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What Parents Should Know About Their Children's Feet
A Guide to Preventing Foot Problems as an Adult
Foreword My experience, in more than 25 years of treating foot, ankle, and leg conditions, is that a great many of children's foot and leg problems are neglected. Some are obvious such as, a club foot, a child who has a severe intoeing gait, or infected ingrown toenails or warts. The parent notices these immediately and seeks out a competent member of the medical community for appropriate treatment. However, most other conditions which the parents think will go away or is reassured that the child will outgrow the problem, unfortunately continue into adulthood. Although some of the conditions will improve with time, most do not. The child, then, doesn't get any treatment. It is no wonder that 70% of all adults report some type of foot problem. A complete history and physical examination will determine whether there is a problem, why the problem exists, ways to treat it, and any benefits or risks. What Parent's Should Know About Their Children's Feet provides information parents need to know to make informed choices regarding their children's foot health. Having this information will lead to a better understanding of common foot and leg conditions and their appropriate treatments from birth to adulthood.
Growth, Anatomy
& Development Common Conditions
Found at Birth Common Leg Conditions
During Early Childhood Conservative
Treatment Methods Common Childhood
Nail & Skin Problems Conditions Affecting
the Growth Centers of Bone Injury-related
Conditions of the Foot &
Leg Common Hereditary
& Developmental Bone Problems Childhood Ankle
Conditions
Growth, Anatomy & DevelopmentGrowth and Development
Statistically, most people have one leg longer than the other. The right leg is slightly longer than the left 70%-75% of the time. The left foot is slightly longer than the right, although the right foot is somewhat broader. The foot doubles in length from birth to age four. It increases in size almost one centimeter per year. At age 10, girls reach 90% of their foot growth, boys reach approximately 80%. By age 14, most girl's feet have stopped growing, whereas growth stops about 16 years of age in boys.
The same holds true with flat feet. A flattened foot structure where there is no arch is not abnormal in the first two years of life. We will discuss these conditions later in greater detail. Again we need to know what the normal foot structure is in order to make appropriate decisions as to when the child will either outgrow the condition or needs treatment. (back to the table of contents) Anatomy and
Development
Hereditary factors can and do play an important role in how we develop. If a child's grandparents, father, and mother have flat feet, it would be highly likely that the child will also have flat feet. This may be normal because it is a hereditary condition, and the parents should not be overly concerned. However, not all conditions can be blamed on hereditary factors. In addition, even if there is a strong hereditary background, it does not mean that the condition should be neglected or left untreated. (back to the table of contents) When to Examine
for Problems Another examination of the feet and legs should be done at four to six months of age. This is the age at which most children try to stand and then begin to walk. A child can usually walk unassisted by 10-14 months. Most conditions associated with flat feet, bowlegs, knock knees, leg length differences, and ankle problems become obvious with standing. Hopefully, parents will follow the examination recommendations very carefully. This will help identify and allow treatment of most conditions without letting them get too advanced. An annual checkup or an examination at least every two years after age 10 is essential for proper foot care and prevention of problems. (back to the table of contents) Foot and Leg
Functions
(back to the table of contents) Common Conditions Found at BirthCongenital Dislocation of the
Hip Congenital dislocated hip is caused by abnormal position in the uterus or a problem with development. It is eight times more common in girls than boys, with the left hip being six to eight times more involved than the right. There is a strong family predisposition, usually running 20%-30%. The condition is characterized by looseness or laxity of the joint with one leg being shorter compared to the opposite leg. A "clunking" noise may be heard when pulling on the leg and then letting go, as it snaps back. It is easily diagnosed by examination and x-rays. Treatment: Treatment is successful when initiated early. Typically, either double diapering, splints, or braces, can relocate the bone and it will heal uneventfully. Surgery is rarely needed. (back to the table of contents) Club Foot Treatment: The treatment of choice is a series of foot casts done immediately after birth. This will manipulate the foot back into its normal position. Statistically, however, a club foot condition will require some type of surgery 70% of the time. (back to the table of contents) Reverse Club
Foot (Calcaneal Valgus) Treatment: Unlike clubfoot, the treatment is relatively easy and the results excellent without surgery. The use of casts and braces are all that is needed. (back to the table of contents) Rocker Bottom
Foot Treatment: This type of foot problem is highly resistant to any type of casting, manipulation, or conservative care. Surgery is usually the treatment of choice. (back to the table of contents) Metatarsus
Adductus (Turned in Foot) Treatment: There are two types of metatarsus adductus: flexible and rigid. The flexible type can be easily straightened and treated with casts or special shoes. The rigid type is far more stubborn. If conservative care fails, surgery would be required. (back to the table of contents) Overlapping
Toes Treatment: Normally no treatment is needed as it is a condition that will be outgrown. Simple taping of one toe to another is usually all that is needed. (back to the table of contents) Webbed Toes
(Syndactaly) Treatment: No treatment is needed unless it is severe and involves all or most of the web spaces. Cosmetic surgery could then be performed if requested. (back to the table of contents) Extra Toes
(Polydactaly) Treatment: The treatment for an extra toe is surgical removal. (back to the table of contents) Long Toes
or Short Toes
Treatment: It is of little concern whether the great toe is longer or shorter than the second toe. There is no treatment. (back to the table of contents) Common Leg Conditions During Early ChildhoodIntoeing (Pigeon-toed) / Out-toeing
(Duck or Slue footed)
(back to the table of contents) Bowlegs/Knock
Knees
Treatment: Most treatments associated with these conditions are actually directed at supporting the foot structure to keep the arch from falling. As previously described, since most of the time the problem self corrects, no treatment is needed. However, if needed, appropriate casts and/or braces can make a significant difference. Surgery is rarely indicated unless the child has a severe problem that has not corrected or greatly improved by conservative treatment. (back to the table of contents) Hyper-Extension
of the Knees Treatment: Fortunately this condition almost always self corrects as the child matures. The best treatment is to do exercises that strengthen the muscles around the knee joint or use braces that help stabilize the knee. If left untreated, the laxity can result in arthritic changes in the knee joint. (back to the table of contents) Leg Length
Differences While 90% of the time one leg is longer than the other, 80% of the time the symptoms or problem will be located on the long leg side. This is because there is more pressure on the long leg side. Subsequently the foot and leg structure has to give more. Symptoms frequently seen on the long leg side are inside arch problems, inside knee pain and shin splints. Conversely, on the short leg side we often see symptoms of outside foot problems, problems on the outside portion of the knee, upper leg and lower back symptoms. These are generalizations, but they are true most of the time. Differences in leg length are due to four variations in structure or combinations of all four: bone to bone length, how the bones are situated in the soft tissue (muscle tightness), combinations of both, or from the foot structure. Treatment: Different types of doctors treat the problem in different ways. Some do not feel there is a real problem with one leg longer or shorter than the other unless the difference exceeds more than ½ an inch. In my opinion, I look at the condition as only one part of the entire examination. Treatment depends on whether or not the difference in length is significant and how it may help as part of the overall treatment plan. In many instances, no treatment is needed. However, if treatment is warranted, just adding a lift to the short leg side is usually not enough. It is necessary to treat the entire foot and leg length as a unit. Therefore a lift on the short leg side is commonly incorporated into an arch support to support and cushion the foot while equalizing the leg length. Additionally, the leg length difference must be rechecked after treatment and at regular intervals, at least every 6 to 12 months. This is because with appropriate treatment the difference can actually change or even resolve. If the lift therapy is continued too long, it may adversely affect the foot or leg structure and cause continued pain. (back to the table of contents) Tight Heel
Cord (Equinas) Treatment: Stretching exercises are sometimes effective if the amount of tightness is not to severe. However, exercise must be done properly so as not to further affect the foot and continue to lower the arch. A lift inside the shoe can be used to bring the heel up to the proper height and take pressure off the tendon. Although rare, surgery can be used to lengthen the heel cord. This procedure, while highly successful, is usually done in combination with other procedures to correct any abnormal foot structure. (back to the table of contents) Night Cramps Treatment: Massaging the legs helps to rid the tissues of the buildup of byproducts and helps relieves the pain. It is best to prevent the problem in the first place by providing a rest time before bedtime, as well as a soothing bath. In resistant cases, orthotics (custom-designed arch supports) or medication can be used. Regardless, the problem resolves as the child matures. (back to the table of contents) Low Arched
Feet (Flat Footed) Mild low arched feet are very common. It is estimated that 70% of the general population has a tendency toward excessive rolling in of the foot. This can lead to a formation of painful bunions, hammertoes, callouses, heel spurs, tendon injuries, and leg and back problems as an adult. Children rarely complain of pain, but often present with chronic leg fatigue, night cramps, appear clumsy, trip or fall, or have uneven shoe wear.
