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Children's feet

Common problems seen in children's feet.


Curly Toes (Varus Toes)





Curly toes are commonly seen in the clinic and can be a source of anxiety for parents. The vast majority of curly toes don't cause any problem at all and don't require any intervention, they correct by themselves through normal walking.  Up to the age of three these toes can be splinted with a sillicone splint or with taping which normally straightens the toes within three months. Stretching the toes as part of the bedtime routine can be a fun way of encouraging the flexor tendons to lengthen.  


Very occasionally severely overrding or underriding toes cause big problems with shoe fitting and can become painful.  In this instance it may be necessary to seek the advice of a foot surgeon.





Intoeing and Outoeing


childrens_feetIntoeing and outoeing occurs in many children as they develop.   The vast majority of children grow out of this.  Extreme presentations need checking out by your clinician because occasionally there maybe some underlying cause. Special note needs to be taken if only one leg affected or there is a lack of symmetry.








Intoeing has three main presentations:


  • metatarsus adductus (an inward curvature of the foot that makes the foot look kidney bean shaped)
  • tibial torsion (longitudinal twisting of the shin bone)
  • femoral anteversion (internal rotation of thigh bone).


Very occasionally intoeing can be a sign of a neurological disorder.  Always check if you are worried or if your child's gait is getting worse instead of better.


Tip:  video your child and then re-video 3 months later - if no improvement or worsening seek medical advice.




Knock Knees and Bow Legs (Genu Valgum and Genu Varum)


knock_knees_and_bow_legs_2Similarly to intoeing and outoeing a certain amount of bow legs and knock knees are a normal part of development. In the early years a child maybe bow-legged followed by being knock-kneed.  Even extreme bow legs at the toddler age usually self correct over time.  It is very rare to have to medically intervene.  Up to 18 months bow legs are considered normal.  By the age of 3 the legs will probably be knock-kneed.  Seek advice if the legs are not symmetrical or if the bow legs persist beyond the age of 3. There are few diseases that can cause bow legs so seek medical advice to reassure yourself.


It is normal for a child's legs to be a bit knock kneed up until the age of 7.  Beyond the age of 7 knock knees can be caused by obesity but otherwise it should be checked out by a healthcare professional to rule out any other underlying causes.




Toe Walking 



Idiopathic toewalking is the name given to a condition where a child or person walks on their tippy toes for no apparent medical reason.



Toe walking is usually habitual and is associated with tight calf muscles and achilles tendon.  More rarely neurological conditions such as cerebral palsy can cause toewalking, it is also observed in some children on the autism spectrum.


If your child struggles to get their heel to the ground treatment may be indicated.  If the calf muscles are tight, stretching exercises will be given.  In extreme circumstances a splint may be necessary. 


Remember, most kids grow out of it, but a small minority choose to walk like this for life.  Toe walking can lead to leg and foot pain and balance issues - if worried, seek advice.














Flat Feet


Flat_footFlat feet in children up to the age of five is perfectly normal. Between the ages of six to eight the arch should have fully formed but if parents are concerned it is worth visiting your podiatrist for advice.  We no longer prescribe special shoes and insoles for the developing foot unless the child complains of pain, has difficulty walking or trips frequently.


Seek advice if your child's foot feels rigid or looks different to the other foot.  Always seek advice if your child says their feet hurt.   Rarely malformations within the foot can cause a rigid flat foot that will require treatment.




Growing Pains




Despite the name, these pains are nothing to do with growth spurts.  They are sometimes known as 'nocturnal limb pains'.  They can feel cramp-like and be in the calf, shin or ankle and ofter occur after a very active day but we don't really understand why they occur.


Bone pain at night must be taken seriously especially if combined with swelling, weight loss, fever and a limp - if this the clinical picture your child presents, visit your GP for further investigations.




Nocturnal limb pain can be eased with paracetamol or ibuprofen - remember, never give aspirin to a child under 12.










Osgood Schlatter Disease and Severs Disease


Osgood Schlatter





Osgood Schlatter Disease is not really a disease, it is an overuse injury usually occurring in adolescents that are growing.  As a general rule it affects girls between 8 and 13 and boys between 10 and 15.  


The pain is felt on the top of the shin bone just below the knee, it is not uncommon to see swelling here.  Treatment involves rest, icing, stretching and strengthening, strapping or possibly wearing a brace on the knee to stabilise the patella.  It is important to check for underlying biomechanical problems.  If biomechanical problem is detected, orthoses may be prescribed. Seeking advice and treatment will speed up the recovery of this condition.




































Severs Disease




This pain is felt at the back of the heel in children between 8 and 12.  It occurs when the shin bone is growing faster than the calf muscles and Achilles tendon (making them tight) which has the effect of yanking on the growth plate at the back of the heel bone.  The commonest presentation is that of a very active sporty or dancing child.




It is usually felt in one heel but can be both and can be very uncomfortable.  It is a self limiting condition but if left untreated it can interrupt activity for some months.  The pain can be eased with supportive footwear, heel lift cushions, ice and rest.





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