poor, or indeterminate for most of the analyzed items. Conclusions: There was a high prevalence of orthopedic alterations in children with DS who did not present with musculoskeletal complaints. The diagnostic capacity of the physical examination was limited. Therefore, all children with DS should undergo a radiological evaluation of the musculoskeletal system and subsequent specialized orthopedic evaluation. Level of Evidence: Level II (Diagnostic Studies).

Orthopedic abnormalities in patients presenting with Congenital Zika syndrome: an analysis of 157 patients

Purpose: The study aimed to describe the characteristics of orthopedic examination in patients with microcephaly associated with congenital infection by the Zika virus, the epidemiological profile, the characteristics of orthopedic disorders, and their relationship to pregnancy. Methodology: We reviewed 157 medical records of infants with microcephaly treated at AACD / PE. All the patients had positive serology for Zika vírus infection, and those with positive serology for another condition or incomplete records data were excluded. Physical exam findings were divided into primary and secondary orthopedics abnormalities and were analyzed by the prevalence. Hypothesis testing for proportions was utilized to verify possible associations between the time of infection (before or after the first trimester) and the presence or absence of musculoskeletal abnormalities present at birth. Results: After reviewing patient data, we found a prevalence of abnormal orthopedic findings in 66,88%. The lower limbs were the most commonly affected area. We also found an abnormally high incidence of arthrogryposis and developmental hip dysplasia, which was the most prevalent one. Most patients presented with more than one deformity. We also found that the association between the time of infection at an early gestational age and the presence of orthopedic deformities was statistically significant. Conclusion: The present research described the main orthopedic alterations found in the physical exam of newborns with microcephaly associated with congenital infection by the Zika Virus, giving special attention to alterations in the lower limbs, and in line with other congenital infections, the gestational period that has the greatest potential to cause changes in the normal development of the child is the first trimester

The use of serial casting in the treatment of children with cerebral palsy: a study protocol

Introduction: Cerebral Palsy (CP) is characterized by a disorder of posture and movement, commonly leading to disabling orthopedic alterations, including muscle shortening, especially in the lower limbs. Stretching methods, performed gradually, are necessary to delay the impairment in function from muscle shortening. The use of serial casting aims to promote proper alignment, and an ideal and stable support base, in addition to better bone and joint health, leading to better posture, mobility, muscle function, and, subsequently, increased fitness and health. Objective: evaluate range of motion, postural control, and motor performance in children with CP, using serial casting, as well as to measure its effect on fitness through the autonomic nervous system (ANS). Methods: Sixty children and adolescents with CP, of both sexes, 3 to 12 years of age, will be divided into three groups: Groups A, B, and C, with 20 individuals each. Group A will use serial casting, Group B will use the orthosis continuously (with removal only allowed for bathing), and Group C will use the orthosis in their daily routine. Range of motion of the ankle of first and second resistance levels (R1 and R2), gross motor function measure (GMFM), and balance (measured by BERG scale) will be used in the initial and final assessments, and after 6 months and one year of follow-up. Timed-up-and-go (TUG), load distribution (baropodometry), motor performance measured through a real basketball game and the virtual MoveHero game, analysis of body angulation with “mydartfish”, and cardiac autonomic modulation through heart rate variability will be assessed in three different situations: barefoot, with orthosis, and with casting. Conclusion: Serial casting demonstrates the potential to produce positive results in the treatment of individuals with CP regarding better alignment, with consequent motor and autonomic improvement.

