Total Care Podiatry

What is normal?

A child of this age should be growing out of the knock-knee posture by 7-8 years old. Sudden growth phases or spurts can lead to unusual walking patterns and postures, which while understandable taking into account the resultant tight and weak muscles, does increase the risk of injuries occurring.

What is abnormal?

If your child begins to complain about having pain in their legs or feet, especially during activities or has frequently trips or falls, it may indicate an issue that needs a podiatrist’s assessment. Injuries such as a ‘pulled muscle’ or a ‘rolled ankle’ that occur regularly, especially for no known reason, or an injury that doesn’t fully get better is indications of dysfunction.

Sometimes pain or problems occur in the leg from poor foot function, such as:

knee pain

shin pain

ankle pain

calf muscle cramps

achilles tendonitis

Treatment can include, stretching and strengthening of muscles, joint mobilisation, taping, footwear modification and orthoses.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is normal?

A child of this age may have an appearance of knock-knees. If this doesn’t resolve by the age of 7, it may continue into adult life. Therefore an assessment by a suitable health professional is advised.

As part of this, there may be an internal rotation of the legs from the hips. This can especially happen after or during a marked growth phase, as the hamstring muscles often become tight and as a result internally rotate the legs on the hips.

What is abnormal?

If a child is still demonstrating structurally “flat feet” at the age of 6 then this should be assessed by a podiatrist. Structural problems such as abnormally joined bones may be present, so tests such as X-rays, CT scans or other imaging techniques may be indicated.

Keep in mind that early diagnosis often means early treatment. If the arch of your child’s foot excessively ‘rolls-in’, it is advisable to have that cause identified by a podiatrist qualified and experienced with young children’s foot and leg conditions. Once the cause of the flattening is discovered, the condition can be addressed. This process of diagnosing WHY the foot rolls-in rather than just supporting the foot to improve it’s posture is most important for the future development of your child’s foot.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is normal?

In this age group a child should be developing a more steady and confident walking gait. The bow legs posture normally is present by 3-4 years of age. The child should be able to alternate feet while climbing upstairs, kick a ball, pedal a tricycle, climb and hop on one foot.

A child may exhibit signs of “toe walking”. It is not uncommon in 2 and 3 year olds, but normal heel-strike should be demonstrated by the age of 4. Most commonly it is from weak muscles as part of their normal growth phase.

What is abnormal?

If “Toe-walking” is present between 3-4, it is advisable to have the child assessed by a podiatrist or other qualified health professional as this condition may be due to

(1) Muscle imbalance

(2) Or may be related to a neurological disorder

Another common problem is an “in-toeing or pigeon toe” gait style. Your podiatrist will be able to determine where the in-toeing is originating and will treat accordingly.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is Severs Disease?

Severs disease is rear foot pain and/or ankle pain as a result of inflammation of the growth plate of the heel bone in children. The heel pain is often localised around the back of the heel. This condition most commonly affects children between the ages of 8 to 14 years. This type of condition commonly occurs in those kids who are very active with sport.

In the initial stages of the condition most children displaying signs of Severs disease will tend to hobble or limp off the football field, soccer pitch, basketball court or netball court. Kids will complain of sore heels near the end of activity.

What Causes Severs Disease?

The cause of the pain in Severs disease is thought to be the tractional forces applied to the growth plate of the heel bone the Achilles tendon and the plantar fascia.

This tractional force by the Achilles tendon and the plantar fascia on the growth plate is often aggravated by tight calf muscles and excessively pronated feet (i.e. feet that “roll in” too far).

Treatment of Severs Disease?

The good news is that this heel pain in children is very simple to treat and children usually respond very quickly to treatment once treatment of Severs disease commences.

When this condition affects both feet, often the diagnosis can be made clinically. If only one foot is affected then x-rays should always be taken of both feet if your child fails to respond to what is considered normal treatment for Severs disease.  This is to ensure serious problems such as bone infection or  bone tumors are not overlooked. Even in cases where both feet have been affected, x-rays or MRI scans may be carried out if a child is failing to respond to conservative treatment.

