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Does your child complain of heel pain during or after activity? – TSRHC Sports Medicine

Growth plates in children’s bones are at risk of injuries because they are relatively weak and, in many cases, have ligaments or tendons attached nearby. Though some growth plates make bones grow longer, others give the bones unique shapes allowing them to do their jobs.

SAR_1032In the heel, the big tendon from the calf muscle, called the Achilles tendon, attaches to the back of the heel onto the calcaneus bone. In very young children, the bone is not yet grown, so the tendon is actually held onto the foot by the cartilage in the growth plate. Eventually, the bone grows, the growth plate closes, and there is a solid connection for the tendon.

Many children naturally become more involved in sports around 8-12 years old. When a young athlete runs or jumps, the Achilles tendon pulls repeatedly on the cartilage in the heel, causing it to become sore. For patients like Amelia, this can be painful. The impact on the ground with running and jumping can also cause this area to be irritated. Pain and inflammation in the growth plate of the heel is known as Sever’s Disease or calcaneal apophysitis. Symptoms may come and go for 1-2 years while a young athlete is growing quickly in the heel bone.

Shane M. Miller, M.D., tells us that it is safe to play sports as long as the athlete is not limping or complaining of significant pain, and that symptoms should improve with rest and ice, which allows these tissues to recover from the injury. Changing shoes or adding cushioned heel cups may be recommended. Other treatments are available and should be considered on an individual basis.

Here are some situations that increase a child’s risk of Sever’s Disease:

  • Year-round sports participation
  • Sudden increase in training intensity
  • Tournaments and summer camps
  • Running and jumping excessively
  • Sports that involve wearing cleats (such as baseball or soccer)
  • Going barefoot, or participating in barefoot sports (such as gymnastics)

For information about overuse injuries and pediatric sports medicine, please visit our website at scottishritehospital.org/sports.

May: Stephen’s Moment to Shine


Meet Analia, age 6, of Carrollton, and Volunteer Executive Committee President Stephen Apple. In his words below:

My Defining Moment:

As a Scottish Rite Mason, I knew about TSRHC. I took a tour – that did it/ I wanted to be a volunteer.

My Moment to Remember:

I saw a little girl with prosthetic legs running around in the hospital’s atrium and it reminded me…we help kids be kids.

My Moment to Shine:

At TSRHC, I’m never bored. I’m engaged. I truly feel my contributions can make a difference.

Volunteer and Give a Patient like Analia a Moment to Shine – Share a shining moment with TSRHC patients, families and supporters as a hospital volunteer. To learn more about becoming a volunteer, please visit scottishritehospital.org/volunteer.

Exploring Innovations in Imaging

TSRHC is only the fourth hospital in Texas to employ an advanced imaging technology called EOS®, to be used in specific patient cases. The system produces long length images of the spine and lower extremities with significantly less radiation than is normally required using other imaging tools. There is also the additional capability of creating 3-D images of the bony skeleton that can provide our surgeons a more complete review of a patient’s anatomy for treatment planning.

Medical Update_EOSEOS has the unique ability to simultaneously generate two views of the entire spine or lower extremities in approximately 10 to 15 seconds. Today, the most common alternative method of digital X-ray requires at least 30 minutes. This added efficiency provides a better experience to patients and their families.

The system captures weight-bearing 3-D images in the upright or squatting positions that are 1:1, meaning there are no areas of the scan that are distorted or magnified. By using these images, Scottish Rite Hospital surgeons can more accurately understand the unique aspects of a patient’s skeletal deformity and better prepare for surgery.

In addition, unique EOS software created specifically for pediatric patients, called MicroDose, exposes the patient to six to eight times less radiation than traditional X-ray equipment.

EOS imaging is based in Paris, with a U.S. subsidiary in Cambridge, Mass. The hospital’s radiology team is working closely with medical physicists to examine and maximize the potential capabilities and efficiencies of this groundbreaking technology.