Much of this structure develops by age six. Therefore a low arched foot even up to this age is not necessarily abnormal. However, when walking begins between the ages of nine and eighteen months, pressure on the foot structure and its cartilage can adversely effect how the foot forms. Therefore, an examination of the foot very early and again just when the child begins to walk will help determine if any problems exist and whether treatment is advisable. Most flat feet are flexible or non-rigid. While standing, if the foot flattens in the arch area and then without weight bearing looks normal it is the flexible flat foot type. Non-flexible or rigid flat feet show no arch with or without weight bearing. This type of foot usually is seen with a condition called tarsal coalition.
Remember though, flat feet should be evaluated very early, beginning at seven to nine months of age or when the child begins to walk. Unfortunately, most people think little can be done to correct flat feet. This misconception is from a lack of understanding of the problem. Attention to proper treatment will encourage normal development. (back to the table of contents) High Arched
Feet
(back to the table of contents) Conservative Treatment MethodsShoes and Shoe Therapy Infants generally should wear high top shoes with a soft, flexible bottom or sole. The only reason for a shoe at this age is for protection. Until 18 to 24 months of age, the high top shoe is used to merely hold the shoe on more securely. It does not truly support the ankle nor restrict motion of any kind. The soft, flexible sole allow the child's soft foot structures plenty of room to move and grow. The oxford type "low top" shoe is best used as soon as the child begins to bear weight and then begins to walk. The low top allows for needed ankle motion. It not only affords protection for the foot, but more importantly provides a firm flat surface. The foot can function more correctly when on a flat surface. Therefore the shoe should also have a rigid shank. A rigid shank is where the sole of the shoe is reinforced from the heel to just in back of the bones in the ball of the foot. However, at the ball area, the shoe needs to be quite flexible. The correct size should be frequently checked as the child's foot grows rapidly.
Athletic types of shoes (tennis shoes) are fine to wear but are best reserved for times when the child is involved in very active or sporting type activities. Most parents have a tendency to allow the child to wear this type of shoe all of the time. While not considered the best choice for the foot structure, with today's construction methods, materials, and shoe industry technology, wearing this type of shoe is a close second choice and perfectly acceptable. The most important and best quality of athletic shoes is their ability to absorb shock. Be careful not to buy very cheap shoes. They cost less in general because they do not have the quality materials nor the proper construction needed to support the foot. They frequently do not last very long either. You always wind up buying shoes more frequently than really needed. A word about other popular type of shoes: sandals made with a good arch support that do not cause irritation are fine during warmer weather; flip-flops other than for use at the pool are not recommended. Moccasins do not provide any support and only a minimal amount of protection. They should be avoided. Patent leather Mary Janes for the occasional dress up time are acceptable. However, they should not be worn for any extended period of time. The patent leather does not breathe and is frequently lined with a nylon type material. Children can develop friction burns on the skin of their feet from this type of shoe.