Treatment of Severs disease usually involves a combination of ice therapy, activity review and/or modification, review of training surfaces, exercises, footwear review and orthotic inserts where foot function is causing excessive traction on the heel growth plate.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

Many parents who bring their child through our Podiatry Centre are concerned that they may have chosen incorrect shoes in the past.

They are worried that the shoes may have contributed to the problems their child is now experiencing in the feet or legs.

To assist parents in making the best choice we have put together  FEW ideas worth thinking about before purchasing shoes…….

How to choose the most appropriate shoes for your child……………

When Purchasing shoes for any age:

• Always get the size refitted each time; not only could your child’s feet have grown in size and / or width, but sizes vary amongst shoe maufacturers.
• It is best to buy shoes in the afternoon when you child’s feet are likely to be warmer and to have spread more through daily activity.  You will then be buying shoes when the feet are at their widest.
• Always have you child walk around when trying on shoes, as the feet will elongate as they stand.  Also walking in the shoes will give you an idea of any tight spots or areas which are slipping.
• When standing there should be a thumb space between the child’s longest toe  ( which isn’t always the big toe) and the end of the shoe uppers.  This allows ample growth room.
• When standing the child should be able to wriggle the toes freely and you should be able to ripple the leather over the toes.  This indicates the depth in the forefoot  is ample.
• Your child should wear the socks normally worn in the daytime.  If stockings are worn on the day of purchase, but thick sports socks are normally worn, then of course the shoes will be firmer.
• The shoes should be approximately the same shape as your child’s feet and should be made from a “last” to suit your child.  Your podiatrist will be able to tell you what type of shoe last your child needs.
• The sole of the shoe should be firm and only bend across the ball of  the  foot.  This also helps to limit excessive motion and allow the foot to act as a good lever.
• The upper should be of good quality, good breathing leather.

Are boots or shoes better for a growing child?

• We have all heard reasons for and against wearing either of these shoes.  Here are a few factors to go on when next trying to decide between the two.
• Children under the age of two have very flexible joints, feet and quite thin heels.  With the normal ” oxford” type of shoe, they simply tend not to stay on the foot well, no matter how good the shoe is.  It is primarily for this reason that the boot is typically recommended for this age group.  The uppers of the boot should be soft so as to not limit the ankle joint range of motion.  You may be concerned that the softness or flexibility of the boot will give any support to the ankle, and that they are not therefore much different to the oxford style.  However it is the foot posture which causes most instability in the ankle, rather than the shoe itself.  An inner support or insole would help in correcting any excessive instability.

Notes to remember:

• Worn our “hand me down” shoes are a definite “no-no”. The first owner has his or her own walking habits and WILL, therefore, wear the soles, uppers and inners in a particular fashion.  The second person then will be forced to wear and walk in the same way as the first person.
• While it is true that various aspects of the shoes can assist with an excessive motion problem, shoes themselves are not corrective devices.  If you suspect the need for correction, then please make an appointment at Total Care Podiatry.
• If you are continually faced with fitting problems or excessive or abnormal wear or distortion of uppers, this would be primarily due to the feet and not the shoes.  These would be indicators that is is time to see us at Total Care Podiatry.
• Dress-up shoes should be just that; for dressing up only and only worn occasionally.  A good fitting lace-up shoe worn most of the time is ideal for growing feet.  Not all “fashion” shoes will suit your children’s feet so be realistic.
• Our feet were made to walk on soft uneven terrain and doing so actually helps strengthen the muscles on the foot and leg.  However, with all the hard flat terrain about, it is best to protect your child’s feet from wanting to contour to this type of surface.
• Before the crawling stage, it is best to leave the child’s foot as free as possible, so that no restrictions are placed upon it – and it is allowed to develop freely.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.