What is a Paediatric Podiatrist
A paediatric podiatrist specialises in the care of children’s feet and lower limbs. Children grow rapidly and live very active lifestyles. Often parents are told that your child will out-grow their conditions, this is true of some conditions, but many can be prevented from worsening and deteriorating and many can be corrected gradually over time or they can be manageed so your child becomes symptom free. If parents are concerned about their child’s feet they should always seek a professionals advice.
This is when it’s important to get the opinion of a podiatrist:
- If your child is in pain (look for subtle signs like unwillingness to walk, asking to be carried, a dislike of sport, sitting out when their friends are playing).
- If your child is unstable and tends to trip and fall more than their peers.
- Your child has some evidence of deformity such as flat feet, deformity of toes, bunions, hammertoes.
- Pigeon Toe walking (walking with their toes and feet facing inwards)
- Out toe walking (walking with their feet facing outwards)
How A Podiatrist can help?
At MyFootDr, we have a highly trained, skilled and experienced team of podiatrists. A podiatrist is a specialist that focuses on conditions that affect the feet, ankles and lower limbs and indirectly the entire kinetic chain. A podiatrist will provide an entire care management plan from prevention and “pre-habilitation” through to diagnosis and care management and rehabilitation.
Our podiatrists frequently advise parents who are concerned about the development of their children's feet. From young children, through to teens and all the way to adulthood. Not just for musculoskeletal conditions but we manage children with dermatological issues such as Fungal infections, Warts and Ingrown toenails. We will take an in depth look at your child’s medical history, developmental milestones, crawling patterns, walking/gait biomechanics, foot morpology, their play patterns and any questions that the parents may have.
For biomechanical conditions that the parents are concerned about we will also assess the child's gait through a walking and running gait analysis using our state of the art treadmill and video gait analysis system. The podiatrist will carry out clinical tests to get an understanding of your child's condition, watch the child play to help see how the child interacts with the parents. All of this to help us with an accurate diagnosis. From our gait analysis and clinical tests we can design a plan to help your child's condition.
The type of care management prescribed will depend on the condition and can include but not limited to:
- Exercise Rehabilitation Programme
- Strength, stability and mobility exercises
- Footwear modifications
- Custom Insoles (orthotics)
- Strapping Techniques
- Derotation Straps
- Supramalleolar Orthotics (SMOs)
- Ankle Foot Orthoses (AFOs)
- Physical therapy and physical modalities
Common Paediatric Conditions Affecting Children
Flat feet or fallen arches
If you have flat feet, you will have a very low arch or no arch at all, meaning one or both of your feet press flat on the ground. Flat foot are normal and should not be considered abnormal, but it can increase the risk of an individual having or developing musculoskeletal conditions and injuries. “Flat feet'' are not a medical diagnosis by itself but contribute to increased loads on the support structures throughout the lower limbs and entire kinetic chain.
Flat feet can be congenital (ie you are born with it) or can develop over time. Most who suffer from flat feet have no symptoms and normal foot function. But for others it causes pain and discomfort. Common areas of discomfort for children; in the calves, along the arches of the feet, the inside of the ankle and back of the heel. Those who suffer from flat foot pain can suffer increased pain from activity and when wearing shoes lacking support.
In Singapore, Flat feet are more common due to the genetic demographics. Certain ethnic groups have a greater degree of ligamentous laxity, which leads to a higher prevalence of flat feet. Our environment plays a big part too, our feet were meant for a soft environment, which would mould to our feet, but now we spend 80-90% of our lives in hard environments where our feet are required to perform a shock absorption roll. This shock absorption comes through the arches collapsing and the foot rolling inwards (pronating).
Paediatric patients with flat feet may experience symptoms like:
- Pain on the inside of the ankle and arch
- Pain in the Calves
- Tiredness from walking short distances
- Cramping
Flat feet “cannot” be fixed because they are actually normal, however they can be supported in biomechanically more congruent and efficient positions through podiatrist-prescribed customised insoles, exercise prescription, stretching and appropriate footwear changes.
Heel pain (Severs disease) (Calcaneal Apopysitis)
Sever’s disease (also known as calcaneal apophysitis) is one of the most common causes of heel pain in growing children, especially children who are very physically active. This injury results in inflammation of the growth plate in the calcaneus (heel bone).
Sever’s disease is caused by repetitive stress to the heel. It most often occurs in children with underlying biomechanical issues (eg flat feet, over pronation, poor mobility) that create increased stresses to the growth plate, but can also occur during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly.
Children and adolescents who participate in athletics — especially running and jumping sports — are at an increased risk for this condition. However, less active adolescents may also experience this problem, especially if they wear very flat shoes.
At MyfootDr Severs Disease is something we commonly see, there are many care management options available to your child and it is best to seek professional advice at an early age to give the best chance of success.