Biometric alterations in thoracic limbs of vaquejada horses

This study aimed to determine the frequency of biometric alterations in thoracic limbs of vaquejada horses. A sample of 1,270 horses of either sex and different age groups competing in vaquejada as either puxador (leading) or esteira (trailing) roles were used. Measurements were made of body length, thoracic circumference, and circumferences of the forearm, knee, cannon, fetlock, and pastern of the right- and left-side thoracic limbs. Asymmetry in the five regions of thoracic limbs was also determined by calculating the difference between the right- and left-side circumferences of each region. Physical examination was conducted in 598 horses by palpating the knee, cannon, fetlock, and pastern to identify possible orthopedic alterations. The results of the differences between the circumferences of thoracic limbs of either side were submitted to Kruskal-Wallis test and the prevalence of orthopedic alterations was compared by frequency distribution test. Asymmetry was observed between the right- and left-side thoracic limbs in 99.3% of horses, especially in the forearm. Of the 598 horses examined via palpation, 481 individuals (80.4%) exhibited orthopedic alterations in at least one of the four regions examined, with the highest prevalence of alterations in the cannon and fetlock. In addition, the proportions of individuals with orthopedic alterations increased linearly with age, while higher values in the conformation and dactyl-thoracic indices also resulted in higher prevalence of alterations. It was concluded that the frequency of biometric alterations in thoracic limbs of vaquejada horses is high.

Fuzzy Cognitive Map to Classify Plantar Foot Alterations

The function of the back, hip, knee, ankle and other orthopedic alterations of the human body can be analyzed through plantar pressure distribution. The development of Clinical Decision Support Systems (CDSS) can handle the uncertainties present in biological data using different Artificial Intelligence techniques to obtain accurate and easy-to-use systems. This paper presents the application of a Fuzzy Cognitive Map (FCM) formulation, for knowledge extraction in the classification of human plantar foot alterations, with a relatively small and transparent model. The FCM is trained using the Bacterial Search Optimization Algorithm (BFOA). One hundred and twenty-five volunteer subjects (aged 20-68 years) participated in the study. Classification of the foot into normal (n=31), flat (n=32), cavus type III (n=31) and cavus type IV (n=31) to train the system was performed by specialized physicians. The test was performed by walking on a FreeMed platform. The proposed method shows an accuracy rate of about 89% in the classification task and allows extracting information related to the important factors that the system considers to make a decision.

PREVALENCE OF CLINICAL MANIFESTATIONS AND ORTHOPEDIC ALTERATIONS IN PATIENTS WITH LIPEDEMA: A PROSPECTIVE COHORT STUDY

Lipedema is a chronic disease seen frequently in women that causes abnormal fat deposition in the lower limbs and associated bruising and pain. Despite increasing knowledge concerning lipedema, there are still aspects of diagnosis that need further investigation. We performed a prospective, observational cohort study to describe prevalence of clinical characteristics present in patients with lipedema in an attempt to establish diagnostic criteria. Participants were consecutive patients with lipedema presenting at a public hospital in Spain from September 2012 to December 2019. Patients were examined for the following signs and symptoms of lipedema: symmetrical involvement; disproportion between the upper and lower part of the body; sparing of the feet; pain; bruising; Stemmer' sign; pitting test; fibrosis; venous insufficiency; upper limbs involvement; vascular spiders; skin coldness; and lymphangitis attacks. In addition, orthopedic alterations were examined in all patients. We recruited 138 patients (median age=47.6 years; mean BMI=29.9 Kg/m2). Using waist-to-height-ratio, 41.3% of the patients were slim or healthy. The most frequent type of lipedema was Type III (71%), and most were in stage 1 and 2. The features of lipedema with a prevalence >80% were symmetrical involvement, unaffected feet, pain, bruising, vascular spiders, and disproportion. Pain was nociceptive in 60.2% and neuropathic in 33.1%, and there was a reduced social or working activities in 37.9%. Orthopedic alterations including cavusfeet or valgus-knees were observed in 1/3 of the patients. X-ray of the knees was performed in 63 patients and knee osteoarthritis diagnosed in 37. We found that the most frequent manifestations of lipedema were bilateral involvement, unaffected feet, pain, easy bruising, vascular spiders, and disproportion between the upper and lower parts of the body. These should be considered as major criteria for diagnosis. In addition, our findings on the prevalence of orthopedic alterations in patients with lipedema highlights the need for a multidisciplinary and integrated approach.

