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Pediatric foot care

While the majority of children may not need a podiatrist while they’re young, some parents may have concerns about the way their children are walking or the way their feet or ankles are developing. Some of the conditions common to children like flat feet, pigeon toes, bowlegs, knock-knees, and toe walking will straighten out by themselves as time goes on. Other conditions will require the intervention of an experienced doctor who can help the parent and child develop a plan of treatment.

Dr. Kleis is a board-certified podiatrist with more than 25 years of experience treating adults and children with disorders of the feet. He works with parents and children to develop a personalized plan of treatment for conditions and disorders common to the feet and ankles. If you are concerned that your child may show signs of non-typical development in their feet or delays and abnormalities in their walking or running abilities, please schedule a consultation with Dr. Kleis by calling (714) 760-4944.

Foot Disorders Common to Children

Children develop at different rates and in different ways. Children sometimes just “grow out” of many developmental issues that arouse concern. However, others require intervention before they can be corrected. And, the earlier intervention is sought, the better the outcome often is. If parental instinct is leading you to be concerned for the way your child walks or runs, allow Dr. Kleis to perform a thorough evaluation. He can either allay your concerns or develop a plan of action that will give you direction, rather than worry.

Flat Feet

Chubby baby feet are naturally flat. Their arches have not developed, yet, and the extra padding of fat along the bottom of their feet often hides the arches as they first do begin to develop. When babies are born, and for the first few years of life, their bones are softer and much more flexible than they are as they grow older. This flexibility causes the bottoms of children’s feet to flatten out when they put weight on them, making them look flat even after arches have begun to develop.

Usually, flat feel will disappear by the time a child reaches six or seven years old. Their arches have developed and the chubbiness of infancy has started to disappear. By this age, only about 10 to 20 percent of children will still have flat feet. Parents may notice the flat feet because they believe the children have weak ankles, noticing that the feet turn in at the ankles because of the way the bottom of the feet touches the floor. The problem is a lack of arch, or flat feet, however, and not truly a weak ankle.

Of the 10 to 20 percent of children who have flat feet beyond six or seven years old, most will not require any type of intervention. If the child has difficulty walking and balancing, or if the foot is stiff or painful, then the parent should have a podiatrist take a look at the child’s feet.

Certain forms of flat feet will require treatment. A tight Achilles tendon may be causing the stiffness and pain, limiting the motion of the foot. Special exercises can stretch the Achilles tendon and often relieve the pain and stiffness.

In rare instances, a child may have a truly rigid flat foot. This is a condition that can cause serious problems. A child with a rigid flat foot will have difficulty moving the foot at the ankle, unable to make the foot move side to side or up and down. This condition is rarely seen in young children but may manifest itself in the teen years. A child struggling to move their foot through the normal range of motion should be evaluated by an experienced podiatrist, like Dr. Kleis.

Pigeon Toes

Many children have what is referred to as “pigeon toe,” meaning that they tend to point their toes inward, especially when walking. While this common condition can be concerning to parents, it does not often require medical intervention. Most children will grow out of their pigeon toes by the time they are 8 years old.

Potential Causes of Pigeon Toes

Pigeon toe develops in-utero and is thought to be genetic. However, three conditions could be the cause of pigeon toe in children. These potential causes are metatarsus varus or metatarsus adductus, internal tibial torsion, and femoral anteversion.

Femoral Anteversion

This is the most common cause of pigeon toe and occurs in as much as 10 percent of children. Femoral anteversion is a twisting of the upper leg inward, at the hip. While the cause is not certainly known, it is thought to perhaps occur due to pressure in the womb or trauma during birth. It may also be a natural genetic trait. Femoral anteversion may cause the child to be more “clumsy” than their peers, as the leg’s turning in causes a lack of balance when the child runs. An odd gait, or running with the legs swinging to the side, is another sign of femoral anteversion.

Most children will not require medical intervention for their femoral anteversion. More than 99% of children who experience this condition will outgrow it on their own. Parents who are concerned about their children’s development should seek the advice of a qualified pediatrician or podiatrist who can examine the child and determine the extent of the anteversion.