Although shoes as a correction do exert some small measurable affect, most of the time the problem should not have been treated in the first place, or it corrected itself as the child grew. The shoe itself did very little. Some shoe types and certain modifications are valuable to use in rare instances, and only for a short period of time. For instance, while it is best to cast an infant's foot when there is a problem, sometimes an open toed shoe can be used to realign a problem or help hold it in place. Arch cookies, like corrective shoes, do little to alter a flat foot or other foot problem. Studies have determined the end result to be the same whether arch cookies were used or not. Remember, shoes are a necessity to protect and support the foot structure and to help absorb shock. We walk an average of 70,000 miles in a lifetime. Good shoes will help ensure our feet will last a lifetime. (back to the table of contents) Orthotics
(Custom Designed Insoles) What is an orthotic? It is a custom designed foot support. It is not an arch support. Orthotics help to balance the front and back part of the foot structure to keep it in alignment with the ankle and leg. The arch is only secondarily affected. An arch support appears to help the arch because it pushes up on the soft tissues. When the support is removed the arch of the foot simply flattens back down. An orthotic balances the foot structure and allows for growth in a proper alignment. When growth has been completed, the orthotic can be discontinued, and the foot structure, now normal, will remain in the proper position. Remember that initially, almost all children's feet pronate or appear to roll in. When they begin to walk, usually at age 10 to 15 months, their feet will look flat. If the doctor's examination determines an abnormal foot condition, treatment is best begun at that early age. Also recall that many foot problems can be influenced by intoeing and out-toeing. If these are present in addition to a foot condition, treatment is needed. While there are literally hundreds of different styles of orthotics, there are really only two types: rigid and soft. Soft orthotics are generally reserved for adults who not only need control of their foot structure but cushioning as well. Children almost always require rigid orthotics. Do not confuse rigid or hard orthotics with discomfort. When made properly an orthotic is very comfortable. Orthotics for children need to be made of rigid materials to control and balance the foot structure best. How is an orthotic prescribed and then made? First, your doctor will perform an examination and determine if an orthotic is needed for your child. The type of device will then be determined and a cast impression of the foot is made. This is done in a variety of ways. Regardless of the method, it is painless. The foot is held in the correct position, and an exact copy of the foot is made. The impression cast is then filled with plaster. When dry the result is a mold of the child's foot. Plastic materials are then used to fabricate the orthotic device over the mold. A word about taping. Sometimes tape is used to help support the foot structure to see if an orthotic will be beneficial. While sometimes appropriate in an adult, there is no reason for this type of treatment with a child. What about over-the-counter arch supports like those sold in stores. Orthotics are like eyeglasses. If you need an orthotic, it needs to be your own. Over-the-counter or prefabricated devices only rarely work and should not be used. A child's orthotic, to be effective, needs to be worn all the time. That means orthotics and shoes should be worn all the time except when taking a bath or sleeping. While this may sound like a lot, think of your child wearing braces on their teeth for 24 hours a day. An orthotic can only work when it is worn. If it is used off and on, the results of the therapy will be less than satisfactory. Or course, orthotics can be switched from one pair of shoes to another. Parents must remember that it takes time for the effectiveness of an orthotic to be judged. It is not a short term therapy. It is used at least for a period of one to two years and can be utilized past puberty. Generally, in a growing child, new orthotics will be needed every two to three years or four to five changes in a shoes size. Most children can wear their orthotics right away and do not require a break-in period, although some children will need to break their orthotics in gradually. If the child complains of pain or discomfort, or develops blisters or areas of irritation from the orthotics, consult your doctor immediately. Sometimes the device will need a minor adjustment. Socks should always be worn with orthotics. If the child's foot perspires excessively, lightly dust the inside of the shoe with talcum powder, or spray the feet with underarm spray deodorant with an antiperspirant in it. This is an easy and inexpensive way to reduce excessive perspiration. Orthotics function best in a good pair of shoes. If the shoe is excessively worn down, it will not allow the device to work properly. An orthotic functions to bring the ground up to the foot rather than the foot going through abnormal motion to contact the ground. They can be quite effective when used correctly in treating many children's foot problems. (back to the table of contents) Common Childhood Nail and Skin ProblemsNails Ingrown nails are best treated by prevention. That is, proper trimming either straight across or slightly rounded will help the nail sides from developing hooks on them which can become ingrown with subsequent infection. If such a problem does occur in a very young child, most often it can be treated successfully with local measures, such as topical antibiotic creams and soaks. Because the nails are very thin and pliable, conservative care until the nail grows out is usually sufficient. If not, there are several minor surgical procedures that can be performed in the office with excellent results. However, it is important to treat an ingrown nail as soon as it occurs. A chronic infected nail can lead to other more serious problems. If a child unfortunately drops something on their toe, it can cause bleeding underneath the nail, and it is very painful. The blood that collects underneath the nail plate itself makes the nail look very dark blue or even black in color. It is best to seek the advise of your doctor when this occurs. It may be necessary to make a small hole in the nail to let the blood come out in order to alleviate the pressure underneath. Sometimes the whole nail must be removed. It almost always will grow back normally. An x-ray picture may be needed to make sure that there is no injury to the underlying bone. (back to the table of contents) Warts Characteristically, a wart will have small dots or seed-like markings, whereas other lesions do not. These "seeds" are really the ends of very tiny blood vessels called capillaries, which provide the blood supply o the wart and helps it to grow. There may be just one wart or many. Permanently getting rid of warts may be exceedingly frustrating. There are many different treatments for warts, ranging from the simple over-the-counter medications to advanced laser techniques or surgery. In young children, it is best to use the simplest and easiest treatment which is an over-the-counter acid preparation. The child's foot is soaked in warm water for two to three minutes, gently rubbed with a washcloth, and then acid is applied to the wart area two to three times as day for two to three weeks or until the wart is gone. If a new wart appears, or there is a recurrence of the old wart (up to 30% of all warts re-grow), the process is repeated. When the medications are used as directed, they are usually successful. However, if this fails, other types of wart treatments can be attempted. Surgical removal is an option but is mostly reserved for warts resistant to conservative care or in very difficult cases. (back to the table of contents) Foreign Bodies Obviously, the best protection against stepping on sharp objects is to make sure your child wears shoes as much as possible. This not only helps prevent an accident but helps the foot structure to grow better because it is supported and balanced. (back to the table of contents) Fungus Infections Parents frequently ask if the fungus can spread from one child to another. It is not really contagious like a viral infection. Just because one member of the family has the fungus infection does not necessarily mean anyone else will get it. Certainly, standard precautions such as wearing clean socks and shoes and avoiding direct contact are advisable. Fungus infections present themselves in several different ways. There may be a small area of redness between the toes, there may be many small water blisters which itch and look like a rash, or a combination of all of the above. Typically, treatment is straightforward and simple. The feet should be kept dry and good quality shoes used. Almost any over-the-counter anti-fungal medication will cure the problem. Remember to use an underarm antiperspirant spray on the feet two to three times a day if the child perspires excessively. This will help control the sweating. If the problem is very resistant, consult your physician for prescription medication. Remember, some fungal infections may never really be totally cured. They may recur over and over again, even with treatment. (back to the table of contents) Contact Dermatitis The best treatment for contact dermatitis is to identify the cause of the irritation and remove it immediately. After that, various types of over-the-counter cortisone creams are used to reduce inflammation. If itching needs to be controlled, Benadryl@ can be obtained at any drugstore. (back to the table of contents) Impetigo (back to the table of contents) Eczema (back to the table of contents) Psoriasis (back to the table of contents) Foot Odor (back to the table of contents)
It is uncommon to see corns and callouses on a child's foot. When they are present it is the result of some type of abnormal foot problem and should be evaluated and treated.
They may be treated conservatively with a change to shoes with more room in the toe area, corn or callous pads, or trimming. An orthotic (custom designed insole) is the best treatment. It controls the mechanics of the foot structure that causes the problem. If the abnormal pressure is relieved, the symptoms improve.