Foot rotation asymmetry in Down syndrome and the relationship with crawling and walking onset: a cross sectional study

Introduction: Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry. Objective: The aim of this study was to analyze the relationship between this asymmetry and the previous acquisition of hands-and-knees crawling in Down syndrome children, as well as the probable association of this gait to gender, ethnicity, comorbidities, physiotherapy, and occupational therapy interventions. Methods: In this cross-sectional study, 361 children with or without foot rotation asymmetry were selected. An online questionnaire was administered to the parents or guardians of those children. Results: Hands-and-knees crawling decreased the prevalence of foot rotation asymmetry in Down syndrome children. The longer it took for walking onset, the higher the prevalence of this asymmetry. Indeed, for each month of delay there was a 7% increase in prevalence. There was a significant relationship between orthopedic alterations in knees or flat feet and foot rotation asymmetry. There was no significance related to gender, ethnicity, other comorbidities, physiotherapy or occupational therapy interventions. Conclusion: The findings in this study revealed that foot rotation asymmetry may be related to the acquisition of the motor skills described above, especially with regards to hands-and-knees crawling and walking onset.

Percentiles and Reference Values for Accelerometric Gait Assessment in Women Aged 50–80 Years

Background: The identification of factors that alter postural stability is fundamental in the design of interventions to maintain independence and mobility. This is especially important for women because of their longer life expectancy and higher incidence of falls than in men. We constructed the percentile box charts and determined the values of reference for the accelerometric assessment of the gait in women. Methods: We used a cross-sectional study with 1096 healthy adult women, who were asked to walk a distance of 20 m three times. Results: In all of the variables, a reduction in the magnitude of accelerations was detected as the age of the group advanced. The box charts show the amplitude of the interquartile ranges, which increases as the age of the participants advances. In addition, the interquartile ranges were greater in the variables that refer to the maximum values of the accelerations. Conclusions: The values obtained can be used to assess changes in gait due to aging, trauma and orthopaedic alterations that may alter postural stability and neurodegenerative processes that increase the risk of falling.

1674. Orthopedic Complications of Congenital Zika Syndrome in Brazil

BackgroundCongenital Zika Syndrome (CZS) has a broad spectrum of clinical presentations that are still being described. This cohort study aimed to describe the orthopedic complications in children with microcephaly (MCP) related to Zika virus (ZIKV).MethodsWe evaluated 36 children with CZS up to 17 months of age followed at a pediatric rehabilitation center in the northeast of Brazil. Cohort enrollment occurred with children born between January 2015 and May 2016. We assessed their social profiles and orthopedic findings.ResultsOf the 36 cases, 25 were male. All of them lived in rural area. 25 had at least one congenital orthopedic alteration. Hip subluxation was the most common problem detected (n = 15); other lower limb abnormalities included knee subluxation (n = 7), clubfoot (n = 7); congenital vertical talus (n = 4); plano-valgus foot (n = 5). In relation to the upper limbs, 11 children presented with some shoulder and/or elbow abnormality and 16 had some alteration in the hand and/or on the wrist.ConclusionOrthopedic problems appear to be common in children with CZS and should be a focus of larger clinical studies. An initial orthopedic assessment may provide a better quality of life by helping children avoid further complications/deformities. Our results emphasize the orthopedic problems associated with CZS and the need to better describe many complications in the natural history of this infection.Disclosures All authors: No reported disclosures.

60. The role of neurophysiology in the diagnosis of incorrect foot support in childhood: Who hides a neurological disease?

The “orthopedic alteration” of foot in the child may underlie neurological disorders that may be underestimated. The aim of this study is to demonstrate the important role of neurophysiological tests for the identification of the source on the pathological foot support incorrect in children. We studied 71 subjects (33 females) with incorrect foot support with a defined neurophysiological protocol that includes the ENG (at least 3 nerves), EMG and Muscular Ultrasound (at least two muscles) studies; Motor Evoked Potentials (from Tibialis Anterior muscles) and Somatosensory Evoked Potentials (from Tibialis posterior nerves). Of the 71 patients 31 subjects showed equinus foot, 16 prone foot, 13 pes cavus, 4 spurious valgus, 3 clubfoot, 21 had not specific incorrect support. Neurophysiological tests have identified a neurological cause in about a third of patients (35%). Of this 35%: 48% had a hereditary neuropathy, 28% mono-multi-neuropathy, 8% myopathy, 8% cerebral palsy, 8% being defined. An appropriate neurophysiological protocol, largely executable by technical trained staff, allows the identification of neuro-muscular disorders underlying the incorrect foot support in children. This recognition enables a targeted treatment for these specific changes, assuming a close collaboration between orthopedic and neurologist.

