Paediatrics

The London Podiatry Centre frequently advises parents who are concerned about the development of their children's feet. Compromised posture, pain or unusual walking patterns are common reasons why they will consult the Centre. Often, only reassurance and postural exercise is required but sometimes specialised orthoses or other forms of treatment are indicated. In some instances computerised gait analysis is required to study a child's walking pattern so as to determine the extent of the problem.

Child development, gait and common conditions is extensively discussed in our dedicated website: gaituk.com. link: http://www.gaituk.com/children/

Some common paediatric conditions treated at our Centre include.

1) Verrucae: These are viral warts which appear differently on the foot because of the fact that they become compressed. Treatments offered at the Centre include; cryotherapy, cold laser, chemical treatments and surgical excision.

2) Ingrown toe nails: A very common condition routinely treated at the Centre, either conservatively by reduction of the nail or with surgery under local anaesthetic (see conditions page)

3) Heel pain: This often occurs due to a condition called Severs disease which involves inflammation of a growth plate in the heel (see conditions page)

4) Anterior knee pain: This is usually the result of an abnormality in gait and their biomechanical function. Most children respond well to treatment following an in depth evaluation of their gait. (see conditions page)

5) Pigeon (in-toe) gait: In-toeing is common and usually part of normal development and in most cases it resolves spontaneously. In-toeing is considered a torsional (twisting) deformity and may result from medial femoral torsion (ante-version), medial tibial torsion or forefoot adductus (forefoot pointing inwards). It is only considered abnormal when your child falls outside of 2 standard deviations when assessed through a rotational profile examination where the level of the problem can be identified. This condition is common in early childhood from the ages of three to six years, but can persist in some children until the age of 10. It is more common in girls and can be hereditary. It is not uncommon for only one side to in-toe more than the other. The imbalance can worsen during growth spurts, when the hamstring tightens to pull the hip in. This condition occurs normally, however if your child is experiencing persistent tripping, falls or pain associated with this condition, then an opinion is recommended. A Specialist examination and computerised gait analysis will help to identify the cause and will determine the best method of treatment.

6) Great toe position: During the early stages and onset of walking, the great toe may claw and bend excessively to help aid balance and stability. The position of the great toe after the first three months of walking should be relativity straight and in line with the foot.

When the child begins to walk, the great toe should be in line with the foot and not pointing towards or away from the midline of the body. However, during the early stages of walking the great toe may claw and bend excessively as the child learns to improve their balance and stability. After three months of walking the great toe should remain relatively straight.

7) Small toe position: As with the great toe, the small toes may claw and bend during the early stages of walking. However, they should only bend in the forward plane (up and down), any deviation where the toes bend toward each other is generally not normal. A small degree of bending / curly toes, especially of the 4th and 5th toe (the 5th toe is the one furthest from the great toe) is common and may not require treatment, although it is best to obtain an opinion from the London Podiatry Centre if in doubt. Toes that are elevated away from the floor are not considered normal and in such instances the 5th toe is most commonly effected.

8) Arch height: The term flat feet is often used to label feet with a lowered medial (inner) longitudinal arch. This occurs as a normal part of development and babies have no detectable arch because of the fatty padding that is present at this time. It is more important to assess the ankle position than the arch height in very young children, especially in the first one to two years of walking. A rigid, fixed flat foot (often caused by an abnormal fusion of some of the bones in the foot) is abnormal and can best be assessed by asking / or assisting the child to stand on their tip toes. If a normal arch forms at this time, then a more rigid type of flat foot deformity is less likely to be present. If in doubt, then it is always best to seek a specialist opinion with our Centre. Where the child is old enough, their ability to walk on their heels and toes is a good way of assessing muscle strength, foot function and development. A positive family history for painful flat feet is another clue that may prompt parents to seek a specialist opinion regarding their child’s foot posture.

9)Lower leg position (bow leggedness and knock knees): Bow leggedness and knock knees are part of normal development at certain ages. Babies are born bowlegged and when a child first learns to walk they tend to be a little bow legged and this may persist until the age of two years. However, the "knock knees" position during the first few years of walking is never normal and requires a further medical opinion. Most children begin to develop "knock knees" between the ages of three to six and this is often accentuated by large medial knee condyles (inside and end of the femur bone) which is a completely normal stage of development. Usually, by the age of seven the configuration of the lower limb and knee is in its ‘normal’ anatomical position, however girls can often go through a further temporary “knock knee” stage as they go through puberty and their hips widen. Bow leggedness and knock knees will occur in both legs, is pain free and usually of no concern when it occurs at a certain ages. However, if your child develops pain in association with this presentation, or if the conditions persists, or a knock knee or bowed leg position in one leg only, then this is not normal and further medical opinion is required.

10) Feet that point outwards (i.e. "ten to two" or “Charlie Chaplain” style of gait): Most children have this type of foot position to some extent during the early stages of walking. A wide, outward rotated hip position aids stability in the early stages of walking and the position can also be exaggerated by the wearing of nappies in early childhood. By the age of 6-8 years old, the position should have normalised so that both feet are pointing about 15 degrees outwards. If the "out toe" position persists or the angle of the out pointing toe is extreme, then there may be a number of causes (e.g. abnormal pronation and torsions / bony rotations of the femur (thigh bone) and tibia (shin bone). Through biomechanical assessment and gait analysis, the causes can be accurately identified and treated.

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