(back to the table of contents) Conditions That Affect the Growth Centers of Bone
Fortunately, these conditions are all self-limited. That is, as the child grows and matures, the condition will go away. The goal of treatment is to make the child as comfortable as possible during the condition, and to try not to limit their normal activities unless they are unable to continue because of pain. The disturbance at the growth center in the hip joint (Legg-Calve'-Perthes' Disease) is seen between the ages of 3 and 12 with boys being affected six times more frequently than girls. Although it most commonly affects only one hip, both sides can be involved. It presents with a noticeable limp and pain in the hip which can extend all the way down to the knee. Treatment is to reduce the pressure on the hip joint. It could take three to four years for the condition to resolve. Pain and swelling just below the knee is characteristic of Osgood Schlatter's Disease. Just as with the hip problem already described, the adolescent will have a limp and usually have problems climbing stairs. It is most often seen in children between the ages of 10 and 15. Treatment is designed to reduce stress on the knee. The keystone to the arch bone, the navicular, often undergoes a disruption of a growth center (Kohler's Disease). X-rays will demonstrate a markedly flattened or fragmented bone. This problem occurs most often between the ages of 5 and 7 and predominately affects boys. The child will complain of pain in the arch of the foot and will often limp. The preferred treatment is an orthotic (custom designed insole) to help support and cushion the area. Frequently seen in children between the ages of 12 and 14 years of age is a disruption of the growth plate at the head of the second metatarsal bone in the ball of the foot (Freiberg's Disease). The child may or may not have had an injury to this area. Symptoms include pain, tenderness, problems with wearing shoes, a limp, and difficulty participating in sports because it hurts when trying to push off the ball of the foot. X-rays confirm an irregular flattened head of the second metatarsal bone. The second toes looks shorter and there is less motion in the joint. This condition, although common, rarely needs to be treated unless there is pain or restriction of range of motion that causes constant problems. The use of injections and physical therapy normally does not help. The child may respond to orthotics or require surgery to reshape the joint and improve motion. The most common disruption of the growth plate in a child occurs in the heel area (Calcaneal Apophysitis or Sever's Disease). It is most frequently seen in overweight or active boys between the ages of 8 and 13. It predominantly affects only one heel but can involve both. The child will complain of a painful heel on the bottom or back part of the foot. It feels better during periods of rest. Treatment is always conservative utilizing spongy heel cups or soft orthotics. (back to the table of contents) Injury Related Conditions of the Foot and LegFractures and Dislocations The main difference in fractures in young children versus adults is that the child has much more soft cartilage and numerous growth plates. When a child sustains an injury not only might they break a bone, but they also may injure the cartilage or growth plate. This can affect the way the bone will grow. In fact, about 30% of all injuries in children also involve a growth plate. X-rays of fractures or dislocations in children frequently reveal the injury across the growth plate. They may also have bone fragments that get pulled away from the bone because the ligaments in children are very strong. Children's bones are much more pliable and able to bend before they completely break. They may have an incomplete fracture (greenstick) which will heal more rapidly.
Sometimes the bone will break or crack, but it will not show up immediately on x-rays. It should be treated as if it were broken, and a repeat x-ray taken several weeks later. If symptoms persist, a special test called a bone scan can be ordered by your doctor. This will detect a fracture that is invisible on a standard x-ray. The most common area for a stress fracture is the second bone in the ball of the foot called a metatarsal bone. It occurs because there is a weight shift from the first to the second metatarsal bone which occurs with a flattening or inrolling of the foot structure. This weight shift causes excessive pressure on the second bone. When the amount of pressure exceeds the bone's ability to withstand, the bone cracks.
Dislocations due to injury can occur when two bones separate at the joint. If a dislocation occurs, the surrounding soft tissue, such as the ligaments, also will be stretched and torn. The dislocation must be reduced as quickly as possible to restore proper alignment and function. It generally will heal satisfactorily in two to four weeks. Physical therapy may be required to aid in restoring the active range of motion, tone, and strength. (back to the table of contents) Overuse Injuries
to the Knee (Chondromalacia) Treatment is directed not only at the symptoms but at the cause of the problem. We often use anti-inflammatories and an orthotic to help absorb shock and balance the foot structure. This helps to prevent twisting of the leg and prevent the abnormal rubbing of the knee cap in it's groove. (back to the table of contents) Shin Splints The type that occurs on the front
of the leg is mostly due to
overuse and poor conditioning.
The muscle tendon unit gets
overused, swells, and causes
pain. The treatment for shin splints is physical therapy, anti-inflammatory medication, strengthening exercises, and most importantly an orthotic to control foot and leg position. (back to the table of contents) Achilles Tendonitis Associated with overuse or a tight heel cord, it can become very painful and swollen. The child will often not want to walk and will limp. More than one-half of the injuries to the Achilles tendon are from abnormal inrolling of the foot. Slow motion video studies have demonstrated a whipping type motion of the Achilles tendon that occurs with inrolling or a flattened foot structure. This causes micro-tears in the tendon and results in inflammation. Treatment for Achilles Tendonitis is threefold; stretching of the calf muscle and tendon, control of the inflammation and pain, and control of the function of the foot structure. This would include physical therapy with the use of stretching exercises and massage, the use of anti-inflammatory medication, and orthotics to control foot motion and to raise the heel thus decreasing the pressure of the tendon. (back to the table of contents) Common Hereditary and Developmental Bone Problems Seen in ChildrenJuvenile Bunions Juvenile bunions are usually seen more often in girls than in boys between the ages of 10 and 12. They do not commonly cause pain unless there is excessive pressure from a shoe. The great toe shifts towards the second toe and a large bump develops at the joint area in the ball of the foot. This is not an extra or new bone as we might see in an adult. The bump we see is actually the entire first metatarsal bone in the ball of the foot having shifted or moved out of alignment. If it remains in this abnormal position the child's condition will progress and worsen. Unsightly and painful hammertoes with corns and callouses on the bottom of their foot structure will also form. There are two treatments for juvenile bunions. First and most importantly, an orthotic must be used to control the forces that caused the bunion in the first place. Second is to operate on the juvenile bunion to reposition and realign the bone. This will allow the foot to function properly. (back to the table of contents) Hammertoes
/ Mallet Toes Hammertoes and mallet toes are caused by an imbalance between those muscles and tendons on the top of the foot which pull the toes up, and those on the bottom of the foot which pull the toes down. These problems are often seen on all the toes in children with a very high arched foot structure because the muscles and tendons pull the toes up and to the side. Conversely, a child who has a flat foot structure will have contracture of the second and fifth toes.
