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Foot Care During Childhood Requires Specialized Approach

Pediatric patients present unique challenges to diagnosis and treatment of foot conditions.  

The American College of Foot and Ankle Surgeons (ACFAS) calls for a renewed effort in diagnosing and treating pediatric foot conditions. Despite its complex anatomical structure, pediatric conditions of the foot are often misdiagnosed as issues of structural development that children will outgrow. The College's members advocate for education to help pediatricians, the primary care providers for children, diagnose and advise parents about the best way to manage foot problems.

Childhood foot conditions and treatment guidelines were a key topic of discussion during the 73rd Annual Scientific Conference of ACFAS in Phoenix. At the conference, a panel of five expert foot and ankle surgeons delivered expert commentary on when and how to treat common pediatric conditions, including painful heels (calcaneal apophysitis), bunions (hallux valgus) and flatfeet (pes planovalgus). 

Foot problems are common in children due to their high levels of physical activity, but it is easy for the signs and symptoms of underlying foot issues to go unnoticed because of children's resiliency. Common symptoms to look out for include ankles turning in more than usual, foot arch flattening, cramping and, in some cases, a drastic change in physical activity level or the lack of desire to play outside.

"Pediatric foot problems are a distinct class of care and diagnosis, but parents often think that these conditions are a matter of growth that will eventually resolve," says Michelle Butterworth, DPM, FACFAS, a South Carolina foot and ankle surgeon and Fellow member and past president of ACFAS. "Every bone in the foot has a growth plate. Many of them remain open, allowing growth, through the teenage years. Before the growth plate is closed and fully developed, foot problems in youth can be difficult to treat, requiring a complex, specialized approach. Foot and ankle surgeons are specially trained in this area of caring for bones that are still developing in children."

According to Dr. Butterworth, consultation with a foot and ankle expert is important for children to ensure that foot issues developed in childhood do not become more serious as they get older. "A common misconception I see in patients who previously visited a physician or pediatrician is that children will 'grow out of' foot conditions like pediatric flatfoot, which is simply not true," Dr. Butterworth adds.

Some initial treatment options for pediatric pain and deformities may include activity modification, custom orthotics and anti-inflammatory medications. If these conservative treatments fail to alleviate symptoms and the deformities persist or worsen, more aggressive treatments, including surgery, may be required depending on the age of the patient and the progression and severity of the deformity.  Fortunately, when surgery is performed, these young patients often feel less pain, heal faster and are more mobile after surgery than adults.