Children's Feet

Podopediatrics is the evaluation and conservative management of congenital, developmental and traumatic conditions affecting the foot and lower limb of newborns to adolescents.

My child has flat feet – What should I do about it?

Young children tend to have a fat pad in the arch giving the appearance of a flat foot.

It is usually not indicated to interfere earlier than about 6 or 7 years of age once their foot resembles that of an adult unless the youngster exhibits significant orthopedic or congenital deformities.

Expert diagnosis will alleviate your fears. If necessary proper care and treatment of the feet by your podiatrist beginning in childhood will prevent many of the mechanical and orthopedic problems seen in adults.

  If your child has flat feet - take action early while podiatric intervention can make a permanent difference.

 

If your child has flat feet - take action early while podiatric intervention can make a permanent difference.

Deviation from Normal

Certain neurological conditions result in spastic gait for instance and orthopedic conditions such as congenital deformities, osteochondroses, fractures, torsional and positional deformities.

Manifestation of X and O legs is common in Indonesia as is flat feet.

In addition, many children walk with an excessively in–toe or out–toe gait. Although they may not be in pain, they are damaging their feet. If indicated, orthotics can be fabricated with a gait plate to help correct in–toeing or out toeing.

Another common deformity is toe-walking. This condition is easily managed even in older children with 1 or 2 below knee casts with the foot in dorsiflexion over about 2 weeks and follow up orthotic therapy.

Other Disorders that your Podiatrist can Diagnose and Treat

Various osteochondroses which affect the ossification centers of the bone such as:

  • Osgood–Schlatter Disease – active children aged 10–15 years more prevalent in males than females, characterized by local pain, swelling and tenderness over tibial tubercle (knee)
  • Sever’s Disease – usually 8 –15 years, characterized by pain on palpation of posterior plantar aspect of calcaneus (heel)
  • Kohler’s Disease – most commonly in ages 3 –9, more prevalent in males than females, characterized by vague pain and tenderness localized over the navicular (midfoot) and is usually unilateral
  • Freiberg’s Disease – can affect any metatarsal head, but 2nd is most common (70%) pain experienced usually on the dorsum, usually ages 11–17, more prevalent in females than males
  • Diaz or Mouchet’s Disease – osteochondrosis of the talus; rare; probably associated with acute trauma in which there is compression of dome of talus; bone often remodels to a normal shape
  • Buschke’s Disease – osteochondrosis of the cuneiforms. Very rare
  • Osteochondroses of Os Navicular – has been described as affecting this joint; needs to be differentiated from other pathology of os navicularis/accessory navicular
  • Iselins Disease – osteochondrosis of the 5th metatarsal base at attachment of peroneus brevis; need to differentiate from a stress fracture, os vesaleanum or fracture; pain increases on tension on peroneus brevis
  • Treves’ or Ilfeld’s Disease – osteochondrosis of the sesamoids. Tenderness and pain on palpation; significant pain on dorsiflexion
  • Thiemann’s Disease – osteochondrosis of the phalanges

Many of these conditions can be rectified or greatly benefited by wearing conservative in–shoe mechanical corrective devices (orthotics) to realign the foot and leg in the best functioning position

Is My Child Walking Right?

Normal development is characterized by the following milestones:

Around 10 cm long at birth, your baby's feet will double in size in the first 12 months.

At 6 months the foot is still mostly cartilage. Full ossification doesn't take place until 18-25 years of age!

Most babies will start to crawl around 10 months and by 12 months they will start standing and walking with support.

Let them progress at their own pace rather than pushing them to walk too early - their little feet have to gain the strength to support their body weight.

At first they have jerky hip and knee motions.

By 15 months your infant will be walking unaided with a flat foot and full foot strike.

By 2 years they will be running with more flexibility at the knees and ankles with a period when both feet are off the ground, negotiating steps one at a time, jumping off a low step and kicking a ball forward. They will still appear flat footed.

By 2 1/2 years they can jump off a step with a 1 foot landing.

By 3 years they will have a near normal adult gait - that of heel strike to toe-off pattern, will be able to mount steps with alternate feet, jump off a step with a 2 foot landing and put on their own shoes. They will also be able to do some special tricks of walking on their tip toes as well as on their heels.

By 4 years they will be able to climb, walk downstairs with alternating feet, hop on 1 foot for about 5-8 consecutive hops, run on their toes and kick a ball in the air.

By 5 years your youngster will be skipping with alternate feet and be able to place 1 foot directly in front of the toe of the opposite foot walking forward along a straight line and generally be more rhythmical and efficient with assistive upper limb movements. Running by this stage will be characterized by the body leaning forward, arms swinging in a straight line with the elbows bent. They will by now have learnt all the skills of adult gait.

Other Deviations from Normal

Certain neurological conditions result in spastic gait for instance and orthopedic conditions such as congenital deformities, osteochondroses, fractures, torsional and positional deformities.

Manifestation of X and O legs is common in Indonesia as is flat feet.

In addition, many children walk with an excessively in-toe or out-toe gait. Although they may not be in pain, they are damaging their feet. If indicated, orthotics can be fabricated with a gait plate to help correct in-toeing or out toeing.

Another serious condition is talipes adductoequinovarus - club foot - which is rectified by serial casting and bracing. This method has significantly superior long term outcomes compared with that of surgical intervention.

Growing Pains

Your child wakes up crying in the night complaining that his legs are throbbing. You rub them and comfort him as much as you can, but he continues to whimper.

