Foot problems are not limited to adults, as children can experience many of the same conditions that affect the adult foot. Since children's feet are not as fully developed, there can be some differences in how these conditions are treated. Below are some of the more commonly seen pediatric foot problems.
Heel pain is caused by many different conditions. The most common heel pain found in kids is is caused by inflammation in a growth plate on the back of the heel bone, irritated by the Achilles tendon. The pain is located on the back or the back bottom of the heel and is present with increased activity, or even standing or walking.
This pain typically occurs in kids from age 10 until the early teen years when the growth plate ‘closes’, or stops growing. It will generally resolve on its own, but help is needed to accelerate the process. This can include temporary activity/sports cessation, icing, anti-inflammatory medications, stretching, and heel lifts or cups. X-rays are needed to rule out fracture, which, though rare, is possible.
Other causes of heel pain can include stress to a ligament called the plantar fascia, seen in kids with flat feet and high arches. This pain is usually located on the heel near the arch, and is worse after getting out of bed and at the end of the day. Treatment requires stretching, icing, anti-inflammatory medication, occasionally steroid injections, and prescription inserts (orthotics) to control the underlying structural problem (support for flat feet and shock absorption for high arches).
Less commonly seen causes of heel pain can include foot symptoms of systemic diseases like juvenile rheumatoid arthritis. The underlying condition needs to be addressed to fully treat the foot in these instances.
Ingrown nails may be present in any toe and at any age. Ingrown nails may be genetically inherited (as is often seen in younger kids with ingrown nails), and may also be seen later in life due to gradual damage to the cells under the skin that grow the nail (nail matrix). Repetitive injuries to the toe, such as heavy objects falling, pressure from poorly fitting shoes, nail fungus, or toe bruising (common in athletes) may cause irreversible changes to the nail matrix. In time, the nail may abnormally grow inward due to these changes. Less commonly, poor nail trimming technique may leave a spike of nail that may protrude into the skin as the nail grows outward. Regardless of its cause, an ingrown nail will cause pain and inflammation to the skin along side it, and eventually infection will develop. If untreated, the infection may spread and may eventually involve the toe bone underneath.
Temporary treatment may consist of regular soaking in warm, soapy water, application of antibiotic ointment, and the use of antibiotic medication to control the infection. The offending nail border must be removed to resolve the condition. This is accomplished through a short office procedure where the nail border is removed under local anesthesia and a mild acid is used to prevent the nail matrix from ever growing the nail back into the skin. Home based “bathroom surgery” is not recommended as this may significantly worsen the condition.
Warts are hard and often painful lesions usually on the bottom of the feet. They can appear raised or relatively flat, and will often have a cauliflower-like pattern with black speckles. Caused by a virus and spread by contact with skin tissue containing the virus, this condition may or may not be painful and can easily spread around the foot and to other family members. Common areas of infection include bathrooms, showers, and locker rooms. Unlike warts on the hands, over-the-counter medications are usually ineffective.
Treatment takes time and patience. The most consistent and effective treatment involves removing the superficial hard skin every couple of weeks and applying a chemical to irritate the skin surface. In time, this will attract the body’s immune system which will create an antibody to the virus and destroy it. Ultimately, one will be immune to the virus strain after that. Although there are over fifty different strains of virus that cause warts and reinfection by a different strain is possible, it is not common to encounter the virus and most kids stay uninfected. Surgery can be considered to remove the wart, however, this is usually reserved for painful warts not responding to chemical treatment as no immunity is achieved in surgical treatment.
Flat feet are usually the result of one’s own genetics inherited from their family. Flattening is a normal part of the walking cycle of the foot. However, in some individuals the foot flattens outward too much. This changes the way certain muscles in the foot and leg have to function, which causes numerous changes to the feet over time. Some people may live their entire lives without having any problems, while some people may have pain starting in childhood. Young children tend to have flexible, flat feet as a normal finding, from which they usually develop normal arches before they reach school age. In many kids, the feet will remain flat beyond this period. Some kids are even born with a rigid bone deformity that locks them into a flattened position.
Because of the extra demand on foot and leg muscles, people with flat feet become fatigued easier, with leg pain or cramping after activity. A common complaint of children with flat feet is pain in the shins at night. Severely flattened feet may cause hip, knee, or back malalignment. Individuals with flat feet may develop bunions and hammertoes over time, and are eventually more susceptible to injuring their heel. In the most severe cases, early arthritis may develop in a number of joints in the feet.
For most kids, treatment with prescription shoe inserts (orthotics) is generally successful. Orthotics realign the foot to allow it to function properly. This helps to reduce much of the pain associated with flat feet, and will help prevent further progression of associated problems like bunions and hammertoes later in life. Properly supportive shoes are also a necessity. Unfortunately, severe cases, especially those in which the foot is rigidly flat, require surgery to reform the foot into a more functional shape.
Sprains are common in kids, and usually involve the ankle or big toe joint. Recess activities, sports, and active play can cause sprains. These generally heal on their own, and usually only need icing, rest, and support. Sprains that are severe, on which the child cannot bear weight, or minor sprains that do not heal in 2 weeks need to be evaluated. Any suspected fracture, even of a toe, needs to be evaluated as a growth plate can be affected. If improperly treated, growth plate damage can lead to bone deformity as the child develops further.
Bunions are a complex foot deformity of both bone and soft tissue. Usually inherited from one’s parents or grandparents, bunions have several underlying causes. The most common cause is flat feet. Over time, muscular changes needed to adapt to walking with flat feet will contract the great toe towards the second toe, and make prominent the 1st metatarsal head (bone) on the inside of the foot. This can create pain in the bunion when rubbed against tight shoes. Joint pain in the great toe can develop over time due to its abnormal position and eventual onset of arthritis later in life. The great toe can also crowd into the lesser toes. This condition is often seen in hammertoes.
Treatment can include conservative measures that attempt to pad the bump or separate the great toe from the second toe. Wider shoes may also help relieve bump pain. Orthotics (prescription shoe inserts) may help to lessen the progression of the bunion by controlling it’s underlying cause (usually flat feet). However, in most cases, surgical correction with correction of the bone position and soft tissue contracture is necessary to permanently treat this condition. This is only necessary in kids if the pain is severe, or if the deformity is limiting activity. Otherwise, surgery can wait until the teen years when the bones have little growth left.