May is World Foot Health Awareness Month: Baby Walkers

Today’s Foot Health Awareness Tip:  Avoid Baby Walkers.

Children will decide to walk independently when their bodies are able to. Baby walkers place extra stress on joints before nature intended. In addition they cause the foot and lower limb  to move in an unnatural walking pattern.

Research has shown the use of baby walkers is associated with a delay in normal walking and activites such as standing and crawling.

Their use is best avoided – they are banned in Canada.

Source: Children’s Feet. Gordon Watt. Lecturer in Podopaediatrics, Glasgow Caledonian University and Consultant Podiatrist, Royal Hospital for Sick Children, Glasgow. Society of Chiropodists and Podiatrists, UK.

Traction Apophysitis – progress report

I have just seen the 8 year old child with Traction Apophysitis featured in previous posts. Since January 26, when I first saw him, he has followed a strict programme of reduced activity.

He has been fantastic in wearing trainers at school – remember that all the other children are barefoot – and severely limiting or stopping any activity that caused pain. Although, about a month ago we did let him start swinging a golf club at the driving range!

His mother reports that he no longer sits on the side of the bed in the morning rubbing his painful feet. Has no pain after school, even though he has recently started playing some soccer at break time and he is completely pain-free.

Today’s X-rays show a normal appearance of the calcaneal epiphysis (the growth area/point at the back of the heel), and improved bone density.

The plan now is to slowly start activity again and that will be rugby.(He plays barefoot). The trainers must still be worn as often as possible. Follow up will be in 6 months.

The diagnosis of Traction Apophysitis is usually based on the presenting clinical symptoms, as the X-ray findings are often inconclusive. Nevertheless we must never ignore the younger child with painful heels and always consider Traction Apophysitis.

Management is clearly “rest”, by reducing or avoiding those activities that cause pain. A supportive but soft/cushioning trainer is the best footwear. There is a place for short term anti-inflammatories followed preferably by topical gels and plasters.

Whatever we try, there is always the question of ‘what would have happened if we had done nothing?” I believe that that decision can only be made with the individual patient in front of you, so that you can respond with clinical judgement and personal empathy. However there is no doubt that for many children it is a transient condition.

My apologies for not getting the case history on the site as promised.
THE COMPLETE CASE HISTORY WILL BE ON THE WEBSITE SOON.

Traction Apophysitis-feedback

Here’s some feedback on the boy with the traction apophysitis. Did you think the overuse was extreme? What did you think of the training routine?

Firstly, he has wonderful parents! They have followed  my advice to wear shoes and avoid all activities that cause stretching of the Achilles tendon. Secondly,they have been surfing the Internet to find out more about the condition. They showed the youngster pictures and explained the reasons why he has to take it easy. This means that he understands that time spent recovering now will enable him to participate again when the condition settles. Thirdly, they have stopped all sport at school.

Fourthly and this is the best bit. His father tells me that he asked his son to rate the pain. If the pain was rated as a 10 when he saw the podiatrist what is the rating today? About 2 or 3 says the boy.

In our sports mad country its refreshing to get such team work going.

At this stage it is imposible to say how long healing  will take, but the initial response of the foot to simple rest and supportive footwear is encouraging. Rehabilitation will be very important; in the form of stretching very carefully, accompanied by orthotics or simple insoles.

Traction apophysitis does heal and all the better it seems with lots of TLC (Tender Loving Care).

Keep looking for the full case history – its nearly finished

P.S. Tune in to Talk Radio 702 17 February 19.00

A Sports Injury or Child Abuse?

How much sport is enough for a child? When does too much sport become abuse? Is an over-use injury at a young age, in the pursuit of excellence worth the possible long-term consequences? Consider this:

Last week, an 8 year old boy, barely able to walk, was brought to see me by his mother. He had a severe limp, walking with his foot out and his ankle stiff, to reduce the pain. Three days previously he had spent nearly 5 hours doing athletics at school. His mother told me that the initial pain began more than 6 months ago, after he had played a lot of rugby.

The school under 8 team had been very successful, winning their area age group, so had a long season. Then he moved up an age group to under 9 which extended the season further. Nevertheless he continued with all sports, despite the pain and the fact that he was not running as fast as before. A compounding factor is that athletics and rugby are both done barefoot.

The timetable of sports reads like that of a professional adult, with daily practice depending on the sport and season, with inevitable overlap; plus the fact that the school plays some sports out of season as well.

• Athletics: 1 hour a day, x 5 days, plus meetings
• Cricket: 1 & half hours a day x 5 days, plus club games on Saturdays for a university club junior side
• Rugby: 1 hour a day x 5 days, plus matches

The boy is obviously very good at his sports and according to his mother is always active at home whilst playing. However, this timetable with an injury would cripple most adults.

So what’s the point? How far must we/should we push or allow our children in pursuit of sporting excellence? We try to teach balance in most aspects of life, sleep, study, money etc., but when it comes to sport we seem to make up the rules as we go along.

