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Pediatric Foot Disorders

By DMG Podiatry, Foot and Ankle Surgery

Children's feet

Neglecting foot health invites problems in other parts of the body, such as the legs and back. There can also be undesirable personality effects. The youngster with troublesome feet walks awkwardly and usually has poor general posture. As a result, the growing child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatrist, pediatrician, and other medical specialists helps to resolve these related problems.

 

Baby's feet

The Human foot is one of the most complicated parts of the body - it has 26 bones, and has ligaments, muscles, blood vessels and nerves. The feet of a young child are soft and pliable; abnormal pressure can cause deformities. A child's foot grows rapidly during the first year, reaching almost half their adult foot size. Podiatrists consider the first year to be the most important in development.

 

Tips to help foot development occur normally:

  • Provide exercise; lying uncovered provides kicking and other related motions which prepare the feet for weight bearing.
  • Change the baby's position several times a day.
  • Look at your baby's feet often, if you notice something that does not look normal to you, ask your family physician or podiatrist.
  • Cover the baby's feet loosely; tight covers restrict movement.

 

Growing up

While children's feet continue to grow and develop, it may be necessary to change shoe and sock size every few months. Improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down.

The feet of young children are often unstable because of muscle problems which make walking difficult or uncomfortable. A thorough examination by a podiatrist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.

The American Podiatric Medical Association has long known of the high incidence of foot defects among the young and recommends foot health examinations for school children on a regular basis.

 

Sport activities

Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children participate actively in sports.

 

Pediatric Heel Pain

What is pediatric heel pain? Heel pain is a common childhood complaint. That doesn ’t mean, however, that it should be ignored, or that parents should wait to see if it will “go away.”

Heel pain is a symptom, not a disease. In other words, heel pain is a warning sign that a child has a condition that deserves attention.

The most common cause of pediatric heel pain is a disorder called calcaneal apophysitis, which usually affects 8 to 14 year olds. However, pediatric heel pain may be the sign of many other problems and can occur at younger or older ages. 



 

Symptoms

Heel pain problems in children are often associated with these signs and symptoms:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty participating in usual activities or sports

 

Pediatric heel pain vs. adult heel pain

Pediatric heel pain differs from the most common form of heel pain experienced by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is intense when getting out of bed in the morning or after sitting for long periods and then it subsides after walking around a bit. Pediatric heel pain usually doesn’t improve in this manner. In fact, walking around typically makes the pain worse.

Heel pain is so common in children because of the very nature of their growing feet. In children, the heel bone (the calcaneus) is not yet fully developed until age 14 or older. Until then, new bone is forming at the growth plate (the physis), a weak area located at the back of the heel. Too much stress on the growth plate is the most common cause of pediatric heel pain.

Causes 

There are a number of possible causes for a child’s heel pain. Because diagnosis can be challenging, a podiatric foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan.

 

Conditions that cause pediatric heel pain include:

Calcaneal apophysitis  Also known as Sever’s disease, this is the most common cause of heel pain in children. Although not a true “disease,” it is an inflammation of the heel’s growth plate due to muscle strain and repetitive stress, especially in those who are active or obese. This condition usually causes pain and tenderness in the back and bottom of the heel when walking and the heel is painful when touched. It can occur in one or both feet.
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Tendo-achilles bursitis
  This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Tendo-Achilles bursitis can result from injuries to the heel, certain diseases (such as juvenile rheumatoid arthritis), or wearing poorly cushioned shoes.

 Overuse syndromes  
Because the heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects overuse. Children and adolescents involved in soccer, track, or basketball are especially vulnerable. One common overuse syndrome is Achilles tendonitis. This inflammation of the tendon usually occurs in children over the age of 14. Another overuse syndrome is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from
the heel to the toes.

 Fractures  
Sometimes heel pain is caused by a break in the bone. Stress fractures—hairline breaks resulting from repeated stress on the bone—often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes. In children under age of 10, another type of break—acute fractures—can result from simply jumping 2 or 3 feet from a couch or stairway.

 Diagnosis

To diagnose the underlying cause of your child’s heel pain, the podiatric surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child’s foot and leg. X-rays are often used to evaluate the condition and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.


Topics and Subtopics: Children's Health & Foot & Ankle Problems

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