Podiatry and Children

Children's feet are not just small adult's feet! Children's feet and legs go through several stages of change as they grow. A podiatrist can assess, monitor and give advice on whether normal developmental milestones are being met. Parents or family members can sometimes be concerned regarding the appearance of certain conditions such as flat feet, knock knees and in-toeing. A podiatrist can assess your child's gait and musculoskeletal system and can advise if intervention is necessary.

There are a wide range of reasons that parents may seek the help of a podiatrist for their child.

These include:

  • Ingrown toenails
  • Skin conditions such as verrucas/warts or tinea/athletes foot, chillblains
  • Growing pains (vague night pain or specific eg Severs or Osgood-Schlatters)
  • Flat feet
  • Intoeing or pigeon toed
  • Tripping, falling or reluctant to do physical activity
  • Toe walking
  • Sports injury
  • Toe deformity (bunion, hammertoes, overriding toes)
  • Excessive shoe wear

Toenails

Fungal infection: generally prefer less invasive treatments such as tea tree oil or antifungal lacquer.

Nail issues with infants and preschool age is usually a genetic nail problem such as involuted nails. These nails grow curved and can almost grow in a complete circle. Older children can present with ingrown toenails especially teenagers.

Treatment involves:

  • cutting nails and treating and infection present (topically or GP referral for antibiotics)
  • teaching parent/caregiver correct technique
  • double check enough length, depth and width in shoes
  • surgical removal of ingrown section if no other option.

Skin Conditions

Veruccas or warts are caused by Human Papilloma Virus and are highly contagious.

Treatment involves breaking down the hard wall the verucca builds up around itself

  • Single warts: debride dead skin and apply salycilic based paint daily. Cover with tape
  • Mosaic warts: debride dead skin and in older children punctuate treatment involving multiple jabs through with needle under local anaesthetic. Younger children would recommend acid treatment but warn parents it will take a long time.
  • Tinea/athletes foot: antifungal cream and footcare advice
  • Chillblains: discuss cause and danger of cold to hot temperature change. Chillblain cream if skin intact. Dressing etc if broken open

Growing Pains

One of most common reasons for consultation. The pain can vary from generalised vague aching after activity or at night or very specific localised pain. All warrant a biomechanical assessment to see if can reduce symptoms. Examples of the most common site specific pains are:

Severs

  • Calcaneal apophysitis or inflammation of growth plate in heel
  • Pain around back of heel with activity, running and jumping worse, pain with lateral squeeze of heel bone
  • Extremely common at start of sport season especially winter sport
  • Treatment: reduce activity, footwear, heel raise or orthotic, stretching, ice, strapping

Osgood-Schlatters

  • Tibial apophysitis or inflammation of growth plate below knee
  • Pain with around knee with activity, kicking, palpation of tibial tuberosity or resisted extension
  • Treatment: reduce activity, footwear, orthotics, stretching, ice

Toe Walking

  • Sometimes due to a history of cerebral palsy or other neurological cause
  • Can also be due to muscle tightness or reduced ankle motion with walking or may even be a pain induced habit (Severs)
  • Treatment: exercises, possible heel raise, night splint

Sports Injuries

  • Wide range including shin pain, ankle sprains, foot sprains, turf toe (big toe sprain)
  • More commonly teenagers
  • Assess biomechanics, orthotics, exercises or may need to refer to physio

Toe Deformity

Main clinical objective is to reduce pain but patient or family may be concerned about appearance

Hammer or Retracted (clawed) Toes

  • In young children and can still manipulate toes easily then strapping works well
  • Gel tubes for pressure relief, assess footwear

Syndactyly (toes joined together)

  • No treatment unless family request surgical referral

Overriding Toe

  • If child young and toes can be manipulated the sling strapping
  • Assess footwear and possible pressure

Footwear

Hugely important for kids of all ages.

  • Fit: thumb width between end of shoe and end of longest toe
  • Correct width: if the foot hangs over side of midsole then shoe is too narrow, if foots can slip from side to side then shoe is too wide
  • Shoe should flex across forefoot ( that's where the foot bends after all)
  • Age appropriate
    • Infants: shoes not always necessary or else in a flexible bootie for warmth
    • Toddlers: flexible, soft soled, conforms to shape of foot, no support
    • Children: support only if needed
  • Lightweight: don't want a heavy shoe for growing bodies to run around in
  • Activity appropriate: netball, running, indoor court, football, touch, cross trainer
  • Foot type appropriate: neutral, cushioned, motion control, support

Roslyn Podiatry offers a free service where a podiatrist can fit shoes at Smiths Sports Shoes or else give advice.