CHILDREN AND PODIATRY
"Don’t worry – they’ll grow out of it” is a common response to parents concerns about the development of their children’s feet or legs.
In some cases this can be true, however as children grow up their feet and legs undergo various stages of development. As Podiatrists we are able to advise you whether your child’s development falls within acceptable limits for their age, or if treatment may be required.
Don’t dismiss your chills consistent complaints of aches as “just growing pains” The reason for this can sometimes be due to poor foot and leg posture. Flat feet, intoed, bow-legged and knock-knees are some of the conditions worth assessing. The following are common paediatric conditions treated by our podiatry team:
- Pigeon/In-toe gait
- Severs Disease (Osteochondrosis)
- Flat Feet. (see foot types)
1.Pigeon Toe Deformity / In-toe gait:
Intoeing of the feet commonly referred to as “pigeon toed”, is a common torsional plane deformity of the lower limb in children and is often a common cause for concern in parents.
Children with an intoeing gait may complain of fatigue in their legs or feet and often will trip over more often when running or during exercise.
Apart from being intoed, parents may also notice their child has “knocked knees”, flat feet or that they are just walking awkwardly.
Our Podiatrists understand the function and mechanics of the lower limb, and they can give advice, exercises or other treatment to rectify this condition.
Intoeing can be caused by rotational or positional problems in the hip, knee or foot. There may also be movements in the foot and leg to compensate for an intoed gait, and these compensatory movements may lead to further problems.
Treatment options for an intoed gait include biomechanical assessment with orthotic correction, a personalised stretching program, change to sitting or sleeping position and gait plates that encourage an out-toe gait.
This condition is a common complaint that has very successful results when treated early.
2. Severs Disease (Osteochondrosis):
Severs disease, or Osteochondroses of the Calcaneus as it's technically known, is a common condition causing pain in the heels, typically in growing children. It tends to affect children between the ages of 8 to 14.
The condition is due to excessive strain on the growth plate (or apophysis) of the heel bone. Typically the symptoms come on after some form of physical activity such as running or jumping. The pain can be quite uncomfortable which makes it very hard for a sufferer to walk for some time after the activity. However, with the pain there is usually very little to see for the symptoms, ie there is no swelling or redness and often the area is only slightly tender to pressure.
Usually however the symptoms settle with rest, only to be aggravated again with activity.
The cause of the symptoms is due to strain on the growth plate of the heel bone.
When a child starts to go through a "growth spurt" their bones go through quite an active change so that new bone may develop to enlarge the skeleton. The area of growth in a bone is called the apophysis. The apophysis in the heel bone is at the back of the bone.
For new bone to develop in this area the bone must utilise nutrition from the blood, so the blood supply to this area increases during a growth spurt.
Along with this the leg bones are getting longer and the calf muscles are getting shorter. The calf muscles attach to the back of the heel bone via the achilles tendon, just behind the apophysis. This means that when a child is going through a growth spurt, any contraction of the calf muscles can tend to pull at the area of the growth plate.
The result is, the growth plate (with an already increased blood flow) is irritated by the pulling at the back of the bone. This causes a further increase in blood flow, leading to swelling within the bone itself and pain.
The extra blood to the bone is squeezed in and out of the bone during activity. However after resting for a while more blood has a chance to enter the bone and stay there, thus it swells within the bone itself. Thus the first few steps after rest cause considerable discomfort because the now engorged apophysis is again being strained by compression of the bone and pulling of the achilles tendon.
The area shows no inflammation or swelling because the problem is deep and within the apophysis and not close to the skin.
Often symptoms reduce as a child warms up into an activity. This is due to much of the extra swelling in the bone being squeezed out during movement. However symptoms will usually return quickly after a short rest.
Symptoms are often worse in children who put more strain on their calf muscles.This includes more active, overweight or children with unstable feet.
Because the symptoms are due to strain on the growth plate via the achilles tendon, the treatment should be aimed at reducing this strain. This can be achieved in a number of ways.
These ways are:
Lifting the heel slightly. Wearing a heel lift made from a material that won't compress easily such as cork or compressed rubber may reduce the strain on the achilles sufficiently to stop the symptoms.
- Custom made arch supports (orthotics) can be made specifically for the child's feet. This is the most effective way of stabilising the feet and usually the most effective method of relieving symptoms in the long term.
- Supporting the foot if it is unstable will often reduce strain on the calf muscles. Proprietary arch supports may achieve this in some cases.
- Stretching the calf muscles: Once symptoms have settled slightly it's worth while doing calf stretches to reduce the pull on the back of the heel.
- Avoid wearing excessively flat shoes or sporting boots that may cause strain on the achilles. Football boots, for example with worn heel spikes tend to cause strain on the achilles.
Once the strain has been physically removed from the back of the heel, you may then reduce the swelling within the bone to settle the symptoms. This can be achieved by:
- Icing and resting the area.
- Elevate the foot after activity by sitting down with the feet up above the level of the heart. This helps to reduce blood flow to the feet and thus helps to reduce symptoms.
- Anti-inflammatory medication causes a generalised decrease in swelling. Consult your doctor for best advice for this treatment.
WHAT TO EXPECT:
Severs disease will settle after a growth spurt has finished, however some children put up with symptoms for between 6 months to 3 years. The episodes tend to be periodic, usually offset by sporting activities.
Treatment using simple heel lifts, and stretching tend to improve symptoms enough to allow a child to play sport with minimal discomfort in about 50% of cases. Arch supports improve the condition in unstable feet in another 20-30% of cases.
If the pain is initiated by an injury such as a kick to the back of the heel or if other symptoms occur such as swelling, inflammation or severe pain during activity, then stop activity immediately and consult your podiatrist. This suggests something other than severs disease is causing the symptoms. Further investigation such as x-rays may be necessary in these cases.
If symptoms don't improve, consult your podiatrist.
For further information on this or any other foot, ankle or lower limb related problems see your Podiatrist at Stonnington Podiatry.
Toorak 03 9188 4228
Malvern 03 9576 0467