Children, including teenagers, who complain of foot or ankle pain should be examined by a specialist. The same applies to a youngster who appears to walk abnormally. Even the simple task of buying shoes for kids can be challanging.
Problems related to skeletal maturity are specific to the age of the child and require special attention. Evaluation requires a thorough history and physical exam, and often x-ray or other imaging like MRI.
Foot and ankle pain in the pediatric population is often associated with minor trauma or repetitive stress. Often there is no clear history of an injury. Older children may isolate pain to a specific site whereas toddlers are more likely limp or refuse to bear weight.
Flatfoot symptoms often improve with arch supports (orthotics). Children with an abnormally high arch may need to be monitored for neurological symptoms.
Apophysitis refers to inflammation at the tendon attachment to the bone. It is common in the heels during pre-teen and early adolescent years.
In contrast to adults, children have relatively stronger ligaments than bone or cartilage. Trauma results in growth plate (Salter-Harris) fractures more commonly than sprains. When a sprain does occur, it must be treated aggressively to prevent it from becoming chronic.
Stress fractures are increasingly reported in the pediatric population. The metatarsals are most commonly injured; less common are calcaneus, navicular and cuboid bones.
Tarsal coalition is the abnormal attachment of regular bones. This is distinct from accessory (extra) bones, which usually only need treatment if painful.
In-toeing is often referred to as walking pigeon-toed. Instead of the foot pointed straight-ahead, the foot turns inward. Out-toeing is the opposite. It may affect both feet or only one foot. The child may limp, wobble or stumble when walking or running. In-toeing may be due to a structural issue with the foot itself or related to the leg or hips.
A child who appears to “bounce” when walking may be a toe walker. Common causes are a tight Achilles tendon or a neurologic issue.
Warts are more common in children than adults.
Ingrown toenails can be genetic, from improper trimming of nails, or as a result of injury.
Athlete's foot is a fungal infection of the skin that should not be ignored. Topical medication is usually adequate in the pediatric population. The exception is when the fungus invades the toenail, for which stronger treatment is usually needed.
Skokie Foot & Ankle Specialists, Ltd.
9933 Lawler Ave., Suite 315
Skokie, Illinois 60077