A double-blind, randomized, comparative study of the use of a combination of uridine triphosphate trisodium, cytidine monophosphate disodium, and hydroxocobalamin, versus isolated treatment with hydroxocobalamin, in patients presenting with compressive neuralgias.

ContextThis paper reports on the results of treatment of compressive neuralgia using a combination of nucleotides (uridine triphosphate trisodium [UTP] and cytidine monophosphate disodium [CMP]) and vitamin B12.ObjectivesTo assess the safety and efficacy of the combination of nucleotides (UTP and CMP) and vitamin B12 in patients presenting with neuralgia arising from neural compression associated with degenerative orthopedic alterations and trauma, and to compare these effects with isolated administration of vitamin B12.MethodsA randomized, double-blind, controlled trial, consisting of a 30-day oral treatment period: Group A (n=200) receiving nucleotides + vitamin B12, and Group B (n=200) receiving vitamin B12 alone. The primary study endpoint was the percentage of subjects presenting pain visual analog scale (VAS) scores ≤20 at end of study treatment period. Secondary study endpoints included the percentage of subjects presenting improvement ≥5 points on the patient functionality questionnaire (PFQ); percentage of subjects presenting pain reduction (reduction in VAS scores at study end in relation to pretreatment); and number of subjects presenting adverse events.ResultsThe results of this study showed a more expressive improvement in efficacy evaluations among subjects treated with the combination of nucleotides + vitamin B12, with a statistically significant superiority of the combination in pain reduction (evidenced by VAS scores). There were adverse events in both treatment groups, but these were transitory and no severe adverse event was recorded during the study period. Safety parameters were maintained throughout the study in both treatment groups.ConclusionThe combination of uridine, cytidine, and vitamin B12 was safe and effective in the treatment of neuralgias arising from neural compression associated with degenerative orthopedic alterations and trauma.

No. 49 Correlation of Obesity and Orthopedic Alterations in Children of a Rural Community

PM&RVolume 6, Issue 8S2 p. S93-S93 Oral Presentation No. 49 Correlation of Obesity and Orthopedic Alterations in Children of a Rural Community Nayar Alejandro Durán Hernández, Nayar Alejandro Durán HernándezSearch for more papers by this authorSofía Durán Hernández, Sofía Durán HernándezSearch for more papers by this authorManuel Castillejos López, Manuel Castillejos LópezSearch for more papers by this author Nayar Alejandro Durán Hernández, Nayar Alejandro Durán HernándezSearch for more papers by this authorSofía Durán Hernández, Sofía Durán HernándezSearch for more papers by this authorManuel Castillejos López, Manuel Castillejos LópezSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.320Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S93-S93 RelatedInformation

Modified bluegrass appliance: a nonpunitive therapy for thumb sucking in pediatric patients-a case report with review of the literature.

Oral habits in form of digit/thumb sucking are common phenomenon and part of childhood behavior. They are normally associated with oral pleasure, hunger, anxiety, and sometimes psychological disturbances. Chronic practice can cause major orthopedic alterations to the skeletal structures of the oral cavity and lower face. Aversive approaches in form of punitive therapy have been moderately effective. Modified bluegrass appliance is nonpunitive therapy to treat sucking habits. It acts as a habit reversal technique and installs positive reinforcement in children. Modified blue grass appliance proved to be very comfortable to patients and encourages neuromuscular stimulations.

