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Paediatric Podiatry

Children’s lower limb development is a big part of podiatry practice. Podiatrists treat kids of all ages as there are enormous changes that occur in normal development from before kids start to walk all the way through to adulthood. Podiatrists are able to assess, diagnose and treat all the following conditions for children.

Pressure can be applied to the feet whilst still in the womb and subsequently problems with the feet can occur. A common condition that can occur is a curvature of the forefoot on the rearfoot called metatarsus adductus (MTA). Most often this foot deformity will resolve naturally or with minimal stretching exercises, but monitoring of the condition by a podiatrist or health care professional is important. Sometimes orthotic therapy and/or serial casting is required and in a few cases, surgery. Your Brisbane podiatrist will be able to diagnose MTA and determine whether casting or surgery may be required.

Image source: Mount Nittany Health

As children move into standing and learning to walk, we can see a lot of rotation and de-rotation of the long bones of the legs which can lead to in-toeing or out-toeing. This may be caused by natural joint development or may be due to abnormal position or rotation of the long bones and may occur at different stages in one or both legs. It may be a natural part of lower-limb development however, sometimes treatment is needed to reduce muscle tightness or imbalance around the hips. If pain is experienced or tripping is occurring, assessment and treatment is recommended to determine whether this is part of normal lower limb development and if treatment is required.

From around the ages of 2-5 it’s normal for each lower leg to change from bow legs to knock knees before straightening out. Again this all needs to be monitored and if your child is tripping or falling, orthotic treatment may be necessary to prevent injury. Assessment also allows confirmation of normal age-related development compared with more serious pathology.

Image source: Deepika Patel & Associates

Flat feet are also fairly common in young children as the arch doesn’t form until around 3yrs of age. Still approximately 45% of children aged 4-7 have flat feet. The arch height can increase up until around 7-8 years of age. Most children will develop an arch, however if not a flexible flat foot may become permanent. Treatment varies according to the age of the child and may encompass exercise and strengthening programs or orthoses. However it is important to distinguish a flexible flat foot from rigid flat foot. A rigid flat foot in children can also indicate more serious pathology such as a condition called tarsal coalition.

A tarsal coalition is caused when one or more of the midfoot and/or rearfoot joints are fused fully or partially together, which can cause pain. The connection can be bony or cartilaginous or fibrous tissue and can cause significant restriction of the midfoot and or reafoot joints. This condition can affect one or both feet.  Pain is particularly evident during activity as the joint is pushed beyond its capable range of motion. A podiatrist is able to assess and diagnose this condition and help maintain activity. Surgery is sometimes required to restore full motion to the joints.

Normal x-ray (left) & Tarsal coalition (right)

Another common condition seen by podiatrists in young children is toe walking. Toe walking can be idiopathic or habitual (in that there is no specific pathology causing it) and often occurs in children up to 3 years of age. They may walk on their toes some or most of the time. Tight calf muscles can sometimes contribute to this type of gait, but when reminded the child is able to adopt a heel-to-toe walk. Sometimes toe walking can be indicative of some neuro-muscular conditions such as cerebral palsy, Duchenne muscular dystrophy or spinal disorders. Other times it can be as a result of developmental co-ordination disorders, where the child has a delay reaching major physical milestones and has issues with co-ordination. Your Brisbane podiatrist is able to distinguish if this is a symptom of more serious pathology or can be managed by exercise or orthotic therapy.

Hypermobility can occur in some children and can commonly affect the weight bearing joints such as knees, ankles and feet. Kids with hypermobility syndrome have ligamentous laxity and can suffer from pains and strains, soft tissue injuries and sometimes dislocations. Orthoses are often required to rectify severe flat feet or ankle pain associated with their joint laxity. A more severe form of hypermobility which is a genetic connective tissue disorder is called Ehlers Danlos Syndrome. With Ehlers Danlos Syndrome skin hyper-elasticity and blood vessel complications. Hypermobility disorders often require diagnosis to confirm or eliminate more serious hypermobility syndromes. Your podiatrist is able to determine whether further investigation is required to distinguish between general hypermobility or a more serious connective tissue disorders such as Ehlers Danlos.

Image Source: Brighton Diagnostic criteria for the Joint Hypermobility Syndrome

Another problem frequently seen by podiatrists in children is heel pain. Calcaneal apophysitis (Sever’s disease) can occur when the growth plate in the heel is irritated and inflamed from repetitive force and can occur in one or both heels. Most commonly seen in boys around 10-14 years of age (girls 8-12), it can be exacerbated by activity and is frequently seen in active children but sometimes in children that are first getting into sport. Initially it pain may be present during sport and then settles after activity has stopped. It’s exacerbated by raising up on the toes when running. It can be caused or exacerbated by

  • Decreased ankle range of motion
  • Poor rearfoot mechanics
  • Tight calf muscles

Calcaneal Apophysitis (Sever’s Disease)

This condition is usually treated with more conservative treatments which may include stretches, heel lifts, orthoses and activity modification. Proper diagnosis and monitoring is required to eliminate more serious pathology which can occur at the heel.

If you are concerned about any of the above conditions please contact your Brisbane podiatrist at Pivotal Motion Podiatry for assessment, diagnosis and treatment.