Many of these conditions are quite common to see in the pediatric population. Despite the frequency, it is normal to have many emotions as a parent and or caregiver. Below are brief descriptions of some pediatric foot conditions.
Talipes Equinovarus, typically referred to as clubfoot, is when the foot is rotated inward. Not only is the entire foot adducted and in varus but there is often a tightness of the posterior leg (Achilles). This condition can be genetic and requires treatment to to improve upon the position of the foot.
This condition does not improve without treatment. Often treatment involves a series of weekly casts to gently manipulate the foot. This is called the Ponseti Method. Well-molded casts are applied to the foot and come all the way up upon the thigh. Long leg casts are utilized to minimize slippage of cast and assist with correction.
A coalition is an unusual attachment of often two bones. The most common coalitions of the foot include the Calcaneonavicular coalition and the Talocalcaneal coalition. While coalitions carry a genetic etiology they often become painful or symptomatic as a child develops. Some children do not complain of absolute pain. They may complain of fatigues, stiffness or a "foot feeling stuck sensation."
There are a wide range of procedures performed to treat symptomatic coalitions. Many children have attempted rigid supportive soled shoes and orthoses prior to presentation.
Pediatric Pes planovalgus ( flexible flatfoot)
Pediatric flexible flatfoot is a foot type void of a coalition. There is no rigidity with subtalar joint or midfoot motion. It is important to remember that a flatfoot in and of itself is not pathologic. The longitudinal arch develops over the first 10 years of life. The severity of pronation is the driving force toward pain and intervention.
From a conservative standpoint a rigid supportive shoe (a shoe that does NOT bend in the middle) with orthotic can be helpful. It is important to focus on calf stretching as well.
Toe walking is a common concern among families. There are many thoughts and established reasons for this gait pattern. Often this is noticed when young children walk quickly or run. In stance (standing still) the child will then be visualized with the heel gradually purchasing the floor.
There are other children who cannot physically get their heels to the ground. In this setting a medical evaluation is most helpful.
Polydactyly or Curly Toes
Polydactyly ( Extra or duplicated toes) is one of the most common concerns in children. Polydactyly can present in many fashions with or without Syndactyly (webbed toes). Many elect for surgical removal of the duplicated toe(s) to assist with shoegear use later in life. This is often not an urgent condition and is usually delayed until a child is greater than 1 year of age unless child is undergoing a necessary procedure prior to 1 year of age.
Flexion contractures (Curly toes) often involve the 3rd and or 4th toes. Toes demonstrate a tightness of the flexor tendons the majority of the time. Children may improve with time or if failure to improve may require often a release of tendons.
Metatarsus Adductus is inward deviation of the metatarsals (the long bones of the foot). Children often demonstarte toes drifting inward. Treatment of this condition often depends on angulation (severity), rigidity, and age of presentation. This condition is not clubfoot.