PEDIATRIC FOOT PAIN
If you notice that your child has difficulty walking or keeping up with their peers during sports, they may be experiencing suboptimal foot and ankle mechanics. If children are evaluated and treated while their feet and ankles are still maturing, they can avoid more severe ailments in adulthood.
A pediatric flat foot can be classified as either flexible or rigid. Flat feet are a result of mechanic instability of the rearfoot. Pediatric patients may or may not complain of pain. Biomechanical dysfunction while walking or running may be the only symptoms. A tight calf muscle is usually present.
The earlier in life that a pediatric flatfoot can be recognized and treated, the better the long term outcome. Recognition starts with you, as parents. Key elements to recognize include:
- Your child has difficulty running, or is unable to keep up in sports.
- Your child frequently complains about foot pain
- When examining your child’s feet from behind, their heel bones tend to tilt outwards, while their ankles jut inwards (see pic)
- You may see a remarkable decrease in the arch height
- The child’s shoes wear down quickly on the inside of the heel.
If you suspect that your child has flat feet, bring them in for an initial consult as soon as possible. Flat feet can be managed with a medical grade or custom orthotic. These orthotics will help realign the foot and allow it to mature in a more biomechanically advantageous alignment. Lower extremity strengthening, as well as glute strengthening is paramount for managing pediatric flat feet. Minimally invasive surgical options are recommended for older pediatric patients if their flat foot deformity has progressed beyond conservative intervention. Reconstructive flat foot surgical options may also be warranted in the older pediatric population. The surgical procedure also depends on whether the flatfoot is rigid or flexible. Reconstructive surgery is reserved for severe cases that have failed all conservative care.
Pediatric Heel Pain
The most common cause of pediatric heel pain is a conditional called calcaneal apophysitis (aka Sever’s Disease). The pain stems from the open growth plate (aka the calcaneal apophysis). A tight calf muscle can cause increased tension of the Achilles tendon at its insertion point on the growth plate, contributing to the painful symptoms. This condition is most commonly seen in active children around the ages of 11-14. Pain always resolves once the growth plate fuses, which is around the ages of 13-15 years old.
To diagnose calcaneal apophysitis, gently squeeze your child’s heel bone. This will elicit pain. If you suspect calcaneal apophysitis, have your child ice their heel after activities. Calf stretching should be implemented twice daily (see link). Decrease weight bearing activities until symptoms resolve.
The initial consult with always consist of x-rays to evaluate the growth plate for fractures. A comprehensive biomechanical exam will be performed to evaluate for any gait disturbances. Conservative treatment consists of calf stretching, contrast baths, dynamic contracture therapy, and medical grade orthotics.
Pediatric Sports Medicine
Injuries can happen while your child is engaging in their favorite sports. Although, children have the biological armor to heal their tissues rapidly after injury, persistent pain should always be a red flag that something more could be going on. The faster an injury is diagnosed, the faster rehabilitation can start in order to get your child back to sports safely and stronger than pre injury.
Determine the severity of your child’s pain and adjust their activity levels accordingly. Swimming or other low impact activities are good ways to give your child’s injury a chance to heal. Check your child’s shoe gear to make sure it isn’t worn out. Make sure that your child is spending plenty of time barefoot each day. Walking and running around barefoot will naturally strengthen your child’s feet and allow for optimal foot mechanics.
Initial consults will involve x-ray exams to evaluate for any bony pathology (i.e fractures, growth plate injuries, cysts, tumors) that might contribute to your child’s persistent pain. A comprehensive biomechanical exam will be performed to evaluate for any asymmetries. There may be a utility for medical grade or custom orthotics to address any structural deformities impeding normal biomechanics. Strengthening of the lower extremity muscular is paramount to rehabilitating a current injury and preventing future ones.