FOOT OR ANKLE PROBLEMS

FOOT PAIN

Foot pain in a child can be the result of a vast array of processes ,  ranging in severity  from benign conditions  such as  ”growing pains” and   minor injuries  to  conditions  as sinister as infection and  cancer.

What to look for/Diagnosis:  Not every bump, bruise or complaint of pain warrants a trip to the doctor.  However, if your child’s foot pain has any of the following features, you should seek prompt medical attention:

  • Pain that wakes him or her from sleep
  • Pain associated with a fever
  • Pain associated with swelling, redness or warmth
  • Pain associated with limping
  • Unexplained pain that lasts for more than a week

 

Treatment:  The treatment of foot pain is entirely dependent on what is causing the pain and can range from brief periods of rest or activity modification to surgical intervention.

FLAT FOOT

The diagnosis of flat foot is given to children with low or non-existing arches in their feet. It is a common finding in younger children and often causes no problems at all.  On occasion, however, flat foot deformity may be caused by an underlying problem.

Diagnosis/What to look for: Flatfoot associated with pain, skin problems or unilateral (one sided) flatfoot requires further investigation by your pediatric orthopedic surgeon. Physical examination is often all that is necessary, however x-rays and sometimes CT scan or MRI may be necessary in children with abnormal findings on X-ray.

Treatment: Although custom arch supports are often prescribed, there is no scientific evidence to support their use in flexible, pain-free flat foot.  In children who have painful or stiff flat foot deformity, treatment may range from orthotic devices and stretching to surgical intervention.

SEVER’S DISEASE

Sever’s disease or Sever apophysitis is a painful condition involving the calcaneus (heel bone).  It commonly occurs in active young boys and girls between the ages of eight and thirteen. It is caused by inflammation at the back part of the heel bone in the area of a growth center (apophysis).

Diagnosis/What to look for: Activity related heel-pain in an athletic child is more often than not, due to Sever’s disease. Although x-rays are not necessary to make the diagnosis, they should be obtained to rule out other sources of pain.

Treatment: The hallmark of treatment is rest.  Pain medication like ibuprofen (NSAID’s), ice after activity, heel-cups and stretching are also helpful. On rare occasion, casting is necessary.

CLUBFOOT

Clubfoot is a congenital deformity that occurs when one or both feet turn downward and inward at birth. The causes are not known, but it occurs more frequently in boys and may be passed down through families. It may range in severity from very mild and flexible deformity to very stiff and difficult to correct.

Diagnosis/what to look for: The diagnosis is usually made in the newborn nursery with a simple physical exam. In some cases, it is even diagnosed prior to birth with an ultrasound.

Treatment: The most common, and most effective treatment of clubfoot is called the Ponseti method (www.ponseti.info). It is a treatment that involves gradual correction of the deformity with stretching and casting. This is followed, often times by a minor surgical procedure to complete the correction. A special brace is then used to maintain the correction. For best results, it should be initiated within the first week of life and should be done by a pediatric orthopedic surgeon who is trained in the Ponseti method.

TOE WALKING

Diagnosis/what to look for: The habit of walking on their toes is very common in small children under the age of three, and is not considered an abnormality. Most children will learn to walk in a heel-to toe pattern as they gain coordination and strength. Should they continue to toe-walk after the age of three, there may be other underlying causes that should be investigated by your pediatric orthopedic surgeon.

Treatment: The treatment of toe-walking depends on the underlying cause, the age of the child and the presence or absence of other deformity. In children under the age of four or five physical therapy and bracing are often effective. Older children, or those with contracture (tight heel cords) may require surgery.

 

CAVUS FOOT DEFORMITY

The diagnosis of cavus deformity is given to children with very high arches in their feet.

Diagnosis/what to look for: In addition to high arches, children with cavus foot deformity often complain of pain and instability. Because more than 2/3 of children with cavus foot have an underlying neurologic abnormality which is causing the deformity, further evaluation by your pediatric orthopedic surgeon is recommended in every case.

Treatment: Cavus deformity is frequently progressive and must be closely monitored by your doctor. Non-surgical treatment such as bracing and physical therapy can be effective in some cases, but surgical intervention is often necessary.

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