​

Paediatrics - Podiatry 

​

 

More Than Growing Pains: The Paediatric Foot and How We Can Help?

​

Growing up will always have its’ awkward stages and challenges, but when is it time for the professionals to have a closer look?

​

Although it is important to note that not all children's foot concerns require intervention, and many may be ‘grown out’ in time, signs and symptoms of easily preventable complaints can often be lost in the grey area between what’s normal and what requires a trip to the paediatrician.  A common example of this would be ‘flat feet’.

I find myself regularly having to explain to parents that it is normal for babies and infants to have visibly flat feet, due to various mechanical factors as well as fatty foot pads hiding the shape of the arch. Children’s arch height should continue to develop until the age of between six and eight years as their lower limb rotation shifts and ligaments strengthen.

 

On the other side of the spectrum, we have the children who truly have issues with flat feet. Whether it is from the positioning of their subtalar joint, muscle tightness or weaknesses, hypermobility, or if they are only slightly pronated but their activities/sports are high impact. Referral to a podiatrist can mean the difference in whether they are restricted in their activities or not, waking up at night complaining of pain in their legs, or even whether they develop structural deformities which are otherwise preventable.

 

Other conditions which may be seen as quite benign, such as a simple plantar wart, may be left to the body to clear up. However, what if the wart is on a part of the foot that makes walking normally in shoes painful? The decision to both treat and offload effectively can make a big difference in their involvement in daily activities.

 

 

 

 

 

 

 

 

 

 

 

​

​

​

​

​

​

​

​

Common Signs of When the Podiatrist Can Best Help

​

• Complaints of sore feet, lower legs, or knees

• Frequently tripping

• Dermatological conditions such as ingrown toenails, excessive callus, or chronic blistering at high pressure areas.

• Warts in locations which make day to day activities painful

• Excessively flat feet- Where the midfoot is touching the ground, or there is visible bulging of the ankle or midfoot.

• In-toeing, out-toeing, or ‘knock knees’

• Is kept awake at night with sore legs

• Is reluctant to walk long distance and partake in sporting activity

• Has toes that are not straight, including bunions

• Is walking on their toes, and doesn’t respond to stretching regime

• Frequently twists their ankle

• Has uneven wear on the soles of their shoes

• Is reported to have a ‘funny walking/running style by teachers, parents or sports coach.

• Is hoping to progress to ‘en pointe’ ballet training

​

So how do podiatrists treat paediatric cases?

A Podiatrist will generally take a detailed history and assessment of any patient presenting for their initial treatment.

​

However, where an adult or geriatric patient may be questioned more readily on their medication and surgical history, the paediatric musculoskeletal assessment should always include the following:
 

• Thorough birth and developmental history, including milestones not related to gait

• Description of habits and recreation e.g. do they sleep on their stomach? Do they spend time in walkers?

• History of symptoms and their progression

• Full biomechanical assessment (age appropriate)

• Neurological assessment

• Footwear assessment.

​

From here, podiatrists may prescribe appropriate footwear and orthotics, exercises and stretches tailored to paediatrics, or refer on to relevant professionals if any further red flags arise.

​