Arthritis Affects Children’s Feet
J.I.A. or juvenile idiopathic arthritis is just one of the manifestations of arthritis in children. Just like adults children get pain, stiffness in the morning that can last for some hours, restricted movement of their joints, swelling of their hands and feet. In other words serious incapacity. Unlike the adult form where we see a pattern of rheumatoid arthritis starting to affect women mainly around the age of 40, in children it can happen anytime.
Awareness is the key for both parents and health care professionals. I have been seeing children with local areas of tenderness or pain under the heels, or at the back of them. Pain along the soles of the feet. Ankles that are painful all the time either when moving or resting. Showing reluctance to run around because of the pain. Complaining of swollen and painful toes. Not wanting to wear their school shoes because they hurt. There are many other signs and symptoms that usually the doctor will identify.
Some of my patients are so badly affected by arthritis that they are only able to wear soft slippers to school. Fortunately a donor has offered to provide appropriate soft but firm footwear for them. Some children are completely pain free thanks to the medication that has been prescribed, but they have structural foot problems and so need some form of support – usually with an orthotic – but often just a decent shoe and some advice is enough.
The secret of success in managing these children is teamwork, and I am lucky to be part of the paediatric rheumatology team at Chris Hani Baragwanath Hospital. The specialist doctors are able to prescribe the appropriate medication which frequently brings relief to the painful joints and removes symptoms.
Don’t ignore the child with a painful foot. It probably isn’t arthritis, but it might be.
Foot Screening for Diabetes
A diabetes foot screening takes approximately a ½ hour and when it is finished the podiatrist will be able to identify the level of risk for diabetic foot complications. In addition, if referral to another member of the diabetes care team is required it will be done. Because foot problems are one of the main complications of diabetes, the podiatrist is able to manage non-ulcerative problems and foot ulcers.
The podiatrist treats all skin and nail related foot problems. Treatment includes appropriate foot health advice, cutting of nails, reducing calluses, enucleating corns, measuring for a simple insole, moulding for a foot orthotic, or even an operation to remove an ingrown toenail – this is carried out under local anaesthetic, usually in the podiatrist’s rooms and you go home straight afterwards. The podiatrist may decide on referral to another health care professional, such as an orthopaedic surgeon or physiotherapist.
Although most podiatrists will manage any patient who consults them, modern podiatry has seen the development of practitioners with special interests in particular foot problems, these include chronic diseases like arthritis and diabetes, sports injuries and children’s’ foot problems. Therefore it is a good idea to find out if the podiatrist has a special interest in your problem.
No referral is necessary to see a podiatrist, although many patients are referred by their health practitioner.
Andrew Clarke, Podiatrist
Andrew will be posting his observations on the world of podiatry as well as hints and tips in his specialist areas of diabetes, arthritis and children’s foot problems.
You can read about Andrew’s qualifications and background on the page ‘About Andrew Clarke’ and locate his clinical practice in the ‘Practice’ page.
Podiatric Assistance For Rheumatoid Arthritis Patients
In February this year I was in Nairobi to present a paper at the African League Against Rheumatism Conference. Following is an abstract of the paper that I presented.
PODIATRIC INTERVENTIONS FOR RHEUMATOID ARTHRITIS PATIENTS ATTENDING A TERTIARY HOSPITAL – A CLINICAL AUDIT
EAM Clarke and M. Tikly.
Introduction: Feet are commonly involved in rheumatoid arthritis (RA) but foot pain and disability as a whole are not well-understood. It has been suggested that the African foot with RA, shows increased rearfoot rigidity, with the forefoot retaining more mobility. In an unpublished study of 40 patients attending our hospital arthritis clinic, Phala (1998), reported 100% foot problems, with interventions of footwear in 80%, orthotics in 50%, and corn and callus reduction in 62.5%. The purpose of the present study was to identify and document the extent of foot problems and to identify and analyse the podiatric interventions.
Methods: Hospital records of 99 patients with RA were reviewed to identify the nature and extent of foot problems and the podiatric interventions for these patients.
Results: The mean age and disease duration were 52.4 and 11.5 years, respectively. Gender distribution was female 83 and male 16, a ratio of 5: 1. 80 (81%) patients had deformity, of which 59% were toes, 30% bunions, 47% hallux abducto valgus and 36% involved the whole foot. (Pes planus, pes cavus and metatarsus adductus). Pain was described by 49% of patients, with 52% of these being metatarsalgia, 3% heel pain and 29% ankle pain.
Podiatric interventions n=99 %
Treatment 49 49
Footwear given 7 7
Padding 43 43
Insoles 43 43
Orthotics 11 11
Foot health advice 57 57
Ulcer care 3 3
Conclusion: As part of the team approach to RA, podiatric interventions have an important role and are required by a high percentage of patients. The aim is palliation, pain relief and improvement of function and should utilize the entire range of interventions available.
References:
Woodburn.J., Helliwell.P.S. (1997) British Journal of Rheumatology.Vol.36.(9). 932-934
Woodburn et al.(2002) Journal of Rheumatology. Jul:29(7): 1377-83
Young et al. (1991) Diabetic Medicine. 9: 55-57