Top-Rated Pediatric Podiatrist in Kansas City
Recognizing foot pain in children can be tricky for parents because children may not recognize the symptoms of a problem or be able to express that there is a problem. This is where our Kansas City pediatric podiatrists and foot doctors at Kansas City Foot Specialists can help. Some of the most common foot conditions in developing children include deformities of the toes, pain in the heels, and aching and/or restless legs. In infants who are just learning to walk, symptoms of a problem usually include: bowed legs, curved feet, feet turning inward, feet turning outward, and excessive toe walking (walking on tiptoes). A child’s foot pain should not be disregarded as “growing pains.” Pain is a sign that there is a problem that needs to be addressed by a podiatrist.
Foot Problems to Look for in Children
Deformities of the Toes
The most commonly affected toes are the fourth and fifth toes. While often hereditary, underlapping toes don’t always have a clear cause, but it’s possible they can be the result of the smaller muscles in the foot being too weak. This condition is more noticeable as children age because pressure from walking and running makes the symptoms worse.
Two common treatments for underlapping toes are: For flexible underlapping toes, releasing the tendon at the bottom of the toe to help it straighten out. For stiff, immobile toes, releasing the tendon and removing a small portion of the bone may be the best course of action.
An overlapping toe is a toe that has developed resting on top of the neighboring toe. The most common overlapping toes are the pinkie toe and the second toe (the one next to the big toe). The exact cause of overlapping toes isn’t certain. Theories include that it is the result of the positioning of the fetus in the womb as the body develops and that it is hereditary. Treatment usually includes accommodating the deformity. Wearing shoes with a high, broad toe box is recommended as well as using gel toe straighteners, gel toe caps, and toe combs to separate the overlapping toes. These devices are designed to reduce friction to help relieve any pain.
Hammertoes and Mallet Toes
Two more common deformities in children and adults are hammertoes and mallet toes. Both hammertoes and mallet toes are caused by tendons on the top of the toe that are too tight and cause the toe to bend at a joint. This tendon imbalance is called a hammertoe when the affected area is the middle joint of the toe, and mallet toe when the affected area is the joint closest to the toenail. In children, these conditions are typically not painful, and the toes are still flexible, but hammertoes and mallet toes can grow stiff, develop calluses, and lead to thick and deformed toenails as the children mature.
Hammertoes and mallet toes in children may be caused or aggravated by a number of things including wearing tight shoes, injury, Morton’s toe (second toe is longer than the big toe), and genetics. Depending on the severity of the condition, your foot surgeon may be able to treat hammertoes and mallet toes by cushioning and splinting the toes in a straightened position. More severe conditions may require surgery, which may include tendon release, or in more severe cases, bone removal or bone fusion
Pain in the Ball of the Foot
Sudden development of pain in the ball of a child’s foot may be a condition related to damage to the growth plate near the second metatarsal bone. Known as Freiberg’s Disease, this damage is likely the result of an injury to this area of the foot. This damage can cause loss of blood flow to the growth plate, which leads to the sudden development of pain in the area. Freiberg’s Disease usually affects youth between 13-15 years of age and is three times more likely to affect females.
Symptoms include pain, swelling, and tenderness at the ball of the foot and a surge in pain when putting weight on the foot. An X-ray can determine if the pain is the result of Freiberg’s Disease. However, if Freiberg’s Disease is in its early stages of development, an X-ray might not reveal the damage. Treatment involves removing pressure from the foot. A podiatrist may recommend using crutches or custom orthotic footwear to reduce pressure from the ball of the foot. If left untreated, Freiberg’s Disease can cause permanent damage to the joint behind the affected toes and may cause arthritis.
When the inside border of a foot is flatter than normal, this is considered a flatfoot. People with flatfeet usually develop the condition in childhood and sometimes grow into having normal arches. In many cases though, the flatfoot remains and may require supportive shoes or custom orthotics to prevent the development of worse conditions. Pediatric flatfoot is difficult to diagnose because the foot usually still has a significant amount of baby fat and undeveloped structure. Around the age of two or three, flatfoot is easier to identify. It’s important to have a podiatrist examine flatfeet to determine what kind of support may be necessary to protect the soft bone and cartilage present in a child’s feet, so no permanent damage occurs in other parts of the foot due to lack of support.