Reeducação Postural Global: uma revisão da literatura

The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

Alterações ortopédicas em crianças e adolescentes obesos

INTRODUÇÃO: A obesidade infanto-juvenil é um problema muito frequente e implica complicações que podem estar presentes precocemente, como as alterações ortopédicas. OBJETIVO: descrever as alterações que atingem o aparelho locomotor em crianças e adolescentes com sobrepeso e obesidade. METODOLOGIA: Foram consultadas as bases de dados MEDLINE, SciELO, LILACS, ISI e base de dados da Universidade de Standford, com a combinação dos seguintes descritores: "obesidade", "complicações", "criança", "dores músculo-esqueléticas", "postura", "alterações ortopédicas", "marcha" e seus respectivos sinônimos em inglês. RESULTADOS: Pôde-se observar que as crianças e adolescentes obesos são mais predispostos a apresentar essas complicações ortopédicas que os indivíduos eutróficos, e os principais problemas relatados foram as alterações posturais, como hiperlordose lombar e joelhos valgos, e dores músculo-esqueléticas, principalmente na coluna lombar e membros inferiores. Os principais fatores que causam esses problemas não são bem definidos, mas incluem aumento da sobrecarga articular associado à fragilidade óssea em fase de crescimento e à diminuição da estabilidade postural, o que conduz ao aumento das necessidades mecânicas regionais. CONCLUSÃO: A identificação precoce dessas disfunções é fundamental para que essas crianças recebam tratamento multidisciplinar adequado.

Diabetic neuropathy and orthopedic foot alteration: which is the most influencing factor in peak plantar pressure?

Diabetic neuropathy and orthopedic foot alteration: which is the most influencing factor in peak plantar pressure?

Early detection of podiatric anomalies in children with Down syndrome

Abstract Aims: To verify the importance of podiatric evaluation in patients with Down syndrome for the early diagnosis and treatment of minor orthopaedic problems. Methods: Case‐control study of 50 children affected by Down syndrome (aged 4–10 y) without major orthopaedic malformations compared to 100 healthy children. A complete podiatric examination was performed on all patients and controls. Results: Children with Down syndrome showed several orthopaedic anomalies including bony deformity of the forefoot (90%), flat foot (60%), isolated calcaneal valgus (24%), knee valgus (22%) and pronated flat foot (16%). These abnormalities were responsible for postural alterations as confirmed by baropodometric examination. Conclusion: The data demonstrated a greater incidence of minor orthopaedic alterations and suggest the necessity of regular podiatric examinations in the follow‐up of this syndrome.

Early detection of podiatric anomalies in children with Down syndrome

To verify the importance of podiatric evaluation in patients with Down syndrome for the early diagnosis and treatment of minor orthopaedic problems. Case-control study of 50 children affected by Down syndrome (aged 4-10 y) without major orthopaedic malformations compared to 100 healthy children. A complete podiatric examination was performed on all patients and controls. Children with Down syndrome showed several orthopaedic anomalies including bony deformity of the forefoot (90%), flat foot (60%), isolated calcaneal valgus (24%), knee valgus (22%) and pronated flat foot (16%). These abnormalities were responsible for postural alterations as confirmed by baropodometric examination. The data demonstrated a greater incidence of minor orthopaedic alterations and suggest the necessity of regular podiatric examinations in the follow-up of this syndrome.

Orofacial myofunctional disorders in children with asymmetry of the posture and locomotion apparatus

352 children radiologically identified with asymmetry in the occipito-cervical region were assessed on a number of myofunctional measures. In all children an orthopedic examination was conducted including a functional test of the upper cervical spine and the iliac joint, the postural test by Matthiass, as well as gait analysis. During a second examination the orofacial myofunctional status was recorded. In general, about 70% of the children revealed orofacial myofunctional disorders. Correlational analysis was conducted in order to determine whether specific myofunctional variables were associated with postural and orthopedic alterations. A weak body posture correlated statistically significantly with all assessed myofunctional variables. On the other hand, all orthopedic items correlated significantly with a reclined head position. A blockade of the iliac spine correlated significantly with persistent habits, articulation disorders and tongue dysfunction, whereas functional asymmetry of the upper cervical spine correlated significantly with incompetent lips. A finding of at least five statistically significant correlations within each orofacial variable underlined the complex symptomatology of myofunctional disorders, so that consideration needs to be given to adequate treatment approaches. The data generated by the present study stress the importance of early interdisciplinary screening in children to ensure a physiological development of the orofacial region and the still growing vertebral column. To help understand the complexity of symptoms influencing orofacial development, an explanatory model of the “interactive functional box system” is given.