The initial treatment of hammertoes and mallet toes is conservative. Special toe pads and orthotics can be used successfully. Conditions that do not respond to conservative care can be corrected with surgery. (back to the table of contents) Medial Pinch
Callous of the Great Toe (back to the table of contents) Tailor's Bunion (back to the table of contents) Accessory
Bones (Extra Bones) Usually no treatment is needed for this problem unless it becomes painful or the child has problems wearing shoes because the bone hits the inside of the shoe. Cortisone injections to try to reduce inflammation should not be used as this can weaken the tendon. This is only a temporary relief and is quite painful in this sensitive area. When necessary, surgical removal of the bone is quite successful in resolving the problem. (back to the table of contents) Ganglions
and Cysts Ganglions and cysts can get quite large and feel as hard as a rock. They can cause pain or numbness if they cause pressure on surrounding soft tissues, especially on blood vessels and nerves. If small and not in an area that causes a problem, they can generally be ignored. If they grow in a vital area, enlarge, or cause pain, they should be surgically removed. Sometimes injections can help reduce the size of the ganglion, but this relief is mostly temporary. If surgery is performed, the area where the ganglion was removed needs to be well protected until the healing process completely takes place to avoid re-growth. (back to the table of contents) Enlargement
on the Back of the Heel (Haglund's
Spur) Treatment can be rather simple. A small heel lift inside of the shoe will change the position of the foot in the shoe and reduce a great deal of the pressure on the back of the heel. Changing the style of the shoe can also be helpful. An orthotic is the best treatment to control foot function and lift the heel at the same time. Surgery is indicated in cases where there is no relief from conservative care. (back to the table of contents) Childhood Ankle Conditions
There are ligaments on both sides of the ankle joint. The outside ligaments are much weaker than those on the inside. Often, when an ankle sprain occurs, conservative care such as rest, ice, a compression wrap, elevation, physical therapy, and an ankle support help to restore normal function. If the child frequently injures or sprains their ankle, or has an ankle that is constantly weak or unstable, then further evaluation is needed. A complete examination will include stress x-rays. These are special x-ray views that help determine if there is any looseness to the ligaments. The ligaments around the ankle are like tiny steel cables that connect the bones together and prevent instability. A regular x-ray without appropriate pressure on the ankle cannot determine if the bones move apart when they should not. Besides the ligaments, there is a balloon-like structure called a capsule that surrounds the ankle joint. It has a lining that functions to produce lubrication for the joint to work smoothly. When the capsule and it's lining get inflamed, the ankle joint will swell and become painful. The cartilage inside of the joint
or the bone itself can get injured.
If there is pain or weakness
and it lasts longer than three
to six weeks, it should be investigated
further. (back to the table of contents) Children in
Dance and Sports For example, ballet is excellent for its development of coordination, tone, and strength. Because of certain required dance positions, it can be helpful in de-rotation of the legs such as in pigeon-toed gait problems. On the other hand, dancing up on the toes (pointe) is to be avoided because it puts undue pressure on the bones as they grow. Certainly no child should ever consider toe dancing until the age of 10 to 12 years, or until the feet mature. Certain positions in ballet causes the foot to flatten or cause toe problems such as hammertoes and bunions. The best advice to follow is not to overdo any sport or activity in a young child. Excessive pressure and stress on the growing structures can lead to overuse syndromes with resultant foot and leg fatigue and actual foot problems. As always, use common sense and try not to give into every desire of the child. Remember, the foot structure during growth is delicate and needs to be supported and balanced. (back to the table of contents) A Word About
Children and Surgery In almost every case, the child should first have conservative care unless there is an obvious need to proceed with surgery immediately. After a period of one or two years, if there is little improvement with conservative treatment or normal growth, surgery should be contemplated. Remember, most children do not complain of pain as a symptom. This is due to the cartilage and flexible nature of their structures. They do, however, subjectively present with being clumsy, have problems wearing shoes, or have excessive shoe wear and an abnormal walk. (back to the table of contents) Conclusion Ask questions of your doctor. If you do not like the answer you receive, or do not understand, get another opinion. Do not forget, your child's feet must last a lifetime. Many problems treated early can be resolved so as to never cause a problem later. Parents need to know and understand common foot and leg problems to help their children lead a lifetime of good foot health.
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At birth, a child's legs are relatively
short when compared to the overall
length of the body. From six
months of age until puberty,
the legs grow more rapidly,
until the growth plates start
to close.
When an infant is born, its legs
are rotated outward. In fact,
there is twice as much rotation
outward as there is inward.
The femur, or thigh bone, and
the tibia, the lower leg bone,
untwist as growth occurs. Therefore,
it is most important to know
and to understand what is considered
not normal. Conditions such
as bowlegs, knock-knees, and
walking up on the toes are acceptable,
depending on what their developmental
status is.
At birth there are relatively
few bones in the foot. As the
child matures, new areas of
bone growth appear until the
foot stops growing. By examination
and taking an x-ray picture
of the foot we can determine
the physiological growth (maturity)
as compared to the chronological
growth (age) of the patient.
Knowing this information helps
determine whether treatment
is necessary.
There are two very important "laws
of nature", that determine
the final outcome of how normal
our feet will be later in life.
The first applies to how bones
grow, the other to soft tissues,
such as muscles, tendons, and
ligaments. Basically, the size
and shape of any structure,
be it bone or soft tissue, is
determined by the amount and
direction of pressure applied
to it. If the structure is allowed
to grow normally it will do
so. If abnormal pressure is
applied as growth occurs, such
as a poorly fitting shoe, the
structures will change and grow
abnormally.
Every newborn should be examined
carefully for any potential
foot or leg problem. These are
usually easily diagnosed and
are associated with congenital
abnormalities such as clubfoot,
overlapping toes, syndactaly
(web toes), polydactaly (extra
toes), or congenital dislocated
hip. This is done by the physician
in the newborn nursery where
any limitation of motion or
obvious problem can be evaluated
and quickly treated.
Basically our feet and legs
function to do three things:
provide support for the rest
of the body, absorb shock, and
adapt to the surface which we
stand on.
The lower extremities are divided
into three segments: the foot,
ankle, and leg. It is the foot
and it's many bones, ligaments,
and tendon structures that acts
as the foundation of support.
The foot is uniquely designed
to absorb shock and adapt to
allow for proper function. Studies
have determined that this marvelous
structure works by changing
the angles of how it strikes
the ground and how each of its
individual bones line up and
when. The heel should be straight
up and down and the bones in
the ball of the foot should
hit at the same time when the
foot his he ground. If for example,
this alignment is off, the foot,
ankle, and leg will get out
of alignment and not function
properly. Structural changes
then occur that lead to foot
and ankle problems and to potential
deformities.
The ankle and foot work together
as a unit. The foot allows for
motion to occur mostly side
to side, whereas the ankle allows
for the motion to occur up and
down. Both of these motions
are converted into rotation
or twisting motions that is
taken up into the leg. All three
of these structures, the foot,
ankle, and leg, must work together
to insure proper function.
Definition: Congenital dislocation
of the hip (CDH) is a condition
where the head of the femur
(thigh bone) is dislocated out
of the hip joint.
Definition: Club foot is fairly
common seen with a frequency
of 1 per 1,500 births. It is
a condition where the foot is
held inward and upward in relation
to the leg. Some club feet are
fairly mild and flexible in
nature while others are quite
rigid and stiff.