**This article was featured in the 2016 Volume 1 Rite Up Magazine, view the e-mag version online.

Scottish Rite Hospital Physicians Leaders at Orthopaedic Society Annual Meeting

Physicians and other medical staff from Texas Scottish Rite Hospital for Children are major participants in this week’s 32nd annual meeting of the Pediatric Orthopaedic Society of North America, including 19 podium presentations.

The meeting in Indianapolis, Ind., is being presided over by Dr. Lori Karol, assistant chief of staff at Scottish Rite Hospital and president of the Orthopaedic Society. Dr. Karol is the first female president of the organization.

Dr. John Birch, assistant chief of staff emeritus, delivered the opening keynote speech Wednesday, a historical review of lower extremity deformity correction. On Thursday, the hospital’s Dr. Lawson A. Copley delivered the results of research made possible by his 2014 Arthur Huene Memorial Research Award.

The meeting gathers orthopedic surgeons and other medical personnel for four days of advanced training. The scientific program includes 171 paper presentations, 20 posters and 110 e-posters.

On Friday, six subspecialty sessions will cover medical issues in the areas of spine, sports, hip, neuromuscular/lower extremity, trauma and hand/upper extremity.

Other Scottish Rite Hospital orthopedic surgeons giving talks at the meeting include Dr. Karol, who is also medical director of the hospital’s Movement Science Laboratory and Performance Improvement; Chief of Staff Dr. Daniel J. Sucato; Chief Medical Officer Dr. B. Stephens Richards; Assistant Chief of Staff Emeritus Dr. Charles E. Johnston; Assistant Chief of Staff Dr. Karl E. Rathjen; Assistant Chief of Staff Dr. Philip L. Wilson, a sports medicine specialist; Director of Research Dr. Harry Kim; Medical Director of Ambulatory Care Dr. Brandon Ramo; and staff orthopedic surgeons Dr. Anthony I. Riccio and Dr. Lane Wimberly.

The presentations cover topics such as angular deformity corrections in athletes; treatment of early onset scoliosis; compartment syndrome; and electronic medical record applications in pediatric orthopedics.

Several former Scottish Rite Hospital fellows also are making presentations at the meeting.

Taking Care of Your Throwing Athlete – TSRHC Sports Medicine

PR14_03_MarchWe know that younger throwers have less problems, and that trouble for pitchers typically begins around the age of 12. At this time, young baseball players are becoming involved in more than one team, they are growing rapidly, and they are trying to throw faster and harder. Chuck Wyatt, R.N., C.P.N.P., says to support your young athlete in these ways:

  • Follow pitch count and rest guidelines.
    • Include fast or “hot” throws from other positions including middle infielders.
  • Consider working with a pitching coach. Some evidence shows that poor form may cause problems.
  • Learn proper shoulder strengthening and flexibility exercises.
  • Encourage him to speak up about symptoms.
  • Teach him not to throw when he is in pain.

For information about elbow injury prevention and elbow problems in the throwing athlete, please visit our website at scottishritehospital.org/sports.

We’re Hosting a Career Fair on Thursday, April 28

Working with a world leader in pediatric orthopedics is like no other job. You’ll be part of an organization consistently ranked among the top 10 pediatric orthopedic hospitals by U.S. News & World Report. You’ll join a team of caring, energetic people dedicated to providing the best possible care. Better yet, your role will contribute to our mission of giving children back their childhood. No wonder our employees stay with us so long. Want to be one of them?

Come to our Career Fair

Date: Thursday, April 28, 4 – 7p.m.
Location: Texas Scottish Rite Hospital for Children (2222 Welborn Street, Dallas, TX 75219)

Screen Shot 2016-04-13 at 2.24.50 PM


Explore PRN and FT positions for:

  • Pediatric R.N.
  • Physical Therapist
  • Occupational Therapist
  • Radiology Tech
  • Med Tech
  • Respiratory Therapist
  • Pharmacist
  • Pharmacy Tech

Not a Nurse or Allied Health Professional?

