Don't ignore foot problems in children, doctor says

Dr. Bradley Lamm is a Baltimore-area foot and ankle surgeon and fellow of the American College of Foot & Ankle Surgeons.
Dr. Bradley Lamm is a Baltimore-area foot and ankle surgeon and fellow of the American College of Foot & Ankle Surgeons. (Handout, Baltimore Sun)

Many children suffer from foot problems that often go undiagnosed. There are many symptoms parents can watch for, says Dr. Bradley Lamm, a Baltimore-area foot and ankle surgeon and fellow of the American College of Foot & Ankle Surgeons. Many parents think children can outgrow foot problems, but Lamm said it is important to get treatment.

What are some common pediatric foot conditions?


Ankle and foot problems are common in children due to their high levels of physical activity, but it is easy for the signs and symptoms of underlying foot and ankle conditions to go unnoticed because kids are so resilient. To support your child's foot health, keep an eye out for symptoms of common ankle and foot problems and consult with a foot and ankle surgeon if you notice ankles turning in more than usual, foot arch flattening, cramping, pain, limping, or a change in physical activity level or the child's desire to play outside.

Some conditions are more common than others:


•Flatfoot is generally a hereditary condition that occurs when the foot lacks an arch. Flatfoot can be painful, and can usually be treated with orthotics (arch supports), along with stretching of the calf muscle.

•Severs disease, commonly known as a "painful heel," is a growth plate disturbance that can appear in kids who are very active in sports. Symptoms include aching pain under the bottom or back of the heel, and possibly limping as the condition worsens.

•Clubfoot occurs at birth and can often be diagnosed before birth with an ultrasound. Treatment is typically immediate, about one week after birth, with a specialized casting technique for the first two months, and then specific shoes and a bar is used up to 4 years of age.

•Tarsal coalitions typically occur in older children, usually between the ages of 9 and 14. Tarsal coalitions occur when the devolving joint is fused together by a "bone bridge." Symptoms include a stiff foot that can be quite painful, which decreases the child's activity.

•Growth plate injuries normally result from foot or ankle injury, a common occurrence among active youth. Breaks or sprains can damage the growth plate so that no more bone grows or the position of the bone is deformed.

•Bunions normally occur because of increased motion of the arch region and present as a bump on the inside of the ball of the foot. This bone bump is painful as well as the deviation of the big toe against the second toe. This bunion deformity is painful with shoes and activity. Guided grow plate surgery can correct the bunion at an early age (8-13) through a minimal incision.

It is better to seek medical advice earlier, as the treatment will likely be easier and the child would have a greater chance of returning to activity or their sport more quickly.

What does treatment for these conditions involve?

Initial treatment options for pediatric pain and foot/ankle injuries include rest, custom-made orthotics and anti-inflammatory medications. If conservative treatments fail to alleviate symptoms and conditions persist or worsen, more aggressive treatments, including surgery, may be required.

Treatment should be determined in consultation with a foot and ankle surgeon, factoring in the age of the child and the progression and severity of the condition.

At what age do you start seeing foot conditions in children?

Foot and ankle conditions and injuries can happen to children at any age but are most likely in highly active children. Kids who play multiple sports or participate on multiple teams are generally more likely to experience foot and ankle injury or overuse conditions. Club teams, in particular, place increasing demands on children to play more frequently. Additionally, hard playing surfaces, including indoor facilities and turf, increase demands on the feet and ankles. Our practice often sees kids age 7 to 18 years for conditions stemming from many different sport activities.


How is treating pediatric foot conditions different from treating adults?

Fortunately, young patients often feel less pain, heal faster and are more mobile than adults. When surgery is necessary, children also have greater healing potential than adults. Other differences include a necessity to explain the condition thoroughly to both the child and the parent.

What are the long-term consequences of not treating foot conditions in children?

A common misconception I see in patients who previously visited a physician or pediatrician is that children will grow out of foot conditions like pediatric flatfoot, which is simply not true. Many children may have in-toe or bow legs, which can be normal, but others may be abnormal.

A comprehensive evaluation by a foot and ankle surgeon is necessary to determine the diagnosis and whether it needs treatment, monitoring, or nothing at all. The long-term consequences of not treating these conditions can include pain, joint arthritis, muscle weakness, overloading of the opposite foot and ankle, deformity, inactivity and mental frustration.

Whom do I see for my child's foot and ankle pain?

In the years before the foot and ankle's growth plates are fully developed, growth plate injuries in children can be very difficult to treat. Foot and ankle surgeons are specially trained in this area and are accustomed to caring for the growth plates, bones, and soft tissues in developing children.


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