Definition: The reverse club
foot deformity is seen at birth
and is more frequently found
than clubfoot. It occurs in
1 per 1,000 births. It is caused
by improper intrauterine positioning
and is easily recognized at
birth. The entire foot is tilted
upwards and can actually touch
the front part of the lower
leg. It is more commonly seen
in girls and first-born children
because of a tight fit in the
mother's uterus.
Definition: A rocker bottom
foot is a very rigid flat foot
where there is absolutely no
arch. In fact, as the name applies,
the "arch" area of
the foot looks like the rocker
part of a rocking chair. It
results when the keystone bone
that supports the arch inside
the foot becomes dislocated
out of position. This is usually
due to improper pressure inside
the uterus.
Definition: The turning in of
the front part of the foot (metatarsals)
is one of the most frequently
seen conditions in newborns.
It is sometimes confused with
or associated with being pigeon-toed,
which is really a leg rotation
problem. Metatarsus adductus
frequently affects both feet,
although only one foot may be
involved. The outside border
of the foot is characteristically
"c" shaped, and the
toes point inward.
Definition: This condition is
almost the rule rather than
a real problem. That is, it
is commonly seen in newborns.
The most frequently involved
toes are the second toe which
overlaps the third. Equally
as common is the inward rotation
of the fifth toe overlapping
the fourth. Overlapping is mentioned
here only to note that it is
very commonly seen and is not
really a problem in most cases.
Definition: Webbed toes are
another common and harmless
condition. There is an absence
of the web space between one
or more of the toes. The web
space may be either partially
or completely filled in. This
condition while not harmful,
may cause some concern from
a cosmetic point of view.
Definition: Extra Toes are fairly
uncommon and may involve one
or both feet. Sometimes there
are two big toes, other times
an extra small or duplicate
toe. While not a serious problem
it usually affects the child's
ability to wear shoes and certainly
is a cosmetic problem.
A common concern of parents
regarding their children's feet
is the length of the big toe
compared to the second toe.
The big toe may be longer or
shorter than the second toe.
When it is shorter it is called
a Morton's foot and is characterized
by a short first bone in the
ball of the foot (metatarsal).
The toe only appears to be shorter
because it sits on a bone in
the ball of the foot that is
short. This type of foot tends
to pronate or flatten and is
associated with the formation
of callouses.
When the great toe is longer than
the second toe, the first bone
in the ball of the foot is longer.
This type of foot can form a
skin callous directly beneath
the first bone and contracted
toes or hammertoes. Besides
the great toe, the other toes
may be affected. The cause is
the same, a short metatarsal
bone. 
Definition: When a baby is born
there is normally two times
as much outward rotation of
the legs as compared to inward
rotation. As the child grows
this unequal rotation gradually
begins to even itself out with
the end result being an equal
amount of inward and outward
rotation. Pigeon-toed (inward)
or slue-footed (outward) feet
positions are fairly common
in infants and toddlers with
one leg usually affected more
so than the other. However,
both legs can be affected. The
condition of intoeing or out-toeing
results from involvement of
a variety of soft tissue or
bony structures or a combination
of both. It may involve the
hip, upper leg, knee joint,
lower leg, ankle, or foot. A
thorough examination is mandatory
to determine the exact cause
of the condition. Only then
can it be decided whether the
condition will be outgrown or
needs treatment. The earlier
it is diagnosed the better.
It is unfortunate that parents
are told their child will outgrow
the problem, only to find out
later that the condition still
exists and would have responded
well to treatment at a much
younger age.
Treatment: Fortunately, well over
90% of intoeing/out-toeing conditions
will self correct as the child
grows. Mother Nature helps to
rotate the legs around properly
during three periods of the
child's rapid growth: 1-3 years,
5-7 years, and during puberty.
By age 10-12 only 4% of these
types of problems still exist.
Treatment depends on the age of
the patient. If detected early,
simple changes in sitting or
sleeping habits is all that
is needed. The habit of sitting
in a frog-legged style should
be avoided. Sometimes a night
splint may be used or even leg
casts.
If the condition is left untreated
until the child begins to walk
it becomes more difficult to
treat. The soft tissues shorten
around the hip and the knee
joints have already begun to
tighten up in the wrong position.
Simple non-painful braces worn
during nap time or special supports
that can be used during walking
also can be used successfully.
It is rare that more aggressive
treatment is needed unless the
child trips and falls frequently
or has chronic pain.
Definition: At birth it is normal
for the child to be bowlegged.
The legs are not straight at
this age. There is a normal
progression of development of
the legs. The legs are bowed
from birth to age 2. They then
become straight but become knock-kneed
again from age 2 until age 4.
From age 4 to about age 7 the
process again reverses itself
until they are basically straight.
Often bowlegs/knock-knees are
associated with flat feet. This
will be discussed is a separate
section. Bowleg conditions often
look worse than they actually
are. This is because the soft
tissue structures of the calf
area are rotated to the outside
of the leg making it appear
more bowed. As the child grows,
this apparent bowleg appearance
reduces and goes away.
There are some very rare conditions
(rickets, Vitamin D deficiency,
and bone growth abnormalities)
that need to be ruled out in
some cases. Both legs are usually
affected. If only one leg is
affected it may be due to some
other problem such as laxity
of the ligaments in the knee,
a hip problem, or significant
difference in the length of
the legs.
Definition: Also known as genu-recurvatum,
this condition looks like the
knees are actually bent backwards.
It is often seen with excessive
laxity or hypermobility of the
soft tissue structures (muscles,
ligaments) that support the
knee joint. When standing the
pressure on the knees from the
child's weight makes it more
apparent.
Definition: Numerous studies
have determined that almost
90% of the population has a
difference in the length of
their legs of up to ¼
of an inch. Therefore, it is
not necessarily abnormal to
have a leg length difference.
However, measurements must be
made to determine if a leg length
difference is an influence on
the total condition of the patient.
For example, a child with a
problem with their right knee
or a low arch only on the right
foot may have a faulty foot
structure influenced by too
long a leg on the right side.
In an attempt to help equalize
and straighten the body, the
arch of the right foot may have
lowered to compensate. Conversely,
the arch of the left foot may
attempt to lift up. An additional
way for the body to compensate
is for the foot on the long
leg side to rotate more outwardly.
Definition: The calf muscles
by way of the Achilles tendon
attach to the back of the heel
bone. Besides helping to push
the body forward when walking
and running, they also act to
hold the outside part of the
foot firmly on the ground. If
the Achilles tendon is too short,
it puts tremendous and excessive
pressure on the structure of
the foot. In fact, a tight heel
cord is a major contributing
cause of childhood flat feet.
That is, the tight heel cord
forces the foot to break down
and flatten. In rare instances,
the foot doesn't break down
and the child then literally
has to walk up on their toes.
The heel never really touches
the ground.
