Flat Feet in Children
Posted by on Sunday, 5th April 2009
FLAT FEET
Children trip and fall a lot as their gait is immature and they are in exploratory phase of walking. Toddlers usually have a wide-based gait and put their feet down flat, causing their toe or shoe to catch the ground while on the move. Moreover, less ground clearance than in adults, taking shorter steps to go faster, tendency to overbalance as they naturally twist & turn and some degree of intoeing due to physiological torsions of long bones of lower limbs, just make things worse. Generally, this common situation disappears by itself as the child grows older.
Flatfeet are very common in children under the age of three and most are variations of normal. Usually the foot isn’t really flat; rather the instep hasn’t developed because of some residual “baby fat”. The condition can also be due to ligamentous laxity (double-joints) and/or out-turned feet; in which case, there is a natural resolution by the age of around 4 yrs.
Bilateral flexible and painless flat-feet do not require treatment. Studies have shown that no ‘special shoes’ or any particular shoe inserts help in forming the arch and thus are unnecessary. Children can go barefoot at home as there is no evidence that shoes help them to walk better. Soft, flexible-soled leather shoes would be great for outdoors. There is every reason to believe that these children will grow up as any other normal boy.
On the other hand, if his feet are not supple, if the condition is painful or if it involves only one foot, this would require further imaging and investigations. Use of shoe-inserts is justified under these circumstances. Surgical management is almost never required in a child and would be considered only in a symptomatic adolescent under extreme circumstances.
Dr Ramani Narasimhan
Sr. Consultant Pediatric Orthopaedic Surgeon
Indraprastha Apollo Hospitals, New Delhi.
Mobile no: 09811016102
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Toe Walking in Children
Posted by on Sunday, 5th April 2009
TOE WALKING
It is very natural for the parents to assume that persistence of toe walking is just a force of habit and nothing else. But we ‘docs’ at times need to rule out medical causes before attributing the condition to mere habit. Such children need a thorough assessment in form of a detailed history and a physical examination.
When a young child begins to walk, toe walking is common and is considered within a broad range of normal, particularly when the child can stand with his foot flat when not walking. During normal gait development, “heel strike” (1st event in gait cycle) should occur by the age of 3 yr. Persistent toe-walking past this age is abnormal and neurological causes like mild cerebral palsy need to be ruled out.
The other possible reason for this can be a shortened tendo-achilles tendon/ heel cord, which pulls the ankle and foot down (plantar flexion). When no cause is found for this, it is termed as ‘Idiopathic’. The condition thus, is called “Idiopathic Toe Walking” and may have been present in the older family members in their childhood.
Basis of treatment in both is to correct the deformity around the ankle and maintain it to allow a normal heel-toe gait pattern. One starts by stretching the tendo-achilles at regular intervals, using short-leg casts after stretching to maintain correction initially; followed by orthotic/brace support. In Idiopathic cases, surgical lengthening of heel cord is generally delayed for several years and is the last resort. The condition is known to take a long time to respond and patience needs to be in abundance. For toe walking due to mild cerebral palsy (CP), a proper rehabilitation program (physical and occupational therapy) in addition, needs to be tailored for the patient. As CP itself cannot be eradicated, its effect on lower limb joints needs to be monitored during growth, and managed accordingly. An appropriate controlled surgical release of gastro-soleus at the musculo-tendinous junction may be planned in certain cases at the right age. This is followed by maintenance of correction by casts initially and later by ankle-foot orthosis (AFO). The family needs to be thoroughly educated regarding the utmost importance of a persistent proper rehabilitation in terms of physical therapy and gait training.
Dr Ramani Narasimhan
Sr. Consultant Pediatric Orthopaedic Surgeon
Indraprastha Apollo Hospitals, New Delhi.
Mobile no: 09811016102
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