Children’s Foot Care

Children with strong, healthy feet avoid many kinds of lower extremity problems later in life. That's why it is important to inspect your children's feet periodically.

Infants

The size and shape of your baby's feet change quickly during their first year. Because a baby's feet are flexible, too much pressure or strain can affect the shape of their feet. It's important to allow baby to kick and stretch their feet freely. Also, make sure shoes and socks do not squeeze the toes.

Toddlers

Do not to force a toddler to walk before s/he is ready. Once walking begins, watch the toddler's gait. Many toddlers have a pigeon-toe gait, which is normal. Some initially learn to walk landing on their toes instead of their heels. Most children outgrow both these problems. But other conditions detected early can be treated more easily.

When Foot Care Is Needed

To help with flatfeet, special shoes or orthotics may be prescribed. To correct mild in-toeing or out-toeing, your toddler may need to sit in a different position while playing or watching TV. If your child's feet turn in or out a lot, corrective shoes, splints, or night braces may be prescribed.

The foot's bone structure is well-formed by the time your child reaches age 7 or 8, but if a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With a doctor's care, however, the risk of future bone problems is reduced.

Remember to check your child's shoe size often. Make sure there is space between the toes and the end of the shoe and that the shoes are roomy enough to allow the toes to move freely. Don't let your child wear hand-me-down shoes.

Pediatric Heel Pain

What is pediatric heel pain?

Heel pain is a common childhood complaint. However, it shouldn’t be ignored or parents may be ill advised to wait to see if it will “go away”.

Often heel pain is associated with these signs and symptoms:

1. Pain in the back or bottom of the heel
2. Limping
3. Walking on toes
4. Difficulty participating in usual activities or sports

The most common cause of pediatric heel pain is a disorder called calcaneal apophysitis, which commonly affects 8 to 14-year-old children. However pediatric heel pain may be a sign many other problems, and can be can occur at younger or older ages.

Difference between pediatric and adult heel pain:

Adult heel pain most common form is plantar fasciitis. Plantar fascia pain is intense especially when getting out of bed in the morning or after sitting for long periods, then it subsides after walking around a bit. Pediatric heel pain usually doesn’t subside even after walking around a bit. In fact, the pain may even get worse.

Causes of pediatric heel pain:

There are number of possible causes for a child’s heel pain and the diagnosis can be complicated. A well trained podiatric foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan.

The following are conditions that may cause heel pain in children:

1. Calcaneal apophysitis. Better known as “Severs Disease”, which is very common in children.
2. Although it’s not really a true “disease”, it is an inflammation of the helix growth plate due to muscle strain and repetitive stress especially in children who are active or obese. It can occur in one or both feet.
3. Tendo –Achilles bursitis. This condition is an inflammation of a fluid filled sac, which is located between the Achilles tendon and the heel bone. It can result from injuries to the heel, certain diseases (such as juvenile rheumatoid arthritis) or wearing poorly cushion shoes.
4. Overuse syndrome. Because the heels growth plate is sensitive to repeated running and pounding on hard services, pediatric heel pain often reflects overuse. Children and adolescents involved in soccer, track or basketball are especially vulnerable. Achilles tendonitis is one common overuse syndrome. This usually occurs in children over the age of 14. Plantar fasciitis, is another overuse syndrome which is the inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes.
5. Fractures. Sometimes heel pain is caused by a break in the bone. For example, stress fractures – hairline breaks resulting from repeated stress on the bone – often occur in adolescents engaged in sports.  In children under the age of 10, another type of break – acute fractures – can result from simply jumping 2 or 3 feet from a stairway or bed.

Treatment Options

Treatment will depend upon the diagnosis and the severity of the pain. For mild heel pain, treatment options include the following: 

1. Reduced activity. The child needs to reduce or stop any activity that causes pain.
2. Cushion the heel.  Temporary shoe inserts are useful in softening the impact on the heel when walking, running and standing.

In addition to reducing activity and cushioning the heel, podiatric surgeon may use one or more of these treatment options:

1. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs)-ibuprofen, which helps reduce pain and inflammation.
2. Physical therapy. Stretching of physical therapy modalities are sometimes used to encourage healing of the inflamed tissue.
3. Orthotic devices. Custom orthotic devices prescribed by the podiatric surgeon help support the foot.

However severe heel pain, more aggressive treatment options may be necessary, which includes the following:

1. Immobilization. Some patients need to use crutches to avoid weight-bearing on the affected foot for a while. In fact for severe cases of pediatric heel pain, the child may be placed in a cast to promote healing while keeping the foot and ankle totally immobilized.
2. Follow-up measures. After immobilization or casting, follow-up care often includes use of custom orthotic devices, physical therapy, or strapping.
3. Surgery. There are some instances one surgery may be required to lengthen the tendon correct other medical podiatric issues.

Prevention of Pediatric Heel Pain

To reduce your child’s chances of developing heel pain, follow these recommendations:

1. Avoid obesity
2. Choose well- constructed, supportive shoes that are appropriate for your child’s activity
3. Avoid or limit wearing cleated athletic shoes
4. Avoid activity be on your child’s ability

What if symptoms return?

Often heel pain returns after it’s been treated because the heel bone continues to grow. Recurrence of heel pain may be a sign of initially diagnosed condition, or it may indicate a different problem. If your child continues to have heel pain, be sure to make an appointment with your podiatric surgeon.