Sound familiar? Your child is probably experiencing growing pains

Did you know that up to 25-40% of Children Experience Growing Pains?

Growing pains generally strike during two periods: in early childhood among 3- to 5-year-olds and, later, in 8- to 12-year-olds.

What Causes Them?

No firm evidence shows that the growth of bones causes pain. The most likely causes are the aches and discomforts resulting from the jumping, climbing, and running that active kids do during the day as the pains often occur after a child has had a particularly athletic day.

Signs and Symptoms

Most children report pains in the front of their thighs, in the calves, or behind the knees. Although growing pains often strike in late afternoon or early evening before bed, pain can sometimes wake a sleeping child. The intensity of the pain varies from child to child, and most don't experience pains every day.

Growing Pains always concentrate in the muscles, the joints appear normal whereas in the child suffering a more serious disease, the joints appear swollen, red, tender, or warm.

Diagnosing Growing Pains

One symptom that doctors find most helpful in making a diagnosis of growing pains is how the child responds to touch while in pain. Children who have pain from a serious medical disease do not like to be handled because movement tends to increase the pain. But those with growing pains respond differently - they feel better when they are held, massaged, and cuddled.

Growing pains are what doctors call a diagnosis of exclusion. This means that other conditions should be ruled out before a diagnosis of growing pains is made. A thorough history and physical examination by your podiatrist or doctor can usually accomplish this. In rare instances, blood and X-ray studies may be required before a final diagnosis of growing pains is made.

Helping Your Child

Some things that may help alleviate the pain include:

  • massaging the area
  • stretching
  • placing a heating pad on the area
  • giving ibuprofen or acetaminophen (Never give aspirin to a child under 12 due to its association with Reye Syndrome, a rare but potentially fatal disease)
  • studies show that in 90% of cases, treatment with foot orthoses relieves the majority of growing pains

Growth Spurts

It is the growth plates, which are thin sections of bone, that actually do the growing. As your child continues to grow, their growth plates strengthen and become regular bone.

No child grows at a perfectly steady rate throughout this period of childhood, however. Weeks or months of slightly slower growth alternate with mini "growth spurts" in normal children. Children tend to grow a bit faster in the spring than during other times of the year.

0 - 1

The first year of an infant's life is a time of astonishing change. During this time, a baby will grow rapidly.On average, babies grow 25 centimeters in length while tripling their birth weights by their first birthday.

After age 1, a baby's growth in length slows considerably, and by 2 years, growth in height usually continues at a fairly steady rate of approximately 6 centimeters per year until adolescence.

2 - 3

During the third year of life, most toddlers gain about 1.8kg and grow about 5 - 8cm per year.

They're extremely active and mobile, and learning in very physical ways. They're sleeping less than they did in the year before, running around and exploring their world, and picking up new skills, like riding a tricycle.

Your toddler's appetite may fluctuate greatly now, which is common. Kids who are active, happy, and engaged and eat a variety of healthy foods are probably getting the nutrients they need and growing normally.

4 - 5

Children at this age are still very physical, but they learn in a more focused and less hectic way than when they were younger. These kids typically gain about 1.8kg and grow about 5 - 8cm per year. They're still developing and refining their gross motor skills, using their arms and legs to get around and to get what they want, as well as their fine motor skills, using their fingers, hands, and wrists for small movements, like picking up objects. By age 4, children can usually hop and eventually move on to skipping.

Play becomes increasingly imaginative and is an important part of kids' growth and development now. So it's important to make sure they have time for creative play - whether that means drawing pictures, running around in the backyard, or playing house.

6 - 12

As children grow from grade-schoolers to preteens, there continues to be a wide range of "normal" regarding height, weight, and shape.

Kids tend to get taller at a pretty steady pace, growing about 6 - 6.5 cm each year. When it comes to weight, though, they often start gaining weight faster at around 8 to 9 years of age.

This is also a time when children start to have feelings about how they look and how they''re growing. It's common for girls in particular to worry about being overweight or "too big," while boys tend to be sensitive about being too short.

Try to help your child understand that the important thing is not to "look" a certain way, but rather to be healthy. Your child can't change the genes that will determine how tall they will be, but he can make the most of whatever height that is by developing healthy eating habits and being physically active.

Puberty

A major growth spurt occurs at the time of puberty.

Children usually enter puberty between age 8 to 13 years in girls and 10 to 16 years in boys. The average girl grows fastest between 12 and 13. Once girls start to menstruate, they usually grow about 2.5 - 5cm.

At their fastest, girls can grow taller by as much as 8cm a year and boys at a rate of 9cm a year. The average boy grows fastest between 13 and 15. Puberty lasts about 2 to 5 years. Growth is triggered in both boys and girls by increased levels of the sex hormone testosterone. This chemical also triggers the sexual organs to develop. The puberty growth spurt accounts for about 20% of our adult height. During this time as much as 10 - 30 cm will be gained in height.

By the time girls reach age 16-18 and boys reach age 16-20, the growth associated with puberty will have ended and they will have reached physical maturity although in boys especially their muscles may continue to develop.

Guess which bones can start growing first? The feet! So needing new shoes is the first sign. A teenager's developmental age can be measured by looking at the maturity of the bones in their hand and wrist. Next, arms and legs grow longer. The shin bones lengthen before the thigh, and the forearm before the upper arm. Finally the spine grows. The last expansion is a broadening of the chest and shoulders in boys, and a widening of the hips and pelvis in girls.