There a many other opportunities to join our team. We invite you to see all of our current openings on our website.

For questions, please contact our Human Resources department at 214-559-7590.

Getting back to sports after an ACL Reconstruction – TSRHC Sports Medicine

After an anterior cruciate ligament (ACL) tear, many young athletes choose to have surgery to replace the ACL. In very active kids, the knee is often unstable and at risk of injury without this important ligament. Returning to sports after this procedure takes time and a lot of work.

The post-surgery / “new” ACL, called a graft, needs time to be ready for certain activities. The length of time depends on several things including:


Because very young patients need a different surgery, they need more healing time. Read more about ACL reconstruction for athletes with open growth plates.

Early exercises focus on preventing swelling and stiffness. The graft can tolerate more and more stress over time. Throughout recovery an athlete is allowed to progress from simple exercises for the leg to complex movements that challenge the whole body. We refer to the later stage of rehabilitation as functional training.

The goals of this stage are often shaped by the patient’s sport-specific needs. Research has shown there are also some principles that apply to many athletes. The athlete’s ability to perform certain movements has been shown to help identify patients at risk of an ACL injury or re-injury. We use several different tests to help determine when a patient is ready to return to sports after an ACL reconstruction.

Philip Wilson, M.D., tells us that “as a practice, we are passionate about functional retraining as a means to avoid a second injury. Mounting research has shown that athletes in our pediatric and adolescent age groups are at an extremely high risk for injury to the surgical or opposite leg. Additional research has shown that increasing the time prior to return to sports, and demonstrating documented muscle strength and control are the best ways to avoid these new injuries.”

Because many sports require stability on a single leg in activities like running, pivoting, stopping, kicking, and throwing, the tests challenge athlete’s ability to stand on one leg. Additionally, these functional movements challenge the strength and flexibility throughout the body. A comprehensive rehabilitation program incorporates these concepts from the beginning:


For this, and many other injuries, surgery is only the first step on the road back to sports. An athlete must also be committed to the rehabilitation and functional training required to return to sports. We encourage athletes to use these concepts in their training programs before they sustain game-changing injuries.

For information about injury prevention and pediatric sports medicine, please visit our website at scottishritehospital.org/sports.

Landmark Study May Pave the Way for Personalized Treatment of Lupus and Other Complex Autoimmune Diseases

Dallas researcher, Virginia Pascual, MD, publishes new findings in prestigious Cell journal

DALLAS (March 31, 2016) – New research that may dramatically improve drug development for systemic lupus erythematosus patients will be published April 21 in Cell, the most prestigious scientific journal among biologists. The paper, “Personalized Immunomonitoring Uncovers Molecular Networks That Stratify Lupus Patients,” is authored by Dr. Virginia Pascual, principal investigator of the study and researcher at Baylor Institute for Immunology Research, part of Baylor Scott & White Research Institute.

“This achievement reflects Dr. Pascual’s commitment to excellence and to continuous improvement of quality care for patients with lupus,” said Donald Wesson, senior vice president of medical education and research for Baylor Scott & White Research Institute. “For many investigators, simply getting a publication in Cell is the highlight of their career, but for Dr. Pascual it’s another great honor in a career that has brought prestige to her work and to Baylor Scott & White Health.”

Lupus is a chronic disease that causes the body’s immune system to attack its own tissues, causing inflammation, pain and organ damage. It’s a complicated condition that’s difficult to diagnose – no single test can definitively detect it – and complex to treat since no two cases are alike. Clinical trials for effective drug treatments have had limited success. In this study, Dr. Pascual and her team aimed to understand the molecular diversity of the disease in an effort to make future drug development easier and more effective.

“The results included in this paper provide an explanation for why clinical trials fail in lupus, and opens the door for true personalized approaches to drug discovery and treatment in this disease,” Dr. Pascual said.

