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Children’s Feet Require Your Special Attention

Patients often have questions for The Podiatrist if they notice something unusual about their child’s feet or the way the child walks or runs. For many years, the most common pediatric foot problem seen in doctors’ offices has been in-toeing, especially whenever the child is observed while running.

Let’s briefly discuss several of the more common paediatric foot conditions that result in the feet turning inwards, as well as how these conditions can (and should) be managed by The Podiatrist.

A case relating to paediatric in-toeing often begins when the parent reports an abnormal appearance of the child’s foot, an awkward gait or a “clumsiness,” with a tendency to trip or fall. A structural and biomechanical examination of the lower extremities – including watching the child walk – will allow for differential diagnosis and appropriate treatment recommendations. In-toeing is generally caused by the following three conditions, whose corrective timing and treatment considerations vary.

Tibial Torsion

Tibial torsion is a common condition in which the tibia has not completed its external rotation to normal adult position (resulting, therefore, in a lack of normal torsion). The key to diagnosis is the closed-chain postural evaluation. On standing examination, the child’s knees face forward while the ankles and feet turn inward.

The natural history of tibial torsion is a gradual normalization with growth and use of the lower leg muscles. Most cases resolve by 2 years of age, but rotation values continue to increase an average of 1.5 degrees a year up to age 6. By age 7, the vast majority of children have achieved normal adult position.There is a familial tendency among those who fail to reach normal values. When tibial torsion persists, compensatory pronation commonly develops.

Suggested Care:

Parents need to be involved in the care of their children. Train parents to frequently stretch the medial soft tissues of their child’s lower leg. Show them how to strengthen the peroneal muscles (using a home exercise program and an extremity rehab system) when the child is old enough to cooperate sufficiently.

In addition, recommend buying shoes for the child that have flexible soles and good support to decrease pronation stresses. In cases of hyperpronation, individually designed paediatric orthotics should be considered. Finally, recommend beneficial activities and sports that emphasize lower-leg training and coordination (such as soccer)

Femoral Torsion

Femoral torsion is an inward (medial) rotation of the entire lower leg that begins at the neck of the femur. It is a relatively common childhood condition, one which can be recognized by the medial facing of the knee as well as the ankle and foot. With walking, more than 90 percent will resolve by the 8th year.

Any persistence is thought to be due to ligament laxity of the hip joint capsule. In such cases, physical examination will find excessive passive internal hip rotation. Lumbar hyperlordosis, genu recurvatum, and hyperpronation are frequently associated.

 

Suggested Care:

Begin strengthening the external rotator muscles and extensors of the hip by using an extremity rehab system. Parents can passively stretch the hips into external rotation, and the child should be encouraged to sit cross-legged.

Let parents know that shoes with good support are very important. When hyperpronation is noted, individually designed stabilizing orthotics are indicated to prevent further problems. Also, encourage physical activities such as ballet, skating and bike riding – all of which tend to engage the external rotator musculature of the hips.

Metatarsus Adductus

Metatarsus adductus (also known as a “hooked foot”) is a contracture of the medial soft tissues of the foot. This condition has been found to be present in 6 percent of schoolchildren. On examination, the in-toeing can be passively stretched to normal, since there is no bony abnormality associated.

More than 90 percent of infants with this condition will resolve by the age of 18 months. When more than mild adduction persists beyond 1 year of age, a consultation with The Podiatrist or orthopedic surgeon for consideration of casting is appropriate. However, casting and special foot braces are seldom necessary.

Suggested Care:

Instruct parents to massage and stretch the medial soft tissues of the infant’s foot for several minutes following each diaper change. Frequent stretching is the key. Consider an evaluation by a specialist if significant adduction persists beyond 1 year of age, or if the deformity feels fixed and cannot be temporarily reduced with gentle stretching. Orthotics are needed only if mild adduction continues beyond age 7.

Footwear: What to Look for Developing feet require proper footwear. Whenever safety and comfort allow, going barefoot stimulates proprioceptors and encourages muscular coordination and strength. Children’s shoes should have flexible soles to allow for proper foot-joint movement (thick rubber soles may hamper and confine).

Proper shoe sizing and fit are critical, since the developing bones are soft and malleable. Tight, constricting shoes will interfere with normal growth and may result in deformity. Frequent evaluation of shoe size and fit (palpate the child’s foot for pressure points while they are standing with shoes on) is an important concept for parents.

When to Recommend Orthotics

As described above, the majority of paediatric foot problems will resolve with normal childhood activities, exercise and proper footwear. Orthotics are seldom needed in the early years of growth. If excessive pronation associated with in-toeing is seen to persist beyond the age of 7 or 8, or is responding poorly to home care interventions, individually designed stabilizing orthotics are appropriate.

The additional corrective support they provide will encourage normal development while preventing further deformity and reducing abnormal kinetic-chain stresses on the pelvis and spine during formative years. Parents will need to be educated to bring their child in for regular evaluations of orthotic fit and function, since children’s feet can rapidly outgrow any orthotic.

Serving the Next Generation of Patients

Parents need reassurance and appropriate recommendations when they bring in a child with a “foot problem.” In particular, in-toeing can raise concerns in parents and may be frustrating to athletically oriented children. Most of the common causes of in-toeing in children will resolve during normal growth and development, needing only home-care recommendations and monitoring by the family’s chiropractor.

As always, the child’s developing spine should be evaluated and appropriate Podiatic care is recommended. Specific home exercises may hasten the maturation and coordination of the support muscles. In some cases, paediatric orthotics may be needed to provide additional corrective stimulus.

Should you have any questions or concerns, seek professional advice before starting any homecare.