After requesting X-rays of both feet and discussing them and my diagnosis with two different medical colleagues, it was agreed that the cause of the pain is damage to the growing part of the back of the heel bone, where the Achilles tendon inserts. Clinically called a Traction Apophysitis.

The initial treatment is rest and avoiding any vigorous activity that causes the Achilles tendon to pull on the heel bone. Raising the heel or possibly orthotics may help.

So ask yourself the question – is this youngster suffering an over-use injury or child abuse or both?

A full Case History will be posted during this week.

Footwear For Babies – Barefoot is Best

Babies do not need footwear. Anything that you put on a baby’s feet will constrict and damage it. Don’t be persuaded to buy ‘pram shoes’ they should be hanging from the rearview mirror of your car!

As children develop they are all action and this is part of the normal growth pattern so it is essential that they are allowed freedom of movement at every opportunity.

There can also be damage from clothing that we put our babies in. Romper suits (called a Babygro when my children were small) are often too small or tight and restrict the very important kickiing activity the all growing babies need. In South Africa there is a trend to cover babies when in the pram or stroller. DON”T. Any covering that reduces the normal developmental reflex movements will cause harm. Those beautiful knitted bootees from Aunty Tshidi – watch them – they must allow the wriggling, growing toes to keep doing just that.

If you look at ‘pram shoes’ you will see very little of their shape matches the baby foot, especially at the toes wher usually they are too narrow. It could be the equivalent of you or I wearing a shoe one size too small. Even the fastening around the ankle, although it may look OK has the potential to press into baby’s foot.

During the first 6 months total freedom should be the aim. This allows the unhindered development of the neuromuscular responses. Just take a moment to look at the feet of the newborn and infants before they start walking. What you will see is a range of curling, wriggling, turning in and out, twitching and so forth which need to bee allowed without being enclosed in footwear of any sort.

Barefoot is best. Loose covering obviously to keep warm. Yes keep the sun off, but don’t constrict the feet. Throw away the ‘pram shoes’n the only footwear you need for babies is bare skin.

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.

More Foot Pain For South African School Children?

Thousands of South African children go back to school tomorrow. How many with foot pain?

We don’t know the facts, because the research hasn’t been done. But as children grow, so do their feet. So it’s a safe bet that many feet will be pushed into shoes that were bought at the beginning of the school year in January and are too small 6 months later in July.

On the other hand there will be some children who will suffer the discomfort of a brand new pair of school shoes! It’s not true that shoes have to be “worn in.” They should fit properly and be comfortabl from the start.

Most children wont tell their parents that their shoes are too small, because the soft, developing bones can be easily squeezed and squashed into position. In addition, in the current economic climate, the cost of a new pair of school shoes often has to be balanced against food, rent or travel expenses.

Try to look at your children’s shoes as soon as possible after the start of the term. They have probably complained about having to wear them anyway – having not worn them for a month. Get them to stand up in their school socks and you press gently on the end of each shoe to find the ends of the toes. If there isn’t a finger space at the end, they are too short.

Don’t try the other method of pushing a finger down the back of the foot behind the heel. The shoes should fit around the heels and allow the feet to lie nicely in their normal position. Check also for uneven wear on either side of the shoes – this shows flattening or ‘out-turning’. If the shoes are deforming you should get to see a podiatrist for a check up.

A final word on hockey, rugby and soccer boots. If your child complains that the soles of the feet are sore, have a look for red marks over the areas where the studs are. You probably need to put a soft cushion insole inside to limit stud pressure.

Can’t wait for the next school holidays!

Children’s Feet Take 18 Years to Grow!

The feet of a newborn child are usually perfectly formed and lovely to look at.  Unfortunately many parents easily forget that those feet need nurturing and protecting as they grow to maturity.

It’s going to take up to 18 years for that child’s foot to fully develop. Nevertheless, the newborn foot resembles the adult foot in every respect; it has normal contours and arches and fat padding, but when the foot bears weight it will look abnormally flat – this is one reason why all babies should be allowed to develop at their own pace and parents must resist the desire to get them up on their feet before they are ready.

A newborn foot is usually triangular in shape, broadest at the toes with a narrow heel. The shape and position is also very important, giving clues to any underlying neuromuscular or skeletal pathology. Podiatrists involved in managing children’s feet look for altered shape, restricted movements, stiffness and deviations in different parts of the feet.

For the first 6 months of life the feet are mostly cartilage, so they can be easily deformed by an ill-fitting sock or ‘babygro’ or sleepsuit. The feet and lower limbs of a baby are meant to move, stretch, kick and wriggle as part of normal growth. Freedom of movement is the keyword at this time, which means that any tight fitting devices, pram and cot blankets must be avoided.

Obviously, throughout the entire process of development and growth, correctly fitted footwear is essential for the child, as is the diagnosis and management of any disorder or anomaly, so if you are concerned about your child’s foot health, have their feet checked by a podiatrist.

You can read more about children’s feet here..