Researchers studied the transcription of genes in 924 blood samples from 158 pediatric lupus patients from Texas Scottish Rite Hospital for Children clinics and other children’s hospitals for up to four years. This personalized immunomonitoring approach, which measures gene expression activity of different cell types, allowed researchers to classify patients into seven groups with similar molecular disease structure at the time of both disease flares and remissions.

Dr. Marilynn Punaro, medical director of rheumatology at Scottish Rite Hospital, and members of her team are co-authors of the study, which may improve clinical trial design and implementation of tailored therapies in lupus and other genetically and clinically complex autoimmune diseases.

“This is a landmark study that has the potential to dramatically improve treatment and quality of life for the hundreds of thousands of people suffering with lupus,” Dr. Pascual said.

For more information on studies conducted at Baylor Scott & White Research Institute, visit www.BaylorHealth.com/AdvancingMedicine.

About Baylor Scott & White Health
Formed from the 2013 merger between Baylor Health Care System and Scott & White Healthcare, the system referred to as Baylor Scott & White Health is the largest not-for-profit health care system in the state of Texas. With total assets of $9 billion* and serving a population larger than the state of Georgia, Baylor Scott & White Health has the vision and resources to provide its patients continued quality care while creating a model system for a dramatically changing health care environment. The system now includes 48 hospitals, more than 900 access points, 6,000 active physicians, and 40,000 employees, plus the Scott & White Health Plan, Baylor Scott & White Research Institute and Baylor Scott & White Quality Alliance — a network of clinical providers and facilities focused on improving quality, managing the health of patient populations, and reducing the overall cost of care. For more information visit: BaylorScottandWhite.com

* based on unaudited 2015 fiscal year statements


For more information, view an article on Baylor’s website.

Playground Safety Tips from our Fracture Clinic Experts

Issac Martinez age 3 or Mesquite_04Free play and playground time is becoming more valuable to our over-scheduled children. We want to share some of our experience by giving you some suggestions to keep these moments as safe as possible. Our Fracture Clinic pediatric nurse practitioner, Ray Kleposki, tells us that young kids playing on equipment that is not designed with them in mind greatly increases risk for injuries, including broken bones.

Supervision is very important, but even well-meaning caregivers are not familiar with all the injury risks on a playground. The U.S. Consumer Products Safety Commission in their Public Playground Safety Handbook recommends appropriate equipment and practices for public playgrounds. Ray says to “start with choosing a playground that is right for your child’s age.”

Choose playgrounds that provide:

  • A separate play area for very young children.
  • Rubber or mulch type surfaces, not solid like asphalt or grass
  • Surfaces that extend well beyond the play are of each piece of equipment
  • Equipment in good repair.
  • Guardrails to prevent falls from heights greater than the child’s own height.

Screen Shot 2016-04-01 at 2.46.18 PMLessons to teach your child about playground safety:

  • Never push or rough-house.
  • Slide feet first and slide one-at-a-time.
  • Watch for friends before sliding or jumping.
  • Don’t climb outside of guardrails.
  • When jumping, land on both feet.
  • Don’t play on equipment when it is wet.
  • Follow instructions from supervisors.

With these tips and some common sense, playgrounds can be fun and safe. To learn more about our Fracture Clinics and experts at evaluating pediatric playground injuries, visit scottishritehospital.org/fracture.

April: Layla’s Moment to Shine


Meet Layla, age 16, of Dallas.

My Defining Moment:

I came because I had an extra bone in my ankle that was causing scar tissue buildup, swelling and inflammation.

My Moment to Remember:

I was invited to speak at the hospital’s KidSwing Golf Tournament, which was cool because I’ve never done that kind of thing.

My Moment to Shine:

I’ve performed in the Nutcracker with the Texas Ballet Theater for three years in a row. It’s a lot of fun!

Give a Patient like Layla a Moment to Shine: A gift of $300 will cover the cost of advanced imaging for an ankle problem or injury to plan for a minimally invasive arthroscopic treatment. To donate or learn more about TSRHC’s Center for Excellence in Sports Medicine, please visit scottishritehospital.org/sports.