Definition: Often a child will
wake up at night and complain
of pain and cramping of the
muscles in the legs, specifically
the calf muscles. This generally
occurs in children who are very
active during the day. The cause
of this is thought to be associated
with a flatfoot structure and
tight heel cord. These can cause
an overuse of the muscles in
the lower leg which results
in a buildup of waste byproducts
from muscular activity. During
activity, the child's muscles
contract and dispose of these
byproducts. At rest the byproducts
can buildup and are not eliminated
from the muscles. The child
then complains of pain in their
legs.
Definition: There are three
types of foot structures: normal,
high arched, and low arched
or flat feet. Flat feet are
further divided into three types:
the mild type in which the arch
is still visible when the weight
is on the foot, the moderate
type in which, with weight on
the foot, the arch is not visible,
and the severe type in which,
with weight on the foot, not
only is the arch not visible
but the area on the outside
border of the foot looks "c"
shaped.
Most children never show an arch
in their feet until they are
18-24 months old. This is because
there is a normally occurring
fat pad that occupies the arch
and fills in the normal contour
of the foot. An important difference
in the flat foot of a child
as compared to that of an adult
is that much of the foot structure
in the child is still cartilage
which continues to develop until
adulthood.
Tarsal coalition, a condition
in which there is an abnormal
connection between two bones
of the foot. It can be either
soft tissue, or a bony connection.
Because of the flexibility of
the cartilage and fibrous connections,
this problem is rarely seen
until the age of 10 to 13 years.
At this age the soft cartilage
in the foot changes and becomes
bone. If a rigid connection
forms it prevents the foot from
moving properly. It is often
associated with tightening of
the muscles on the side of the
leg. These muscles eventually
go into spasm and the foot becomes
locked into position (peroneal
spastic flat foot). Fortunately
this condition is rare and is
seen in only one to two percent
of children. It also seems to
affects boys much more commonly
than girls.
Treatment: There are 3 treatment
options depending on the child's
age and degree of problem: special
shoe modifications, orthotics
(custom designed arch supports),
and surgery. Knowing what, or
what not to do, and for how
long, is critical to a successful
treatment outcome. Since these
treatments can be used for other
conditions than flat foot, they
will be discussed individually
later.
The arch of the foot, if too
high, does not absorb shock
well nor does it adapt to the
ground like a normal foot would
do. Fortunately, the excessively
high arched foot is infrequent.
Because it can be associated
with neuromuscular diseases,
it is important to obtain a
thorough family history with
possible examination of other
family members.
High-arched feet do not respond
well to conservative care. When
an orthotic is used in treatment,
it must be constructed with
very soft and shock absorbing
materials. Frequently, severely
high-arched feet make it impossible
to wear shoes or walk comfortably.
Surgery, when indicated, is
directed at correcting the many
different toe, metatarsal, midfoot,
heel, and tendon problems associated
with high-arched feet. The surgery
often needs to be staged, that
is, divided into several different
operations because of it's complexity.
It is also common to fix only
one foot at a time. The surgery
to correct a high-arched foot
repositions and realigns the
bones and tendons of the foot
structure therefore allowing
for proper function.
Before we discuss "corrective"
shoes, it is important to look
at some of the standard recommendations
for shoes by the shoe industry
for each age group.
Generally, a small raised heel
helps prevent excessive wear
and tear on the shoe. Leather
is the preferred material. It
is flexible, wears well, and
most importantly, it breathes.
Children's feet readily perspire.
The leather allows moisture
to pass through and evaporate
easily. Natural cotton socks
are excellent to help absorb
perspiration.
"Corrective Shoes" for
various types of foot problems
have been around for years and
are widely recommended by all
types of doctors. Surveys have
indicated many pediatricians,
podiatrists, and orthopedic
doctors routinely prescribe
"orthopedic" or corrective
shoes. However, there is little
evidence to justify using shoes
to correct most foot problems.
Shoes can be a valuable indicator
of some type of foot problem
when they wear abnormally or
there is a noticeable gap between
the foot and shoe.. But the
problem with corrective shoes
is that the foot moves within
the shoe and could not possibly
hold the foot in the desired
position to really correct it.
Orthotics are used for children
to do three things: control
and balance how the foot functions,
to help correct a foot problem,
and to aid in preventing a foot
problem from getting worse.
In an adult, an orthotic will
not really correct anything
that already exists or has occurred
since birth. It acts more as
an accommodation.
Infants are born with paper
thin nails. They need to be
trimmed often to prevent babies
from scratching themselves.
Fortunately, infants and toddlers
rarely have troublesome nail
problems. If they do, it is
an ingrown nail caused by an
injury such as dropping a heavy
object on the toe.
Warts are caused by a virus.
Mostly seen in young children,
they are often seen on the feet
in numerous locations. When
they occur on the bottom of
the foot, they can be easily
confused with other skin conditions
such as a callous or cyst. It
is important to identify it
as a wart so as not to treat
inappropriately.
Unfortunately, children occasionally
step on a sharp object such
as a needle or sliver of wood.
Most of the time, it can be
easily removed, the area cleansed,
and healing is uneventful.
Commonly referred to as athlete's
foot, it is rare to see this
fungal infection in children
under the age of three. It is
much more prevalent after the
age of four. The fungus likes
to grow in a dark and moist
environment.
A fairly common childhood problem
is an allergic reaction to any
number of products used in the
construction of a shoe. The
materials and glues can react
with the skin and cause it to
get red and inflamed. The great
toe and sides of the foot are
usually affected first. The
spaces between the toes are
rarely affected.
If the child's feet smell, it
is the result of excessive sweating.
The foot becomes secondarily
infected with bacteria which
causes odor. This is a very
common problem, usually from
not wearing socks with shoes.
The socks act to absorb the
perspiration thereby eliminating
the environment for the bacteria
to grow in the first place.
As previously discussed the
use of foot soaks or underarm
antiperspirant sprays on the
feet usually resolves the problem.
Over-the-counter products that
help eliminate the odor are
also effective. If the shoe
also has a foul odor, they must
be washed or thrown out and
new ones purchased.
Corns and
Callouses
The areas of the foot where these
lesions are most common are
the outside of the little toe,
on the side of the big toe,
the top of the second toe, and
under the second and fifth bones
in areas on the ball of the
foot.
Children rarely need surgery for
these conditionss unless all
conservative care has been attempted
and failed, or if the condition
causes pain or problems with
wearing shoes comfortably.
A child might develop pain or
begin to limp without any history
of injury. The complaint does
not go away or can even get
worse. There are several disorders
that occur which affect the
growth centers of the bones
in children. The medical term
used is osteochondritis, osteo
means bone, chondro means cartilage
and itis means inflammation.
This group of disorders of the
growth plates occur in very
specific locations, namely the
hip, tibia (lower leg bone),
arch bone, foot, and heel. While
usually not serious, they are
affected by pressure and weight
on the bone and can change how
the bone is ultimately shaped.
