Foot & Ankle Problems in Children
As well as treating adult foot & ankle problems, we have a specialist interest in Children’s Orthopaedics and Orthotics. Mr Nev Davies and Mr Nick Gallolgly see children and adolescents with all types of musculoskeletal problems. Here we list some of the most common foot and ankle problems in children.
Tarsal coalition is an interesting condition usually presents in adolescence when an abnormal connection of cartilage or fibrous gristle between two of the small foot bones starts to solidify into bone. This causes the foot to become stiff and sometimes painful. Treatment usually involves orthotic management (insoles) and physiotherapy, but sometimes surgery is considered if these non-operative treatments fail.
This curious condition presents in adolescence most commonly in girls between 13 to 16 years old. It causes pain and swelling at the base of the second toe. Treatment begins with rest anti-inflammatories and and orthotic to off load the painful area. For resistant cases of frieberg's condition surgery may be required.
Bunions in children
A bunion is an abnormal prominence on the inside of the big toe joint with accompanying rubbing and redness of the soft tissues. If it occurs in patients younger than 16 it usually has a familial incidence. Treatment is almost always not non-operative as the recurrence rate with growth of surgery is extremely high.
Curly toes are extremely common, are usually familial (run in families), occur symmetrically and rarely cause symptoms. If they do not cause symptoms in the form of pain or rubbing we suggest moisturisation and massage to keep them flexible after baths in the first instance. In the rare cases where this fails to alleviate symptoms surgery can help.
In-growing toe nail
An ingrown toenail develops when the sides of the toenail grow into the surrounding skin and mechanically irritate the soft tissues. It most commonly happens in the big toes and when recurrent can cause infections.
Non-operative treatments include cutting the nail straight across, honey dressings or a course of antibiotics if there is an infection. Persistent infections can be treated with surgery which involves removal of the edges of the nail and nail bed germinal matrix to prevent the sides of the nail digging in (also known as a wedge resection).
Clubfoot is a complex congenital deformity where the foot points downwards and is rolled inwards. It affects boys more than girls and occurs in approximately 1/1000 live births.
Clubfoot is almost always exclusively treated by the Ponseti technique, a nonoperative treatment involving stretching, plaster casts and orthotics. This alleviates the need for complex major surgery and achieves excellent results.
Flexible flat foot
Flat foot is extremely common in children and in most cases is part of the normal development of the inside arch. Often in the children when they go on tiptoes the arch reconstitutes beautifully.
We are often asked whether children require insoles for flexible flat feet. We would only recommend this if there were symptoms such as pain, rubbing and blistering or real problems with asymmetrical shoe wear. The majority of children need no treatment for flat foot.