Pediatric Foot Care

Children and teenagers are not really small adults and their podiatry needs are different. For example, there are many congenital foot issues present in infants, toddlers, children and teens that do not apply to adults.

Importantly, never ignore a child’s foot or ankle pain, whether they are able to tell you about it or you observe from an altered gait or limp. Children outgrow many foot problems, but some can worsen and affect them into adulthood. Only a professional diagnosis can tell the difference.

Here are some of the most common pediatric foot and ankle problems that we see in our office.

Clubfoot

A variety of infant foot abnormalities are called clubfoot, meaning that the baby’s foot is twisted out of shape or position. In this fairly common deformity, the infant’s foot tendons are shorter than usual. Clubfoot may make it difficult for the toddler to walk, so treatment is usually started shortly after birth.

Risk factors for clubfoot include a family history of the deformity. Clubfoot may be associated with other congenital skeletal abnormalities. Conditions during pregnancy such as smoking and inadequate amniotic fluid can increase the baby’s risk of clubfoot.

Untreated clubfoot may cause complications as the child begins to walk including:

• Arthritis
• Poor self-image as a teenager
• Abnormal walking gait and position
• Muscle and skin problems such as calluses due to abnormal walking

Symptoms

Clubfoot usually doesn’t cause discomfort. Symptoms include a twisting of the top of the foot downward and inward, making the affected leg slightly shorter. The calf muscles in the affected leg may be underdeveloped.

Treating Clubfoot

Babies’ joints, bones and tendons are flexible so treating clubfoot begins soon after birth.

The Ponseti method involves moving the infant’s foot into the correct correction and then applying a cast. Every week, the foot will be repositioned and a new cast applied.  This method requires maintenance with stretching exercises as well as special shoes and braces.

If the child’s clubfoot doesn’t respond to these conservative treatments, surgery may be required to lengthen or reposition the ligaments and tendons.

Preventing Clubfoot

You can minimize your baby’s risk of birth defects during pregnancy by not smoking, avoiding smoky environments, not drinking alcohol and not taking drugs that have not been approved by your doctor.

Flat Feet

Children often exhibit flat feet. Flexible pediatric flatfoot occurs when the arch of the foot disappears when the child stands and then reappears upon sitting. Most children with this condition are born with it and will usually outgrow it by age 5.

Rigid flatfoot is rarer and the arches will not reappear when the child sits down.

Symptoms

Most children with this deformity have no symptoms, but some will feel cramping in the feet or legs or foot pain. The heels may seem to tilt outward and you may notice a change in walking. Walking may cause pain and so the child may withdraw from physical activities and sports.

Rigid flatfoot may cause more serious symptoms

Treating Pediatric Flatfoot

Children outgrow pediatric flatfoot without treatment in most cases. However, if your child is experiencing pain, we can recommend a custom-fitted orthotic device that fits into your child’s shoe to help support the arch and ease pain. Older children may benefit from stretching exercises and physical therapy.

In rare cases, surgery can help rigid flatfoot and chronic pain.

Ingrown Toenails

An ingrown toenail is when the sides of the nail grow into the surrounding skin and tissue. Cutting into the skin like this may cause inflammation and infection.

Ingrown toenails may be very painful and make it difficult to wear closed-toe shoes. They are very common in teenagers.

Symptoms

The skin around the ingrown nail may appear red and warm. The damaged skin will allow bacteria to enter and then cause an infection.

When infected, the skin will become painful, red and swollen. There may be discharge of fluid or pus around the nail.

Without professional treatment, this infection may lead to a skin infection called cellulitis or even osteomyelitis, or infection of the bone.

Treating Ingrown Toenails

If the ingrown toenail is in its early stages, wearing wider shoes and trimming the nails straight across can help resolve the problem. Soaking the foot in warm soapy water and bandaging when shoes are worn can help ease the pain and inflammation.

If the toenail becomes infected or you see a discharge, please see a foot doctor. We will remove part of the toenail under local anesthetic and apply medication to stop the problem edge of the nail to regrow.

Preventing Ingrown Toenails

Always cut your child’s toenails straight across rather than rounding and don’t cut them too short.

Your child’s shoes should fit well and have ample room for the toes.

In-toeing and Out-toeing

Children often start walking with their toes and feet turned at an angle. “In-toeing” means the feet turn inward – sometimes referred to as walking “pigeon-toed” – while if they point outward, it’s called “out-toeing.” Most children walk with in-toeing or out-toeing which usually improves as they get older.

Most toddlers walk with in-toeing or out-toeing because of a slight twist or rotation of the lower or upper leg bones. It is uncertain why some children have these gait abnormalities, but a family history may play a role. Cramping in the womb may also contribute to these conditions.

Symptoms

Most children have no symptoms other than observed walking with toes pointing in or out. However, some may exhibit pain in the foot, knee, thigh or hip by limping.

Treating In-toeing and Out-toeing

If your child’s in-toeing or out-toeing doesn’t improve by age 3, if he or she has pain, if one foot turns out more than the other, if gait abnormalities worsen or if there are other developmental delays, please come in for an evaluation.

Some types of torsions may require surgery to untwist the bones to prevent more serious problems when the child is older.

Pediatric Heel Pain

Heel pain in children, although usually not serious, should be looked at and properly treated. These injuries can develop over time and often are due to overuse in rigorous sports training, especially running and jumping.

The most common causes of pediatric heel pain are Sever’s disease, an injury to the growth plate in the lower back of the heel, and Achilles tendonitis, an injury to the Achilles tendon that connects the calf muscles to the heel bone.

