By Dr. Aarti Kumar
October 27, 2018
Category: Foot Care
                             
 
Whether feet are big or small, it is important to pay attention to them all. The pediatric population has a much higher pain threshold than
adults and they will often go a long time before complaining about any foot issues. Some of the most common pediatric foot and ankle problems to look out for are:
 
 Ingrown toenails
 
 Warts
 
 In-toe gait
 
 Flatfeet
 
 Heel pain/Sever’s disease
 
Ingrown toenails: Ingrown toenails can occur as a result of tight shoe gear, sports, inappropriate nail cutting techniques or trauma. The great toenails are usually the most common to become ingrown but the lesser toenails may also become affected. Some of the signs to look for are an incurvated nail with swelling and redness associated with pain. Treatment options depend on the severity of the ingrown toenail and infection but can vary from soaking the toe in warm water and Epsom salt, antibiotics and usually removing the offending nail from the skin after an injection with a local anesthetic. The anesthetic injection is the most painful part of the procedure so it is important to remain calm and supportive as a parent so that our little ones can undergo this procedure as pain free as possible.
 
Plantar warts: Plantar warts appear as painful calluses/pimples on the bottom of the foot. Plantar warts are caused by a virus that children
can pick up from being barefoot around swimming pools, gymnasiums and other public areas. Treatment usually consists of shaving down the thickened skin until bleeding is seen with application of topical agents such as salicylic acid and cantharidin. Oral medications such as zinc and cimetidine have also been used. Plantar warts are contagious so it is important to keep that in mind if anyone in the household is affected.
 
In-toe gait: In-toe gait can present in various ways such as inward facing feet, abnormal position of the knees and torsional twist of the
femur or lower leg bone. Parents and teachers will notice children falling or tripping while running or performing school activities. Parents should be cautious when they are told that their children “will grow out it” since this is not always the case when it comes to in-toe gait. Treatment consists of stretching tight muscles/ligaments and strengthening the lose ones and; most often, orthotics from preventing recurrence and control of the foot structure after the age of 3 years.
 
Flatfeet: Flatfeet in the pediatric population can present as an out-toe gait and decreased arch. Flatfeet can be attributed to genetics, ligamentous laxity and sometimes a fusion between two bones of the rear foot. Children with flatfoot will often complain of discomfort in the feet, knees, hips and back after activity. Stretching of the calf muscles is very beneficial in treating flat feet. The most common treatment option for this condition is the use of custom foot orthotics to support the arch and offload areas of pressure. Surgery can become a topic for discussion if stretching and orthotics do not help with control of the flat foot and the deformity is rigid.
 
Heel pain: Heel pain is very common in children who are active in sports. Males have a higher predilection for heel pain than females. When heel pain occurs in children, the term Sever’s disease or calcaneal apophysitis is used due to the fact that children still have
open growth plates. Immobilization with a CAM boot is the treatment of choice with heel pain along with placing heel lifts in shoes to offload
the Achilles tendon area during ambulation.
 
Our offices offer children foot care of all ages and we are leaders in Long Island.

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