Fractures in children heal at
a more rapid rate than those
in adults. In an adult, a broken
bone can take six to eight weeks
or longer to heal, whereas in
a child it may be several weeks
less. The same is true regarding
the soft tissue structures surrounding
the bone. Whereas an adult may
take three to four weeks to
heal, a child may take one to
two weeks to heal.
Fractures are almost always associated
with an injury. The area will
be painful and swollen. As with
all injuries, immediately ice
the area, elevate the foot and
leg, and wrap the area in an
elastic bandage. Additionally,
no weight should be applied
to the area. Consult your physician
and have x-rays taken.
Another common area for a stress
fracture is the sesamoid bones.
These are like small knee caps
and are situated under the head
of the first bone in the ball
of the foot. They function to
give extra power to the muscles
in the arch to pull the big
toe down. Commonly seen in young
teenage girls, it can be quite
disabling. Cross-country running
or any activity where there
is chronic and repetitive stress
on the bone structure can cause
the bone to break. It must not
be confused with a sesamoid
bone that can grow normally
in two pieces although appear
as if it was fractured. X-rays
of both feet, for comparison,
and a bone scan often help make
the correct diagnosis.
Many times a child will complain
of a painful knee without any
history of injury. In almost
every case it is the result
of an overuse problem caused
by abnormal foot and leg mechanics.
In general, if the problem is
on the inside part of the knee,
it is due to excessive inrolling
or flattening of the foot structure.
If it is on the outside part
of the knee it is related to
a high arched, non-shock absorbing
foot structure (supination).
It can also be due to the presence
of a leg-length difference,
weak thigh muscles or an increase
in the angle formed between
the hip and knee. The condition
is caused by repetitive micro-trauma
as seen in walking or running.
The knee cap (patella) is inside
of a tendon which is attached
to muscles in the thigh. The
tendon inserts or attaches into
the bone just below the knee.
When the foot rolls excessively,
the knee cap is pulled out of
it's groove that it slides up
and down in and irritates the
cartilage. It is commonly felt
as a grating sensation of the
knee cap on the leg bone.
he term shin splints is defined
as any symptom characterized
by pain or discomfort in the
lower leg. More frequently seen
in females than in males, it
is thought to be really a combination
of three conditions: Tendonitis
or an inflammation of the tendon,
myositis or an inflammation
of the muscle itself, and periositis
or an inflammation of the covering
of the bone, termed periostium.
Shin splints can occur on the
lower front part or inside back
part of the leg.
Pain in the back of the lower
leg is almost always associated
with an inflammation of the
Achilles tendon and its covering.
In fact, it is reported to be
the most common problem of the
lower leg.
Often the result of heredity,
juvenile bunions are seen in
children's feet where there
is a strong family history of
the problem. The child typically
exhibits a very flexible foot
structure with a low arch. The
juvenile bunion is really caused
by the flatfoot structure and
a too tight heel cord. Whether
to treat the entire condition
or only the bunion itself is
a matter to be determined by
examination. We will discuss
how to make decisions about
surgery at the end of this section.
The little toes of the foot
have three bones and two joints.
The big toe has two bones and
one joint. When a little toe
contracts and humps up between
the first and second bones it
is called a hammertoe. When
the second and third bones contract
up it is termed a mallet toe.
Hammertoes and mallet toes begin
gradually. At first there is
mild contracture of the toes
with areas of redness and irritation.
They progressively get worse
and can even get infected as
well as very painful.
The big toe often develops a
hard callous on the side caused
by excessive inrolling of the
foot. The toe begins to angle
towards the second toe. It is
commonly associated with other
foot problems such as juvenile
bunions and hammertoes. Treatment
is to smooth down the callous
on a routine basis and use an
orthotic to help prevent the
inrolling of the foot. Surgery
can also correct the problem.
There are two methods used.
Either the excessive bone is
filed smooth, or a pie-shaped
wedge is removed to correct
the excessive angle of the toe.
When there is too much pressure
from a shoe on the outside of
the foot, or abnormal foot function,
or both, the child can develop
a tailor's bunion. Tailors used
to sit and sew with their legs
crossed. Due to excessive pressure
on the outside of the foot,
the underlying bone would enlarge
and cause a painful area directly
over the head of the metatarsal
bone. Thus the conditions were
termed tailor's bunion. In a
child whose foot incorrectly
contacts the ground, too much
pressure is put on the outside
part of the foot from the shoes
or foot structure, thus causing
the tailor's bunion to form.
Also, between the bone and the
skin, there is a balloon-like
structure called a bursa. This
helps to absorb shock and tries
to cushion the area. When this
gets inflamed, bursitis develops.
This is why a tailor's bunion
can get red and swollen and
get seemingly enlarged.
More frequently seen in adolescent
girls than in boys, the accessory
or extra bone, gives the appearance
of a lump or enlargement in
the middle of the arch. Sometimes
called a double ankle, the extra
bone grows inside of the tendon
responsible for lifting the
arch. Studies indicate it occurs
in 15% to 20% of the population.
The extra bone can become painful
and makes shoes uncomfortable
to wear. Conversely, it can
not cause any symptoms whatsoever
until the child accidentally
injures the area. The bone can
then become dislodged or crack
away from its normal position
and cause pain.
A ganglion is a fluid-filled
sack-like growth that can occur
anywhere on the foot or ankle.
It is usually found along the
course of the tendon. Tendons
pass through a sheath or covering.
There is an oil-like liquid
between the tendon and it's
sheath which lubricates the
tendon and aids in it's sliding
action. An injury or poorly
fitted shoe can cause the tendon
covering to tear, allowing the
fluid inside to leak out. The
body then forms a sack-like
structure to prevent it from
spreading. Besides forming along
tendons, this type of structure
can also form from fluid that
leaks out from between joints.
Most frequently seen in adolescent
girls, this enlargement on the
back of the heel is caused by
an abnormal foot structure and
pressure from shoes. Originally
called a "pump-bump"
after a particular type of shoe,
it can be quite disabling. Because
of the enlargement on the back
of the heel, the Achilles tendon
gets irritated as does the surrounding
soft tissue structures. The
top back part of the shoe presses
right on this area and makes
it impossible to walk comfortably.
X-rays will show an abnormal
enlargement on the heel bone.
Ankle problems in children are
uncommon. The structures around
a child's ankle joint are much
more flexible than those of
an adult and rarely get injured.
The foot is a marvelous structure.
It must function properly to
allow the child to grow to adulthood
and to lead a life of normal,
pain-free walking and activities.
Unfortunately, the foot and
how it functions are frequently
overlooked by many health professionals
and parents. Beware of the statement,
"Don't worry, your child
will outgrow it".