BT: What are some common foot problems in children?
Dr ABM: Some of the common foot problems in children are:
- Flat Feet
- In and out-toeing
- Tiptoe walking
BT: How can we get rid of flat feet in children?
Dr ABM: Most babies are born with flatfeet because of “baby fat’’ obscuring the arch on the inner part of the feet. As they grow older, the arch gradually develops as “baby fat” starts to disappear and the muscle of the feet become stronger.
As flatfeet is part of a normal dynamic that changes and disappears by the age of 4 year-old, most do not require treatment even in some children who retain their flatness of the feet as they grow older. In a small percentage of children who has painful, severe and stiff flatfeet, further assessment needs to be done by the doctor to exclude structural or bone problem and this includes x-rays of the feet. Different method of treatment including surgical approach can be recommend depending on the underlying cause.
BT: What are in-toeing and out-toeing and what causes them?
Dr ABM: In-toeing gait is when both feet are turning inside (midline) while the child walks and in the opposite direction in out-toeing gait.
In-toeing is more common in boys of 1- to 4-year-old and the usual cause is internal tibial torsion (leg bone twisted internally). Whereas in-toeing is commonly seen in girls during 4- to 7-year-old and this is caused by excessive femoral anteversion (hip has excessive internal rotation).
Both conditions will outgrow spontaneously. Child with in-toeing from excessive hip internal rotation is advised not to sit in “W” position while on the floor as it could delay the physiological correction as they grow older. Instead, the child is encouraged to sit cross leg.
BT: What are the most common causes of heel pain in children?
Dr ABM: One of the causes of heel pain in a child is from inflammation around the insertion of the heel cord tendon at the heel. This condition is called Sever’s disease where a repetitive traction injury during physical activities triggers inflammation at some part of the bone (apophysis). Treatment usually rests from physical activities that trigger them, icing the affected part and anti-inflammatory medication.
BT: Is it common for children to get ingrown toenails?
Dr ABM: Ingrown toenail is common among older children and adolescents. Some of the risk factors are tight shoe wear, excessive moisture from excessive physical activities.
BT: Why is early detection important for foot problems in children?
Dr ABM: While most common foot problems in children are part of dynamic changes in the feet and legs alignment and position, which will improve naturally, some appear and retain or even progressively worse beyond the expected time and age.
It is more important to observe further, and if the deformity does not resolve as expected, the child needs further evaluation to rule out an underlying cause. This is usually done by x-ray imaging. Further need of correction or intervention will depend on the underlying cause and its severity.
Dr. Abd Razak Muhamad,
Orthopaedic & Trauma Surgery, Paediatric Orthopaedics,
Gleneagles Hospital Kuala Lumpur
