Common Foot, Leg and Ankle Problems in Children
Children experience several foot issues. Our expert looks at the leading issues and suggests treatment options for these conditions.
By Dr Venkataramanan
Parents fret easily about their children. This is particularly so when it comes to problems pertaining to the feet or legs, an important segment of the body for locomotion. In this article, the author has briefly described about common foot conditions and points out that most conditions are self-correcting!
This is a rare deformity of the foot and needs immediate attention. The exact cause is unknown; theories such as a) genetics and b) foot position inside the uterus abound. Gentle stretching with application of POP casts in a weekly interval beginning from the 1st week after birth has given consistently excellent results in over 90% of children. Usually this period extends for around 2 months. After that, special footwear to up to 6 years of age is recommended. In some cases, surgery may be needed.
An even rarer condition that follows a similar pattern of attention and treatment involving serial POP casts. However, surgery could be needed in up to 50% of children to achieve a satisfactory result.
Developmental (after birth):
Most children begin walking from the age of 9-10 months onwards. The normal age range extends till 18 months. Do avoid the urge to make babies walk earlier with special walkers or gadgets. This can lead to a different set of problems as the leg bones may not have adequate strength to take the weight of the child, and hence start to deform. Nature will decide when the time is ready.
Children commonly have bowed legs (gap between the knee usually 1-2 cm) till the age of 1 ½ to 2 years and then gradually develop knock-knees (gap between the feet/ankle usually 2-4 cms) till the age of 3 years. By 5-6 years, these conditions auto-correct and the child ends up with straight legs. Legs more bowed than these measurements may still be “normal”, however other causes like Rickets (Vitamin D deficiency) may have to be ruled out. Even so, some people continue to have this into adulthood. Here, genetic factors may have an influence. If the bow legs appear to be more on one side or progressively increases, an evaluation by an Orthopaedic surgeon will be necessary.
Many children have what is called flatfoot (50%). To understand what flatfoot is one needs to know the ‘normal’ shape of the foot. When a person stands, the inner side of the middle of the foot does not touch the floor. This is called the arch of the foot. In some the arch is absent and this part of the foot touches the floor. This is termed flat foot. If the arch is seen when the child tip-toes, the condition can be left alone. If it is not seen one may use special footwear or orthotics. In most cases the arch develops on its own without intervention, by the age of 6 years. Special orthotic footwear may be prescribed in some cases to help in creating the arch. However, in a small number of children this can be hereditary and hence it may persist in adulthood despite modified shoe wear. Again, not every flatfoot needs Orthotic or special footwear.
In-toeing is a condition where the child walks with toes pointing inwards (pigeon toe walking). This is due to torsional attitude of the thigh or leg bone and is self -correcting by age 8years. Avoiding sitting in a W fashion on the floor and encouraging cross-legged sitting can help in correcting this position. Persistence beyond 8 years, if cosmetically significant, can be corrected by surgery.
Out-toeing is the opposite direction of the above-mentioned condition where the child walks with the feet outwards (e.g., Charlie Chaplin!). Encouraging to walk with toes pointing forwards by turning the ‘knee’ inwards can ensure everlasting correction. A 10-degree outward toeing can be considered normal for human gait.
Toe walking is not uncommon. This generally disappears in 3-6 months after the child begins to walk. Persistence beyond 2 years of age will need evaluation by an Orthopaedic Surgeon/Physiotherapist and serial stretching will resolve this problem. This can be corrected by Botox injection as well, in properly indicated cases.
Curly toes can happen in a few children wherein the second or third toe overrides the adjacent toe. This usually needs to be taped in a serial way over a few weeks which then corrects the condition excellently.
The author is a consultant at Apollo Hospitals, Chennai.
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