Pediatric podiatry: podiatry for children and teenagers

Growth, childhood, adolescence, and podiatry

Between birth and the age of 18 on average, growth causes changes in cartilage, bone, and joint structures at varying rates.

In very young children, before they start walking, a podiatry consultation can identify any deformities and provide a range of advice (strapping, exercises, massage by parents, etc.) to improve symptoms.

Deformities or dysfunctions can be podal (localized in the foot) or in the overlying joints: genu valgum, congenital hip dislocation, scoliosis, etc.

In cases of scoliosis, for example, postural monitoring will allow the pediatrician and, if necessary, the rehabilitation physician to check the child’s posture and pain progression. The practice’s Spine 3D analysis tool allows the progression of curvatures to be quantified, in addition to all clinical tests.

Similarly, growth and sports activities can sometimes be complicated by growth disorders that are benign but painful and debilitating.

Therefore, podiatric and postural care can be a temporary solution to reduce pain.

Here are some cases frequently treated in pediatric podiatry…

Congenital disorders

A congenital condition is a disease or disorder that is present from birth. They are usually caused by genetic factors or abnormalities in the development of the embryo during pregnancy.

Congenital conditions can affect different parts of the body and vary in severity and impact on health. Some congenital conditions can be detected before birth through prenatal testing, while others may not be diagnosed until several years after birth.

Foot and toe deformities

Flat feet

Flat feet refer to feet with very little or no arch.

Flat feet are normal in children up to the age of 2, due to ligamentous hyperlaxity and the presence of fatty tissue on the inner edge of the foot.

The majority of flat feet are therefore benign, normal, asymptomatic, and correspond to a foot morphotype. This is referred to as benign idiopathic postural or static flat feet.

It is important for a growing foot not to be constrained by an overly pronounced arch (due to footwear or insoles) in order to allow the intrinsic muscles of the foot to develop and gradually form the arch naturally.

However, if other symptoms are present, or if flat feet persist in children beyond the age of 6, it may be necessary to seek specialist advice if the child experiences intermittent or permanent pain when walking (in the arch of the foot, ankles, knees, hips, or lower back).

Similarly, if the child has difficulty walking or running, this may be a sign of instability or balance problems. When walking or running, the muscles and joints must compensate for the lack of support from the arch of the foot.

A dysfunctional flat foot can cause an abnormal gait in children, which can affect balance and coordination, promoting dynamic genu valgum (inward rotation of the knee).

High arches

In contrast to flat feet, the arch of the foot is very pronounced. This can also cause pain due to excessive pressure on the metatarsal heads, muscle tension, and ankle instability.

In children, this increase in the height of the longitudinal arches of the foot is frequently associated with a neurological disorder.

Clubfoot (varus, valgus, equinus, talus)

A congenital foot abnormality that causes twisting or deformation of the foot. Surgery may be required to correct the position of the foot.

A common clubfoot is characterized by an inward and backward position of the foot, with the ankle curving downward and inward. The foot may simply appear deformed, having been held in an abnormal position in the womb (clubfoot posture).

In contrast, true clubfoot is a structurally abnormal foot, representing a genuine malformation (a developmental defect in the baby that occurs in the womb).

In this case, the bones of the legs, feet, or calves are often underdeveloped.

The position of the clubfoot can be corrected by joint immobilization and manual therapy (physical therapy, osteopathy) aimed at straightening the position of the foot and ankle.

In cases of true clubfoot, early treatment with immobilization is certainly advisable, but often complex interventions, usually surgical, are also necessary.

Metatarsus adductus

This condition is characterized by a foot that is turned inward. The mobility of the foot and ankle joints may be limited.

In metatarsus varus, the bottom of the foot is turned inward in such a way that the arch is raised. This abnormality is usually due to the position in the womb, does not usually disappear after birth, and may require temporary K-taping or strapping to correct the abnormality.

Syndactyly

A condition in which two or more toes are fused together.

These deformities affect one or more anatomical structures.

In the vertical plane, this is called camptodactyly: the toes are slightly bent like claws.

In the horizontal plane, it is called clinodactyly (the fingers often curve inward or outward due to congenital growth defects of the phalanges).

These variants can be combined with each other.

Lower limb deformities

Hip dysplasia

Hip dysplasia is a congenital malformation linked to problems with the development of the hip joint during fetal growth and is characterized by the fact that the femur does not fit properly into the joint at birth.

If left untreated, it can lead to hip development problems and impaired walking.

On the recommendation of a pediatrician or pediatric orthopedic surgeon, combined physical therapy and podiatric treatment can improve symptoms.

Genu valgum

Also known as “bow legs,” this is a condition in which the knees touch or come close together when the child is standing. It can be congenital and may be accentuated to varying degrees by the leg muscles during growth.

Genu varum

Also known as “bow legs,” the knees are apart when the child is standing.

Growth disorders in children and adolescents

Here are some common growth disorders in children:

Scoliosis

Scoliosis is a permanent deformation of the spine (or vertebral column) in three planes (front, side, and transverse).

This deviation of the spine is linked to a rotation of the vertebrae in relation to each other. In cases of scoliosis, the spine is twisted and its natural curves are altered. This condition causes a hump (a deformity of the upper back in the form of a bump). It occurs mainly in childhood and adolescence, but can also develop in adulthood.

It is important to consult a doctor or specialist if you think your child has one of these growth disorders in order to obtain an accurate diagnosis and appropriate treatment. The management of scoliosis may involve medical supervision, physical therapy, wearing orthopedic insoles, and sometimes wearing a brace, depending on the severity of the curvature.

In addition to EOS radiology (an innovative X-ray imaging tool, particularly thanks to its low radiation doses) prescribed by the doctor, postural monitoring can be carried out every 4 to 6 months at the clinic to monitor the progression of the curvature.

For more information on scoliosis monitoring at the clinic in the diagnosis and monitoring of scoliosis in children and adolescents:

The value of 3D imaging in the diagnosis and monitoring of scoliosis in children and adolescents

On 3D imaging of the spine and its benefits: https://pubmed.ncbi.nlm.nih.gov/21173617/

And on the 3D classification of scoliosis in adolescents: https://pubmed.ncbi.nlm.nih.gov/32026444/

Sever’s syndrome (or calcaneal growth osteochondrosis)

A growth disorder affecting the back of the heel (calcaneus) in children who are very active in sports.

It is benign and often occurs during adolescence between the ages of 8 and 16, more frequently in boys, often associated with overuse due to increased physical activity and sports.

It is characterized by intense heel pain during traction, shearing, conflict, and impact of the Achilles tendon in the area where it inserts into the bone.

Rest, stopping sports, and treatment with orthopedic insoles may be necessary to relieve symptoms and treat the underlying problem in the long term.

If independent limitation of the ankle joint is suspected, physical therapy can be performed, acting synergistically on the mobility of the triceps surae and Achilles tendon. This team effort will lead to gradual healing!

Osgood-Schlatter disease, or tibial tuberosity apophysitis

This is a common cause of knee pain in growing children and adolescents.

Children with Osgood-Schlatter disease usually have swelling and inflammation of the growth plates at the top of the tibia.

This swelling and inflammation can cause a painful bony bump on the tibia, just below the knee.

As bones grow rapidly, muscles and tendons do not necessarily grow at the same rate, causing tension and inflammation at their connection points with the bones.

The pain usually worsens when the child is active and improves when they are resting.

If you suspect that your child has a podiatric condition, it is advisable to consult a pediatrician and/or podiatrist for an accurate diagnosis and appropriate treatment to prevent or reduce the effects.