Care Management include but are not limited to:
- Custom made insoles
- Footwear Advice
- Strapping techniques
- Physical modalities and physical therapies
- Exercise and strengthening programme
- Stretches and mobility exercises
- Activity advice
Children with in-toe walking patterns
Intoeing is very common in children in Singapore. Also known as a pigeon toed gait. Often noticed by parents as the child trips and falls often and is considered clumsy. Often seen in children of all ages and can continue into adulthood if left unmanageed.
There are a number of causes of intoeing, the most common are;
- Metatarsus Adductus
- Femoral Anteversion/Antetorsion
- Tibial Torsion
At MyfootDr Intoeing is something we see commonly, there are many care management that could be suggested for your child and it is best to seek professional advice at an early age to give the best chance of success.
The care management include but are not limited to:
- Custom made insoles
- Ankle foot orthoses
- Footwear Advice
- De-rotation leggings
- Exercise and strengthening programme
- Activity advice
Children with out-toe walking patterns
Out-toeing is a condition that can occur in children in which the toes point outward rather than straight ahead. In many cases, the problems that lead to out-toeing in an infant first occur in the uterus due to the baby’s position. In older children, rotational differences in the legs can result in out-toeing. Some children may have pain, discomfort or limping related to the condition. Severe pronation and flat feet are also common causes.
At Myfootdr the care management for this include but not limited to:
- Custom made insoles
- Ankle foot orthoses
- Footwear Advice
- Exercise and strengthening programme
- Activity advice
Tip Toe walking
Toe walking is a walking pattern in which the child walks on their toes or the balls of their feet and there’s no contact of the heel to the ground. Toe walking is very common in young children who are 3 years old and younger, however, in children 3 years and older walking on tiptoes may not be normal and could be associated with an underlying neurological or medical condition.
At Myfootdr we can assess your child thoroughly and put together a management plan to help your child with their condition. Whether this is by using Paediatric ankle foot orthoses (AFO), custom orthotics or a referral to a specialist.
Juvenile bunions
A bunion, also known as ‘Hallux-Abducto-Valgus,’ is a bony protrusion/bump that develops at the big toe joint. Bunions in children have the same aetiology as adults, however, while adults can have extra bone growth (osteophytes), considerable osteo-arthritis and subsequently inflammation of the associated joint, this is not necessarily the case in children. Bunions develop the majority of the time, because of how the feet interact with the ground during dynamic motion. The way we walk ie our gait patterns, determines the pressures and stresses on our feet which lead to the big toe joint being subject to increased loads. This causes the big toe joint to deviate over time.
Care management for this include but not limited to;
- Custom made insoles
- Bunion splints
- Ankle foot orthoses
- Footwear Advice
- Exercise and strengthening programme
- Activity advice
Genu valgum (knock knees)
Genu valgum or "knock knees" is a deformity of the lower extremities. The majority of patients do not get any symptoms. This condition is generally initially recognised only when a patient complains of foot and knee pain. Children start developing Genu valgum around age 2, and it becomes most prominent between ages 3 to 4. A Genu Valgum position can predispose a child to developing knee and other lower limb injuries, especially if they are very active.
At Myfootdr we will assess your child thoroughly, taking them through a gait analysis and start at the feet to see if there is any correction needed with a custom made insole and correct footwear. We will also help to advise on activities and exercises that will help to build strength and to improve stability and often combine strapping techniques to assist patients as well.
Paediatric Hammertoe
Paediatric hammertoe occurs when a tendon contracture in the foot pulls on one or more toes, causing the affected toe to either point downward or curl under another toe.
Also known as curly toe, hammertoe in children is fairly common, with the condition usually present since birth. It is more often seen in one or two isolated toes. However, hammertoe may affect all of the child’s toes. As your child begins walking, this condition can become more noticeable and progress from a flexible deformity to a more rigid one.
Curly toes in children can be manageed with conservative methods such as using customised insoles to help biomechanical realignment. Coupled with the appropriate footwear for your child, this can help to stabilise and support the child’s foot as they grow, reducing the risk of developing rigid toe deformities.
Digital deformities also result from underlying biomechanical issues such as flat feet. Flat feet result in the extrinsic foot muscles overpowering the smaller intrinsic foot muscles (which keep the toes straight) and as a result cause the digits to claw.
High Arch feet (Pes Cavus foot)
High Arch (Pes Cavus foot) is a condition in which the foot has a high arch causing a large amount of weight to be placed on the ball and heel of the foot when children walk or stand. Their feet become sore at the top and middle and they have trouble finding shoes that fit properly. In addition, the high arches cause children’s ankles to roll outward slightly. This instability can lead to frequent ankle sprains.
Cavus foot can also be a sign of other more serious conditions such as:
- Charcot-Marie-Tooth disease (CMT)
- Spina bifida
- Polio
- Muscular dystrophy
Knowing the underlying cause of a cavus foot is important because it is likely to get progressively worse if it results from underlying neurological disorders. The team at MyFootDr are highly trained to recognise these conditions and to be able to put a care management strategy in place to manage the condition but also liaise with further specialists if required.