Nurture Article | The Portland Hospital Parenting Magazine
Spring/Summer Issue 2014 | Walk this Way
Your children’s feet are made for walking – but sometimes there’s a problem. Consultant Paediatric Orthopaedic Surgeon Sally Tennant advises on how these problems can be easily treated.
As adults we have 26 bones in each foot, but in newborn babies the foot is mainly composed of soft and flexible cartilage.
“This will gradually ‘ossify’ or convert to bone during childhood,” explains Miss Tennant, who runs clinics at the Portland Hospital and the Royal National Orthopaedic Hospital in Stanmore.
“Shoes are unnecessary until a child is ready to walk. Anytime between nine months and two years is considered in the normal range but most children will probably start between walking 12 and 18 months.”
Congenital foot problems
These are problems your baby is born with and many will have shown up on antenatal ultrasound scans. They include:
This condition is also known as congenital talipes equinovarus and affects around one child in 1,000. It’s one of the most common foot abnormalities and affects the foot and ankle from birth.
“Put simply the foot points down and inwards and the soles face backwards,” says Miss Tennant. “Parents are very upset when they hear the term ‘club foot’ because they have a certain picture in their mind about what this means. But the reality is that early intervention can correct the deformity quite quickly in most cases with excellent results.
“Ideally treatment should begin in the first two to four weeks after birth if possible. The best method of treatment uses serial manipulation and casting on a weekly basis using the manipulative Ponseti technique for 5 to 8 weeks. After this a small operation may be needed on the Achilles tendon and later your child will have to wear special boots and a bar at night to prevent the deformity from recurring during the first few years.
“While there is no treatment that can cure the underlying problem, the Ponseti technique achieves an excellent result with a very flexible foot that is fully functional,” says Miss Tennant. “In a small number of cases further minor surgery may be needed.”
Positional foot deformities
Other foot deformities discovered at birth are positional, due to the feet being stuck in a certain position in utero. Structurally, the feet are completely normal and the deformity usually resolves very quickly within a few weeks, sometimes requiring physiotherapy and stretching.
“Examples of this include metatarsus adductus, where the front part of the foot is turned inward, and calcaneo-valgus deformities which cause the foot to appear to be pushed up against the front of the leg. They are associated with first pregnancies and bigger babies where there might be a bit of squashing in utero,” explains Miss Tennant.
“It is important to get the hips checked in these cases as there is a link with developmental hip dysplasia (instability of the hip joint which affects 1 to 3 per cent of all newborn babies).”
Other common foot problems:
“A child doesn’t normally develop arches in their feet until the age of four or five, but sometimes it can be hard persuading parents that it doesn’t need treatment,” says Miss Tennant. “If there is a family history of flat feet then it is possible that the medial longitudional arch (the most prominent foot arch) will never develop, but this usually doesn’t cause any problems.
“We now know that in many cases a flat foot is just a variant of normal. Insoles cannot change the shape of the foot, but if there is pain along the arch in a teenager then an arch support can relieve this.”
This is where a child points their feet inwards when walking. It can be due to metatarsus adductus (in very young children), but in older children is more likely due to excessive internal rotation of the hip, which is a part of normal development. This gradually corrects over the first 10 years of life,” says Miss Tennant.
“It doesn’t cause any functional problems and is nothing to worry about but often means the child has tendency to sit in the W position.”
“Sometimes two bones in the foot are joined together, and may cause a problem in older children when the cartilage ossifies. In some cases surgery may be needed if pain is severe,” says Miss Tennant.
“These are bony deformities affecting the big toe. They tend to run in families especially in girls. We try not to do major surgery until the foot has stopped growing.”
Tips for choosing the right shoes
The Society of Chiropodists and Podiatrists recommend:
Have your children’s feet measured for length and width regularly as recommended by your trained shoe fitter.
Check tights and socks aren’t too tight.
Choose school shoes with a heel height of no more than 4cm with a broad base of shock absorbing material, that fits snugly around the heel, held in place with laces, buckle or Velcro, made of leather.
Avoid totally flat “dolly” shoes or ballet pumps – they can cause stress to the structure of the sole of the foot and back of leg resulting in pain and inflammation.
By Jo Waters