Pediatric Foot Conditions

What are Pediatric Foot Conditions?

Pediatric foot conditions refer to a wide range of foot disorders that may affect the muscles, tendons, and bones of the foot causing significant foot deformity and functional limitations.

Treatment of foot conditions in children can differ significantly from that required in adults. However, the presence of pediatric orthopedists who specialize in treating children with orthopedic conditions has been able to impart a wide range of non-surgical and surgical techniques particularly designed to address distinctive concerns of children, that include special attention to preserving the health and function of the growth plate, thereby enabling continued growth and development of the foot.

Types of Pediatric Foot Conditions

Some of the pediatric foot conditions experienced by children include:

• Clubfoot: Congenital clubfoot is a common pediatric foot condition. The feet get twisted inwards and downwards at the ankles in such a way that the ankle or side of the foot comes in contact with the ground while walking instead of the sole of the foot. The leg and foot may be smaller, and calves less developed than normal.
• Cavus foot: Cavus foot, also referred to as a high arch, is a condition in which the arch on the bottom of the foot that runs from the toes to the heel is arched more than normal. Because of this, excessive weight falls on the ball and heel of the foot when walking or standing, causing pain and instability.
• Flatfoot: Flatfoot, also known as “fallen arches” or Pes planus, is a deformity in children’s feet where the arch that runs along the sole of the foot collapses to the ground or is not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years.
• In-Toeing: In-toeing, also called “pigeon-toes”, is an abnormal condition characterized by the inward turning of the toe or foot instead of being straight. You may observe in-toeing in your child at an early age when they start walking. Usually, in-toeing corrects itself without any specific treatment as your child grows up to around 8 years of age.
• Bowed legs: Bowed legs, also called genu varum, is a bony deformity resulting in outward curvature of one or both knees of the lower legs. It is commonly seen in toddlers and overweight adolescents. It is more noticeable while standing and walking with the feet together where an obvious space is noticed between the knees.
• Ingrown toenail: An ingrown toenail is a common and painful condition of the toe. It occurs when the side or corner of the nail grows inwards and penetrates the skin of the toe. Pain is often accompanied by swelling and redness. The big toe is affected most often.
• Heel pain: The heel is made up of the calcaneus bone and supported by a network of muscles, tendons, ligaments, and soft tissues, which together support the weight of the body and stress during movement. Heel pain is a common symptom of excessive strain placed on these structures.
• Plantar warts: Plantar warts are abnormal skin growths that appear on the bottom or soles of your feet and can spread from one person to another with skin contact. Plantar warts appear as light brown bumps with tiny black dots in them. They can bleed if picked or cut and can cause pain.

Causes of Pediatric Foot Conditions

Some of the causes of pediatric foot conditions include:

• Infection
• Genetics
• Neurological disorders
• Familial history
• Blount's disease
• Rickets disease
• Birth defects
• Abnormal fetal development
• Vitamin/nutritional deficiencies

Signs and Symptoms of Pediatric Foot Conditions

Some of the signs and symptoms of pediatric foot conditions include:

• Abnormal gait pattern
• Difficulty walking/running
• Frequent tripping
• Pain in the foot, leg, knee, hip, or lower back
• Discomfort while wearing shoes
• Inability to bear weight on the affected foot
• Tired, achy feet with prolonged standing or walking
• Shortened foot length
• Callus formation

Diagnosis of Pediatric Foot Conditions

Diagnosis of pediatric foot deformities involves gathering information about the symptoms, reviewing medical history, and conducting a thorough physical examination of the foot and ankle. Some pediatric foot conditions such as clubfoot can be diagnosed during a routine ultrasound performed during pregnancy itself. X-rays, CT scans, and MRIs may be ordered for evaluation of the bony and soft-tissue abnormalities and severity of the foot condition and to clinically confirm the diagnosis.

Treatment for Pediatric Foot Conditions

If your child does not exhibit any symptoms, your doctor may monitor your child’s condition as he/she grows to assess for any changes. If, however, your child has symptoms, your doctor may suggest some of the following treatment modalities.

Non-surgical Treatments

• Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time.
• Physical therapy: Stretching and strengthening exercises of the foot can provide pain relief, strengthen muscles, and optimize foot function.
• Medications: Pain-relieving medications such as NSAIDs can help reduce pain and inflammation.
• Shoe modification: Wearing a well-fitting, supportive shoe with an arch insert or support insole can help relieve aching pain and discomfort caused by the foot condition.
• Manipulation and casting: Repeated manipulation and casting using the Ponseti method are recommended for the early correction of clubfoot.
• Chemotherapy/cryotherapy: Use of chemicals such as salicylic acid to destroy warts and liquid nitrogen to freeze warts may be recommended.
• Orthotic devices: Your surgeon may advise wearing specially designed custom-made orthotic devices to support and comfort the foot. Braces and splints may also be recommended to help support weakened muscles during walking as well as slow the progress of contractures (tightened tendons or muscles that become shorter over time).

Surgical Intervention

Surgery is rarely needed to treat pediatric foot conditions; however, if conservative treatment options fail to relieve your child’s symptoms, surgery may be necessary to resolve the problem. Depending on your child’s condition, various procedures may be performed including tendon transfer surgery, tendon lengthening surgery, joint fusion, implant insertion, altering of the growth plates, and cutting and realigning the bone (osteotomy) to achieve proper foot alignment. Following surgery, physical therapy is usually recommended to improve strength and range of motion.