Children’s Feet
Summary of Chapter 30
Parents who are afraid to put their foot down usually have children who step on their toes.– Chinese Proverb
Children’s Feet
One of the first things the doctors and nurses do in the U.S when a baby is born is take his or her footprints. Most people would agree that those prints and the tiny feet that made them are simple perfection. After all, they’re small, soft, and free of all the wear and tear that our beaten adult feet reveal. However, while babies’ feet may look like miniature replicas of our own, they are actually very different in structure.
If you compare an X-ray of a baby foot with one of an adult foot, it looks as if a baby’s foot has many more bones. This is because the child’s foot bones are not completely formed until he or she is about 20 years old. Until that time, gaps of cartilage remain between the bones.
The most common bone and cartilage problems found in children are derangements of normal bone growth, osteochondrosis, and these should always be considered when evaluating a child’s growing feet. Radiologic evaluation of a problem area will show some increased density, fragmentation, and/or irregularity of the affected bone. Freiberg’s infraction, which is a condition that is most commonly seen in teenage girls. (Interestingly, it is the only condition in this category that is more common in girls.) It is characterized by a flattening of the second metatarsal and can be associated with loose bodies. Although the exact cause of Freiberg’s infraction is unknown, it seems to be linked to trauma. Non-surgical treatments include immobilization, using a metatarsal pad and bar, orthotics, and injections. If these conservative approaches don’t work, surgical options include joint debridement, core decompression, bone grafting, excision of the head of the metatarsal, metatarsal osteotomy, and joint replacement. Kohler’s disease is a condition that is more common in boys and appears before the age of six. Symptoms include arch pain, mild swelling, and a limp. X-rays of the area may show changes such as sclerosis, fragmentation, and flattening of the navicular bone. Typically, a below-the-knee cast is the treatment for more severe cases of this condition and longitudinal medial arch supports are used for less severe symptoms. If these treatments don’t work, other options include core decompression, bone debridement, bone graft, and fusion. Sever’s disease is associated with heel pain and tenderness over the posterior calcaneus and most commonly appears in active children, especially those between the ages of 9 to 11yearsold. These children may also over pronate. Sever’s disease can be treated conservatively with heel lifts, gel heel cups, physical therapy, and, in severe cases, a cast to immobilize the area.
In this chapter of My Feet Are Killing Me Dr. Levine discusses:
- Osteochondrosis
- Freiberg’s infraction
- Kohler’s disease
- Sever’s disease
- Baby Basics
- Creative Correctives
- Metatarsus Adductus
- Internal tibial torsion
- Femoral torsion (hip)
- Gait Plate
- Other problems
- Examining your baby at home
- Walking Tall
- First Shoes
- Sizing them up
- If the Shoe doesn’t Fit
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