Symptoms of pediatric flatfoot include flatness on the arch along the inside of the foot, an outward bowing appearance due to shifts in the heel bone, excessive flexibility in the joints of the foot, instability when walking or running, complaints about discomfort in the foot, heel, or ankle. In cases of mild flatfoot, there is usually no treatment, but yearly check-ups with your podiatrist are suggested. For moderate to severe flat feet, treatment includes supportive shoes, wearing inserts to support the arch, custom orthotics to support the arch and limit the rolling of the heel bone in more severe cases, and exercises to strengthen the calf muscles. Flatfoot typically responds to conservative methods, but in extreme cases, surgery may be required to correct the deformity.
Pain in Heels
The sudden development of pain in the heel of a child’s foot is usually related to an injury to the growth plate of a bone located near the heel. This condition is called Sever’s disease. Another condition that behaves similarly to Sever’s disease is Achilles tendonitis – inflammation of the tendon at the back of the heel. It is not a growth plate injury. Achilles tendonitis can actually be a contributing factor to Sever’s disease if the inflamed tendon pulls too hard on the growth plate of the heel bone. Symptoms of Sever’s Disease include pain and swelling in the heel(s), tenderness in the back of the heel, a surge in pain with activity and weight-bearing, and a tendency to walk on toes and keep weight off heels. This condition is most common among active and athletic adolescents between 8-15 years old, especially those who wear cleats for their activities. Males tend to be more affected than females.
Sever’s Disease is not a serious condition that requires surgical intervention. Resting, icing, stretching, and taking over-the-counter anti-inflammatory medicines can provide some relief. The pain should subside after a couple of days. If the pain persists, the child should be examined by a podiatrist to check for a more serious condition. Severe cases may require a walking cast or boot, or the use of orthotic insoles or footwear.
Aching & Restless Legs
When a youth’s leg muscles feel weak or sore, or may be limited in movement, this is often dismissed as “growing pains.” However, these symptoms should be treated immediately. Symptoms of “growing pains” include complaints of persistent soreness in legs, feet not functioning properly due to fatigue, and leg muscle fatigue and cramping.
Many cases of growing pain symptoms can be treated with custom molded footwear inserts (orthotics). These can help reduce the stress experienced by the leg muscles and in turn help eliminate the soreness. However, these symptoms may be related to more serious conditions and will require various treatments accordingly. Normal growth should not be painful, and the presence of pain in the feet or legs indicates an abnormal occurrence that should be examined by a podiatrist.
Metatarsus Aductus is a common foot disorder that is often identified at birth. An increased curvature of the foot gives the foot an inward “C” shape. While the cause of metatarsus adductus isn’t fully known, the deformity is relatively simple to diagnosis during a physical examination. The symptoms include the foot bending inward and not in proportion with the rest of the leg, the foot appears to have a high arch, the inside of the foot is bowed inward, creating the telltale “C” shape, the big toe is separated from the other toes.
Most children with the condition can be treated with stretching and strengthening exercises, braces and orthotics, and casting. If a cast is used, it’s usually replaced every week or two as the foot gradually straightens itself out. If the deformity is severe or left untreated for a long time, it may not respond to these non-invasive methods, leaving surgery as the best option for treatment. Often, surgery involves only soft tissue releases or tendon transfers, but some cases may require an operation on the bones. After surgery, the patient is usually fitted with a brace, orthotic, or orthopedic footwear.
A tarsal coalition is a condition between two of the bones at the top of the foot or the arch that inhibits motion due to the abnormal growth of bone, cartilage, or fibrous tissue across the joint. It can limit the motion of the joint. This condition typically causes pain in the surrounding joints as they try to compensate for the stiffness in the affected joint. Tarsal coalitions can be the result of arthritis, infections, or trauma, but are more commonly genetically inherited. Symptoms include aching in the foot near the ankle or arch, muscle spasm on the outside of the leg attached to the affected foot, and lack of flexibility in the foot accompanied by flatness.
Treatment of tarsal coalition typically consists of conservative methods, including custom orthotics to decrease motion in the affected joints, physical therapy, anti-inflammatory medication, and cortisone injections. In more severe cases, surgery may be necessary. The goal of surgery is often to fuse the bones or joints together to inhibit the painful motion in the affected area. Recovery involves a period of time spent on crutches and wearing a cast on the foot.