Legs and Feet

All children are born with flat feet. By twelve years of age 9 out of 10 will have developed arches.

In most cases, the painless flexible flat foot is due to joint stretchiness commonly found in children. At the clinic the child’s joints, nerves and ligaments in the legs will be checked.

Treatment:

Flexible flat foot. In general no treatment is required. Physiotherapy, chiropody or shoe modifications are usually not needed. In a few, some tests including x-rays will be needed. However, this is only for rare conditions.

Painful, stiff, abnormal flat feet are unusual. Operation or below knee plaster casts may be needed for these feet (abnormal bones in the foot).

Curly Toes

Often found at birth. One in four will improve without treatment. The 3rd and 4th toes are the most common and the condition is often bilateral.

Treatment:

Chiropody, shoe modifications or strapping do not usually help. However, if by the age of five, there is pain or a deformity of the next toe, release of a tendon in the toe may be done. This is a minor operation undertaken as a day-case (in hospital for the day).

This usually straightens the toe, although the toe may not bend after this. This is usually not a problem. Some numbness in the toe may occur after surgery, but this is rare.

Overlapping fifth toe (varus 5th toe)

This is usually found at birth. If necessary surgery is not done until after the age of six as the toe is too small to correct before this age.

Treatment:

Strapping and stretching do not work. Surgery will only be done if the toe is rubbing or painful. Surgery will improve the toe position, although will not make it normal. Occasionally, minor numbness or pain in the cold may occur after surgery.

Hallux valgus / bunion

This is uncommon under the age of ten. Usually shoe modifications, chiropody or physiotherapy will not help.

Treatment:

If there is a moderate painful bunion an operation may improve the position of the toe. Though this will usually improve the shape of the foot it will not make the toe normal. The hospital stay is for one day.

The child will have to keep their weight off the foot and use crutches for two weeks and a plaster cast will be needed for four weeks in total. Surgery is usually undertaken at the age of twelve or thirteen.

Intoeing (pigeon toe), turning in of the feet, is a common way of walking.

However, this is not a disease is usually a variation of normal and it is not usually serious. This condition is generally found in children who are very supple (stretchy). It usually becomes noticeable by two to three years of age.

The cause is due to joint stretchiness and increased movement of the hip joints.

In general, children of this age do tend to fall over, particularly if they have older brothers and sisters (trying to keep up). Falling over is usually due to general joint stretchiness and muscle immaturity rather than the intoeing of the feet (they don’t fall over their feet).

With time most intoeing improves, usually the age of six to eight years of age. In 1 out of 8 adults, slight intoeing can be permanent. This will not cause joint problems or arthritis. Some of the best athletes (runners) involved in the Olympic games intoe.

In the clinic, rare causes will be looked for and usually excluded. Investigations (ie MRI, blood tests) are not usually done, though occasionally x-rays of the hip joints are needed.

Treatment:

Usually reassurance is the only treatment needed.
Shoe modifications, chiropody and physiotherapy are not needed. In toeing is a normal variation not a disease.

Surgery for intoeing is only rarely required, such as for severe intoeing at the age of twelve or secondary to rare muscular or neurological conditions.

Anterior Knee Pain

Anterior Knee Pain (pain at the front of the knee) is common in children.

It is more common in girls than boys, usually in teenagers. It is thought to have many causes and it is not usually serious. It is associated with stretchy joints, a growth spurt and with active children. Occasionally it can be associated with rare hip or knee conditions.

Clinic:

The nerves in the legs, the hip and knee joints will be checked. If there appears to be a hip or knee problem, x-rays would be taken. Occasionally blood tests may be required to check vitamin D levels and rule out underlying metabolic conditions.

Treatment:

In general, if there is soreness of the kneecap, various exercises and occasionally medication will be advised.
A disease called “Osgood Schlatter’s disease” may present with a sore lump on the front aspect of the knee. This is not a serious condition and will usually improve over months though it may occasionally take one to two years.

The treatment is to “slow” down the child by limiting activities and sport. The lump at the front of the knee may be permanent (though harmless).

Shoe modifications, chiropody or physiotherapy are not usually required for this condition.

Prognosis:

The majority of individuals with pain at the front of the knee will improve. There is no significant link with osteoarthrosis of the knee cap.

Instability of the Patella (kneecap coming out of joint)

Occasionally, pain at the front of the knee can be associated with the kneecap coming out of joint. This usually can be confirmed when seen at the clinic. Occasionally special scans are needed to check if the kneecap is coming out of joint.

Treatment:

Initially the treatment is by the physiotherapist. Occasionally surgical operations to the kneecap may be needed. Shoe modifications, or chiropody are not usually needed.

An ingrowing toenails happens when the toenail grows into the skin around it.

The skin can get damaged, cause infection and pain. The problem usually happens to the big toe.

The most common cause of an ingrowing toenail is not cutting your child nails properly by cutting them too short down the side of the toenail.

This problem often runs in families as a common cause is having toenails that do not grow straight.

Wearing shoes that do not have enough width to fit the toes in their natural position can also cause an ingrowing toenail.

In general, most tip-toe walking is due to habit and the general cause is not known.

Only rarely is there some underlying condition of the nerves. A further specialist opinion from a neurologist would be sought if this rare cause was suspected. Observation is often the only treatment required.

Treatment:

Casting initially with a plaster cast for four to six weeks. The plaster is changed every two weeks, and this may be all the treatment that is required. This improves matters in about 50% of the cases. The plaster cast is below the knee and includes the ankle. The child is able to walk on it once it’s dry.

If the condition recurs further tests such as scans may be needed. If plaster casting fails lengthening of the heel cord may be needed.

Surgery (lengthening of the Achilles Tendon) this is usually undertaken by using three little nicks in the skin. Your child will have a general anaesthetic for this procedure and will only be in hospital for the day.

A plaster cast is usually required for six weeks. The child can usually walk on the plaster cast within two days, once the plaster has dried. The cast is usually changed at ten to fourteen days in the clinic.

Results:

The treatment will usually improve the way your child walks.