CHILDREN’S “SILENT” FOOT PROBLEMS
The human foot is made up of 26 bones, over 100 tendons and ligaments and four layers of muscles on the bottom of the foot in the arch. It is a very complicated structure that is truly a miracle regarding its function. A child’s foot grows rapidly and can develop a number of problems quickly if not addressed. In fact, the child’s foot can reach almost half of their adult foot size in the first year. So attention to the child’s foot is important and cannot be dismissed as “growing pains” when they complain of problems.
A child’s foot is very flexible. Even the bones have flexibility at a young age that very quickly is lost as they mature. I have seen some remarkable injuries in even my daughter’s feet and bodies that in an adult would result in serious injury. Yet they came out of it without even a complaint. So when children complain, we need to pay attention as adults and parents.
The most common problems dismissed in children I see in my office includes the “Flat Foot” and “leg cramps” or pain at the end of the day that is often referred to as “shin splints”. These are actually all related. The heel position is crucial. If your child has a low arch or flat foot, look at their heel position. If the heel is vertical or straight up and down (perpendicular to the ground), the arch is not as great concern especially in the child under 12–18 months because there is a great deal of arch fat in the infant and early toddler months that causes the arch to look flat. The arch will tend to form after this time but heel position will persist and can even worsen becoming more tilted. This leads to deformities in the ankle joint as well as the joint below it called the subtalar joint and even the joints in the middle of the foot and beyond.
Heels that are not vertical can lead to common problems such as bunions and hammertoes but also problems in the back part of the foot and with the ankle that lead to adult problems that necessitate even surgery to correct at a later age that could have been prevented. Heel position can be addressed early with a wedge in a good support shoe for the toddler and, with advancing age, custom inserts in the child’s shoe.
My own daughter suffered from a tilted heel bone which I addressed in this very manner and, to this day, has made a significant difference in her foot without the need for surgery. Another very common problem is a pain in the heel bone or what some people refer to as the ankle of the foot in the child aged 8–14. This is often referred to as Sever’s disease or calcaneal apophysitis. It is an inflammation of the growth plate in the heel bone and if addressed/ treated early, can be resolved with stretching, heel or shoe inserts and icing. But the longer it persists the more difficult it becomes to resolve and may even require casting and taking a child out of activities.
It’s best to treat and catch this one early parents, and they can continue with their activities. The above two problems are not visible to the parent and so often overlooked or dismissed. Things like ingrown toenails and warts are easy to see and call for our attention. Don’t dismiss the above “silent” or non-visible problems as they can become advanced and more serious. The bottom line… If a child complains of pain with their foot or ankle or lower leg, get them seen right away. Better safe than sorry! If the child complains of pain, get them evaluated!!! Walter Warren, DPM, CPed