For more information, contact The Podiatrist

www.thepodiatrist.co.nz

www.kidsnmotion.co.nz

 

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Are you pushing too hard?

Recreational athletes can push their bodies a little too much—people are exercising, walking, jogging and going to the gym and the result is that overuse injuries to the lower extremities are skyrocketing.

The flip side of this is that these active lifestyles are helping to control obesity and increase wellness and fitness. Despite many in our society becoming more active and health and nutrition conscious, children and adults are still falling further behind in the battle against obesity. We’ve got to keep pushing to educate
people, especially parents, about this struggle. The costs of health concerns associated with inactivity and obesity are staggering—they’ll break us! So stay
active and pay attention to better nutrition habits. Keep gym classes in schools.

With the huge amounts of walkers, runners and aerobics over the past 10 to 20 years, we’ve seen increases in foot, ankle, shin and knee problems. This is true whether we’re looking at the adult, especially baby boomer recreation athletes, or kids with club, traveling or school team demands. Shoe technology has come a long way in all sports, especially in running and walking. Also, it seems that the specific shoes for all sports have taken a big step up. Better support, shock absorption and conformance to specific weights are examples. Proper fit, as obvious as it sounds, is still important, so always make sure you and your children are measured and fit properly.

Foot mechanics and foot type often are one of the causes of persistent overuse problems. In many screenings and evolutions of athletes with ongoing or persistent lower extremity overuse, we see the flat or overpronating foot type. Flat feet are susceptible to strain to ankles, arches and heels. Over rotation of the lower legs or twisting of the knees can show up as compensating motions related to these foot imbalances. Shin splints or tendonitis can be the result.
Identifying your foot type or your youngster’s can help in prevention of many overuse problems.

How much is too much? If you or the young athletes are consistently sore, if overuse injuries stay with you, then evaluate the schedule. Are you running every day without enough recovery time? Are the kids keeping year-round athletic schedules? Do you need pain medicine or anti-inflammatories just to keep going?

Intelligent rest is one of the favorite terms. Getting athletes to back off isn’t easy. Somehow, the culture of playing hurt, sucking it up or pushing through pain has filtered down even to children 10 to 12 years old.

Sports can really take a toll on young, growing bodies. If your child is constantly complaining of pain or discomfort, pay attention! Check with a sports-related doctor or Podiatrist. Better strengthening, more sensible schedules, proper shoes for foot type or just more intelligent rest might be all that is needed to solve the problem.

Exercise, fitness and sports should be enjoyable and positive. Being injured, constantly tired, sore or fatigued is not.

For expert advice see The Podiatrist- specializing in Children’s foot problems

‘Growing Pains,’ Is There Actually Such A Thing?

Parents frequently hear their children complain of aches and pains that affect their lower extremities. Some parents and even pediatricians attribute that to “growing pains.” But is there such a thing as growing pains? In this article we will take a look at some conditions that affect lower extremities in kids.

Sever’s Apophysitis

Sever’s apophysitis is a condition that affects children of the ages 8-14. Boys are more commonly affected than girls. Typical symptoms include pain in the back of the heel, which is worse with and after activities. The affected foot does not normally look any different than the unaffected foot. There is no noticeable swelling or bruising. X-rays also do not show any visible pathology.

Clinically, the patient will complain of pain when the heel bone is squeezed. Normally there is no history of trauma, however, trauma can also trigger this painful condition. Predisposing factors include high level of athletic involvement (doing more than one sport at a time), body weight, tightness of the calf muscles, flat feet and improper shoes (flip flops or flats).

Although Sever’s apophysitis is self-limiting, meaning that it eventually resolves by itself, it is best to have it evaluated and treated, as it may take a long time (months and, in some cases, years) until the symptoms go away.

Due to the intensity of symptoms, aggressive treatment is recommended and includes modification of activities, rest, ice, massage , anti-inflammatory medications, heel lifts in shoes, custom orthotics (inserts in shoes), calf stretches, and physical therapy. In severe cases, cast immobilization for 2-4 weeks is helpful. Overall, the prognosis for Sever’s apophysitis is excellent.

Iselin’s Disease

Iselin’s disease is inflammation of the growth plate of the fifth metatarsal base. Just like Sever’s apophysitis, Iselin’s affects physically-active children between ages of 8 and 14.

The most common sports leading to this condition include soccer, gymnastics, dance and basketball. Iselin’s apophysitis is an overuse condition of the base
of the fifth metatarsal. Tight calf muscles, high arch and flat foot type are predisposing factors.

Your child will complain of pain along the outer edge of the foot that is worse with activity and improves with rest. He/she may limp or walk on the inside of the foot.

The growth center may be enlarged, red, and painful to the touch as compared to the other side.

Treatments are similar to those of Sever’s apophysitis: modification of activities, ice, anti-inflammatory medications, custom orthotics, calf stretches, and in severe cases- cast immobilization.

Osgood-Schlatter

OSGOOD-SCHLATTER is a common cause of knee pain in children ages 10 to 15. It occurs due to a period of rapid growth, combined with a high level of sporting activity.

Osgood-Schlatter sounds far more frightening than it actually is. It is a common cause of knee pain in children ages 10 to 15. It occurs due to a period of rapid growth, combined with a high level of sporting activity.

These changes result in a pulling force from the patella tendon on the tibial tuberosity (bony protrusion at the top of the shin). This area then becomes inflamed, painful and swollen. Typical presentation includes pain over the tibial tuberosity, which is worse with and after athletic activities.

The area may become visibly inflamed and even larger in size than the unaffected side. Treatments include rest, ice, anti-inflammatory medications, quadriceps stretching, bracing (knee support knee strap to decrease tension on the patellar tendon) and physical therapy.

If you are at all concerned about your child, make an appointment today.