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!

Is Your Backache Caused by Your Leg Length?

Well it could be. Are your legs the same length? Do you have a Limb Length Discrepancy? When you stand, is one foot flattening or collapsing whilst the other one stands up straight? Do you suffer from chronic back pain?

During the past few weeks, we have been people of all age groups with significant differences in the length of their legs. Limb Length Discrepancy or LLD as we call it. This condition causes all sorts of problems and pains. people complain of pain in the lower back, between the shoulder blades, in the knees, in the soles of the feet, at the heels and at the ball of the foot.

Usually the longer limb gives the most trouble and the typical view the podiatrist gets is of a person who rolls from side to side as they walk with one shoulder higher. In technical terms the condition is referred to as being Functional or Measurable.

The LLD can be very subtle and is often difficult to spot, especially if the person is an athlete or physically fit. This is because well-toned muscles enable the body to compensate for the oddity in structure. We usually diagnose it visually during a biomechanical examination and gait analysis.

There are signs such as spinal curvature – scoliosis – dropped shoulders on the side opposite to the short limb plus some changes in arm swing. The diagnosis of a Functional LLD is confirmed by something called a Scanogram, which is carried out by a radiologist.

The management requires teamwork involving podiatrist, physiotherapist and biokineticist, because it is easy to jump in with heel raises or to buy ready-made devices from the pharmacy without fully analysing the components of the condition.

More on this tomorrow

Fitting Children’s Shoes – Again!

Fitting children with shoes can be really difficult and is often unpleasant for all involved. That includes brothers, sisters and fathers hanging around nearby! This means that the responsibility for getting the correct usually lies with Mum. The trauma increases due to the fact that in South Africa, there are virtually no shops who know how to measure children’s feet and fit the correct size of shoe.

Some stores have had measuring boards available in the shoe section for some years, but using it was left to the customer. At the same time there was no guarantee that the size system on the board matched the size system of the shoes. Anyone who has bought sports shoes/trainers recently will know that they have three or four different size numbers on the tongue of the shoe. This is because the shoes are made in Asia for sale all over the world where the basic unit of measurement differs – including different centimetre units.

In an attempt to bring some order and science into the art of shoe fitting, the South African Podiatry Association (SAPA) has been working with various manufacturers and retailers to establish standards for footwear in this country. There is a committee of experts headed by a podiatrist who has done ground-breaking original research into the feet of South African women. This committee assesses lasts(the plastic shape around which a shoe is built) and footwear design, against a checklist based on this scientific research.

One retailer is Woolworths and if you buy your child’s shoes there – although you will have to fit them yourself – you will see certain styles have the SAPA approval logo on the green tag. Look out for other large retailers getting involved in 2008.

Do Your Children’s Shoes Fit?

Children’s feet need special care and attention and nothing is more important than selecting and fitting children’s shoes.

Oh yes, Happy New Year! The year is racing along already with Christmas holidays a fading memory. At present summer in Johannesburg also feels like a fading memory thanks to all the rain. With January came the start of a new school year and being too distracted with moving the practice I missed a great opportunity for ‘back to school tips’, but it’s never too late to review some of the basics. Especially as children grow so quickly and usually don’t tell you about short shoes because they get used to squeezed toes, or they hate the look of their prescribed school shoes. (Remember how long they stay as soft cartilage).Look at the page on Children’s Feet.

Did you have your children with you when you bought their shoes? Many parents buy based on size and take the shoes home to fit. [There are valid socio-economic reasons in South Africa, but it’s still a bad idea]. Also getting children into school shoes can be difficult if they are first-timers or have just spent six weeks barefoot or in sandals. (Or possibly Crocs!!)

Did you buy the shoes with your children wearing the socks they normally use for school?

Are the shoes stable and protective for those soft  vulnerable feet?  Is the sole firm with a flexible leather upper?How much synthetic material is there which is going to make the feet sweat? How do they fasten? Velcro is ‘cool’ but not often found on a school shoe. Doing up laces is currently ‘uncool’.

I doubt very much that you were able to check the fit of the shoes by having your child’s feet measured! A simple method of checking fit is to pour some powder into the shoes, put them on and have the child walk round the kitchen. Carefully take off the shoes and look inside for a centimetre of powder beyond the end of the toes. If you don’t see it then the shoes are probably too small.On the other hand never buy shoes too big so that they "can grow into them" or in the hope that the shoes will last a school year.

Children can outgrow shoes as quickly as new cars lose their value, so at the end of every school holiday check the fit of your children’s school shoes.

It could be that your "little Einsteins" are suffering irrepairable damage to their feet and you haven’t checked.

You And Your Feet

I’ve just come across an article I wrote a while ago for the South African Journal of Natural Medicine and thought it might be useful as a reminder as we embark on another year.

We need to take care of our lives, our relationships and our bodies as we renew our efforts in the New Year – and that includes our feet. 

Take a look now at You and Your Feet

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..

Do podiatrists like Crocs?

Some do, some don’t.

“They should not be worn by people with diabetes” says a colleague in Cape Town.

On the other hand, a British podiatrist, writing in Podiatry Now, thinks they have great therapeutic potential and presents a case history as evidence. He suggests that they be researched by the podiatry profession.

Some UK websites are full of therapeutic ‘evidence’ and testimonials.

WATCH THIS SPACE!

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.