Internal Tibial Torsion

The tibia is the large, shin bone, in the lower leg. Similar to femoral anteversion, internal tibial torsion is a twisting of the lower part of the leg inward. The condition often affects both legs and is thought to occur because of the child’s positioning in the womb, though this is not known for certain. Internal tibial torsion is not usually painful, though it may cause a more than normal clumsiness in the child, as the feet and legs aren’t as balanced as they could be.

Most children will outgrow their internal tibial torsion without intervention by age four. If the child still shows signs of the condition by age nine, surgery may be required to correct it. Parents concerned about their children’s development in their legs, feet, gate, or ability to walk or run, should have their child evaluated by a pediatrician or podiatrist.

Metatarsus Varus or Metatarsus Adductus

This condition is characterized by a foot that is curved or has a half-moon appearance. The condition is almost certainly caused by the child’s position in the womb, as it is most common in children who were born breach. The condition is flexible, meaning that the foot can be straightened out, and will often correct itself as the child begins to walk. If the foot position is “fixed” or stiff, the child should be evaluated by a pediatrician or a podiatrist.

Club Foot

The causes of club foot are unknown, though genetics are thought to play a large role. It is not caused by the baby’s position in the womb but may be linked to other skeletal abnormalities. Club foot is twice as likely to occur in boys and more likely to occur in children where one or both parents were born with a club foot.

Clubfeet are often diagnosed before the baby is born, using ultrasound. No treatments are available until after birth, however, treatment often begins within the first week of life. While clubfoot is not painful if left untreated, it is difficult for the sufferer to walk normally or wear regular shoes. Most parents seek treatment immediately to correct the foot or feet before the child is of walking age.

Treatments for Club Foot

While there are several treatments for club foot available worldwide, there is one primary method utilized in the United States, the Ponseti method. The Ponseti method of treatment involves manual manipulation of the foot by a therapist and then a series of casts that slowly move the child’s foot into a normal position. For four to ten weeks, the child gets a new cast which slowly corrects the positioning of the foot. Once the foot has reached the correct position, a small surgery to release the Achilles tendon is sometimes necessary.

After the casting stages, the child wears a boot to hold the foot in place. This boot is worn most of the time for several months and then whenever the child sleeps until about age four. If the corrective procedure and followup therapies are strictly adhered to by the parents, children with club foot should have no difficulty keeping up with their peers. They will be able to participate in athletics and run and play like other children. Following the treatment plan fully is key to a full recovery, however.

Sever’s Disease

Commonly known as “painful heel,” Sever’s disease is a disturbance in the growth plate of children who are very active in sports. The official name is “calcaneal apophysitis,” and the condition is an inflammation of the growth plate in the heel or calcaneus.

Sever’s disease affects the back of the heel, where the growth plate is still vulnerable in children who are growing. Repeated stress on the heel, as occurs in sports, can cause trauma to the growth plate. The growth plate is the attachment point for the Achilles tendon, which can put additional stress on the heel and further irritate the growth plate.

Many times, both heels are affected by Sever’s disease, although it can occur in only one. The disease is manifest by pain and tenderness in the heel that is made worse by activity. The heel is painful to the touch and there may be mild swelling at the heel. A doctor exam can diagnose Sever’s disease and a treatment plan may include orthotic inserts to help relieve pressure on the heel, physical therapy exercises that will stretch the Achilles tendon, and anti-inflammatory medication to reduce swelling. If the case is severe enough, the doctor may prescribe a boot to immobilize the foot until the heel has an opportunity to heal.

Wearing supportive shoes during sports activities can help the child avoid a recurrence of Sever’s disease.

If you are concerned about pain in your child’s feet, Dr. Kleis is here to help put your mind at ease. Call us today to schedule an examination. Dr. Kleis can devise a personalized and prevention plan that will help your child have healthy, happy feet for life. Call (714) 760-4944 to schedule a consultation today!

 

 

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