Symptoms

Sever’s disease causes pain in the back of the heel, especially when squeezing the back of the foot. You may see swelling and warmth in the area. The child may limp or walk on their toes.

With Achilles tendonitis, the child will feel pain in the heel or the back of the foot. The pain may be mild and then gradually get worse. He or she may have difficulty walking.

Treating Pediatric Heel Pain

Treatment depends on the cause of the heel pain. For Sever’s disease, treatment includes stretching the calf muscles, icing the area and pain medications. Custom orthotic devices can help redistribute pressure. Rest and cushioned heel lifts can help the child return to normal activities in 3 to 6 weeks.

With Achilles tendonitis, the RICE method of rest, ice, compression and elevation can help ease symptoms. Anti-inflammatory medications like ibuprofen can help relieve pain and swelling. Stretching can help to minimize re-injury.

Prevention

You can reduce your child’s risk of heel pain by:

• Keeping a normal weight
• Choose footwear that is appropriate for each activity
• Shoes should be supportive and well-constructed
• Limit wearing cleats and select models with a greater number of studs
• Not letting your child workout beyond his or her ability
• Making sure your child doesn’t accelerate speed or duration of activity too quickly

Sports Injuries

Youth safety when playing sports should be of utmost importance for the athletes, parents and coaches. Young athletes should not play or practice through the pain of a sports-related injury. Continuing to stress the injury can cause even more damage and may even end an athletic career.

Teach Your Child To Report an Injury

Teens and children should be coached on the limits of their bodies. Teach them to speak up when they feel pain and that it’s okay to sit on the bench until fully healed.

Be alert to signs of pain or injury including an unusual gait; limping; favoring a foot. Stop the activity and visit your foot doctor for professional help.

Preventing Youth Sports Injuries

Make sure that coaches are trained in their sports as well as CPR and first aid.
Equip your child with the right equipment and footgear for each sport.
Encourage adequate hydration before, during and after workouts.
Coach your child on the importance of stretching, warming up and cooling down.

Sprains

A sprain is an injury to the ligaments that connect bones to one another. This type of injury occurs when the ligament is excessively stretched or even torn.

The most common type of sprain for a child is an ankle sprain.

Symptoms

The symptoms in a child of a sprain are similar to those for a fracture and include:

• Pain
• Joint swelling
• Inability to bear weight
• Inability to walk

Treating Ankle Sprains

If after icing the ankle and resting the pain and swelling continue, visit a foot doctor. Treatment usually involves immobilization with a splint or compression with an elastic bandage. For a severe injury, a walking cast will help with immobilization.

If the swelling comes back or the pain persists, be sure to follow up with the podiatrist again to prevent chronic ankle instability.

Preventing Ankle Sprains

• Always have your child warm up and gently stretch before activities.
• Pay extra attention when running or walking on cracked or uneven surfaces.
• Watch for overuse and stop when you are tired or fatigued. Be sure to stop if you experience any foot or ankle pain.
• Make sure that an ankle sprain is fully healed before going back into workouts. Start slowly.
• Get the right shoes for each activity and replace them when they become worn.

Toe Walking

Toe walking, or walking on the toes or the balls of the feet, is common in toddlers who are just learning to walk. Most children outgrow it.

A child who continues to toe walk may do so out of habit. Generally, toe walking is not likely a cause for worry. However, toe walking may result from a shortened Achilles tendon as well as conditions such as muscular dystrophy, cerebral palsy and autism spectrum disorder.

Symptoms

You will observe your youngster walking on his or her toes, or the balls of the feet, instead of placing the heel down first. In some cases, the child will have reduced coordination and balance.

Treating Toe Walking

Your foot doctor will monitor your child’s gait. If a physical problem is diagnosed, treatments may include:

• Physical therapy to stretch foot and leg muscles.
• Leg splints or braces to help promote a normal gait.
• A series of casts below the knee may help pull the toes toward the shin.
• Injections into the calf muscle can bring about a more normal gait.
• Surgery can help by lengthening the tendons or muscles at the back of the leg.

Plantar Warts

Warts are caused by viruses in the human papillomavirus (HPV) family. When they appear on the soles of the feet, they are called plantar warts because they grow up into the feet toward the plantar fascia tissue. Plantar warts are especially common in children and teenagers.

HPV viruses are very contagious. For children, it’s easy to catch the virus on the soles of their feet when walking barefoot in public areas such as locker rooms, swimming pools and gym showers.

Symptoms

A plantar wart on the bottom of the foot can be very painful as it grows deeper. It can feel like you are walking on a pebble.

You may observe a grainy spot on the sole of the foot or a callus that has grown over a pinpoint plantar wart.

Treating Plantar Warts

Many plantar warts will go away by themselves. However, if it is painful for your child or the warts are spreading, see a foot doctor for permanent relief.

Treatment options include:

• Prescription-strength peeling medicine like salicylic acid can slowly take away the layers of the wart.
• Cryotherapy uses liquid nitrogen topically to freeze the wart. Repeat treatments may be necessary.
• Medication delivered topically or through an injection can stimulate your immune system to fight the virus.
• For very stubborn warts, minor surgery may be indicated to cut the wart away or destroy it with an electric needle.

Preventing Plantar Warts

You can minimize the risk of plantar warts for your child by:

• Caution him or her not to touch the warts. Wash hands carefully after touching it.
• Keep feet clean and dry. Alternate shoes to allow them to dry thoroughly and always wear clean, dry socks.
• Have your child or teen wear shower shoes or flip-flops in public areas like swimming pools, locker rooms, gyms and showers.
• Watch that your child doesn’t pick at or scratch warts.