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Flatfoot in children is referred to as “Pediatric Flatfoot.” There are several types of flatfoot, but they all look very similar and they all have a common denominator—collapse of the arch.
Some signs and symptoms of Pediatric Flatfoot:
· Pain, tenderness, or cramping in the foot, leg, or knee
· Generalized leg and foot fatigue
· Muscle cramps in the foot and calf
· Outward tilting of the heel
· Awkwardness or changes in walking (gait)
· Difficulty with fitting in shoes or abnormal shoe wear
· Reduced energy when participating in physical activities
· Voluntary withdrawal from sports/athletics/physical activities
Types of Pediatric Flatfoot
1. Symptomatic versus Asymptomatic
Symptomatic simply means “with symptoms” or pain and asymptomatic means “without symptoms” or without pain. Both types are typically treated conservatively with Custom Orthotics, at least initially. Orthotics help hold the foot in an optimal position to help prevent the progression of the deformity. If a patient is still having pain while wearing Orthotics, surgical correction may be necessary.
2. Flexible versus Rigid
A flexible flatfoot is one that has a normal appearing arch when non-weight bearing, but once the patient stands, the arch collapses. A rigid flatfoot has a stiff, flattened arch when both weight bearing and non-weight bearing. Flexible and Rigid Flatfeet may be either symptomatic or asymptomatic. Rigid Flatfeet typically are caused by an underlying condition (i.e. Tarsal Coalition) and may require special consideration.
3. There are other types of Pediatric Flatfoot, such as those caused by injury or disease.
How is Pediatric Flatfoot Diagnosed?
In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when the child sits and stands. The surgeon also observes how the child walks and evaluates the range of motion of the foot. X-rays are often taken to determine the severity of the deformity. Sometimes an MRI or CT scan and blood work may be ordered.
Treatment for Pediatric Flatfeet
Depending on the type of Flatfoot, treatment may be either non-surgical or surgical.
Some Examples of Non-Surgical Treatment
· Activity Modifications: The patient may need to temporarily stop painful activities.
· Orthotic Devices: Patients with painless flatfeet are typically placed in a Custom Orthotic device and the condition will be observed and re-evaluated by the foot and ankle surgeon.
· Physical Therapy: Stretching exercises, icing, formal Physical Therapy by a Physical Therapist, supportive taping and bracing may be necessary as well.
· Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation. NOTE: Please consult your physician before taking any medications.
· Shoe Modifications: The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with a flatfoot condition.
In some cases, surgery is necessary to relieve the symptoms and improve foot function. Foot and ankle surgeons provide a variety of techniques to treat the different types of pediatric flatfoot. The surgical procedure or combination of procedures selected for your child will depend on his or her particular type of Flatfoot.
Flat feet are a common condition of the foot structure in both children and adults. In infants and toddlers, prior to walking, the longitudinal arch is not developed and the appearance of “flat feet” is normal. Most feet are flexible and an arch appears when children begin walking. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.
Flat feet are generally associated with pronation, a leaning inward of the foot and ankle bones toward the center (midline) of the body. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Flatfoot may occur on both feet or just one foot.
Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.
The bones of children and adults share many of the same risks for injury. However, a child's bones are also subject to a unique injury called a growth plate fracture.
Growth plates are areas of developing cartilage tissue near the ends of long bones. The growth plate regulates and helps determine the length and shape of the mature bone. When a child becomes full-grown, the growth plates harden into solid bone.
Because growth plates are the last portions of bones to harden (ossify), they are vulnerable to fracture. In fact, because muscles and bones develop at different speeds, a child's bones may be weaker than the ligament tissues that connect the bones to other bones.
Children's bones heal faster than adult's bones. This has two important consequences:
• A child with an injury should see a doctor as quickly as possible, so the bone gets the proper treatment before it begins to heal. Ideally, this means seeing a Foot and Ankle Specialist within 5 to 7 days of the injury, especially if manipulation to align the bone is required.
• The fracture will not need to stay in a cast for as long as an adult fracture would require for healing.
Appropriate evaluation by a podiatric surgeon experienced in trauma will determine the nature of the growth plate injury, will provide counseling about treatment options, and will allow for longer term follow up to assess the outcome of the injuries.
In general, smelly feet can be controlled with a few preventive measures:
1. Always wear socks with closed shoes.
2. Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh, or other materials that let your feet breathe.
3. Bathe feet daily in lukewarm water, using a mild soap. Dry thoroughly.
4. Change socks and shoes at least once a day.
5. Check for fungal infections between toes and on the bottoms of your feet. If any redness or dry, patchy skin is observed, get treatment right away.
6. Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.
7. Dust your feet frequently with a nonmedicated baby powder or foot powder. Applying antibacterial ointment also may help.
8. Practice good foot hygiene to keep bacteria levels at a minimum.
9. Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.
10. The best home remedy for foot odor is to soak feet in strong black tea for 30 minutes a day for a week. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.
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