It is normal to be concerned with the health of your child’s teeth and eyes, but have you ever given a thought to your child’s feet?
Just like many adult ailments, foot and leg conditions are often notable during early childhood development.
Children’s feet are highly vulnerable to injury as they continue development into their late teenage years.
For active children, pain and injury can be exacerbated during sport, so it is important to be able to recognise a few more common lower limb aches and pains that may affect your child.
Heel pain/Sever’s disease
What is it ?
There are numerous causes of heel pain in children. Sever’s disease is an injury to the growth plate of the heel bone (calcaneus) where the Achilles tendon attaches. This is most common in active children between the ages of 8 to 14 years.
What to look for?
Your child may experience pain at the back of the heel bone. This is worse with exercise, particularly high impact exercises such as running and jumping. The pain can range in severity to a slight niggle to being severe enough to make a child limp or to stop playing sport.
What to do?
Initially, it is best to reduce aggravating activities or sports and apply ice to the painful area. Also check the fit of your child’s footwear, as ill-fitting shoes can exacerbate the problem. If pain continues, it is time to make an appointment with a health professional such as a podiatrist and physiotherapist for further assessment and treatment.
Knee pain/Osgood-Schlatter disease
What is it?
Osgood-Schlatter disease is a common cause of knee pain in young children, whereby the quadriceps tendon becomes inflamed at its insertion into the tibial tuberosity (just below the kneecap). The condition causes knee pain, tenderness and swelling just below the knee, and down the shin. It is more common in boys, overweight children and from overzealous activities such as running, jumping and rapid changes of direction.
What to look for?
Osgood-Schlatter disease will usually present with tenderness and swelling just below the front of the knee and will be exacerbated by high impact activities or sports. Pain can be intermittent and mild, only occurring during certain activities or can be persistent and debilitating. It usually only occurs in one side however can occur in both knees at the same time.
What to do?
Avoid activities which involve deep bending of the knee and apply ice to the affected area. If pain continues, seek a professional assessment from a podiatrist or physiotherapist to determine the right method of treatment for your child.
Frequent ankle sprains
What is it?
An ankle sprain is one of the most common injuries for children. It occurs when there is a sudden twisting motion at the ankle (either inward or outward) during weight loading. This can overstretch or even break the ligaments which support the ankle joint resulting in pain, bruising and the inability to weight bear. When ankle sprains occur frequently it is often the result of poor foot biomechanics.
What to do?
If your child sprains or twists their ankle frequently, a podiatrist and physiotherapist are able to manage this through exercises, footwear advice and sometimes with the use of orthoses.
Growing pains
What is it?
‘Growing pains’ have not much to do with growth at all. Growth is not a painful process and nor should it be for any child.
Musculoskeletal pains that can affect children from 3 years of age through to adolescence, can come from a variety of causes such as muscle fatigue and poor postural control. They often occur of an evening and affect either the calf muscles, thigh muscles or behind the knee.
What to look for?
Growing pains usually occur of an evening or at night. They can be infrequent and can be brought on by increased activity during the day. The pain is always gone by the morning. The pain does not affect the way a child walks or runs directly although variables in a child’s biomechanics of the lower limb can be an attributing factor to the problem. Growing pains do not make a child unwell. If your child is unwell or their leg is swollen or sore to touch, it is important that you seek medical opinion as there may a more serious condition at hand such as infection or injury.
What to do?
If you are concerned about the frequency or severity of your child’s growing pain, a Podiatrist can assess and determine the cause of the problem. If their pain is suspected to be associated with illness or injury, it is best to seek a medical opinion from your Doctor immediately.
In-toeing
What is it?
In-toeing is when a child will walk or run with their feet pointing inwards instead of straight. It is not a pathologic condition itself however is a gait abnormality which may be caused by a structural deformity within the foot or lower limb. The inwards rotation of the feet may also be noticeable at rest.
What to look for?
Diagnoses of the cause of the in toeing is variable upon the age of onset of the in-toeing. When the in-toeing is noted before walking has commenced in a baby, it is usually the result of an adductory deformity which began in utero such as hallux varus, talipes equinovarus or metatarsus adductus.
When in toeing is noticed in a toddler before the age of 2 years, it is usually caused by a structural abnormality within the lower leg (tibiofibular part). If in toeing begins after 18 months of age, it may be due to structural issues within the thigh and hip region.
After this age, also look out for your child sitting in a W position – where their bottom is on the floor but their thighs are internally rotated, and knees bent so their legs are away from them. This seated position places extreme internal rotational forces through the hip joint which can influence a child’s gait pattern.
What to do?
No matter the age of onset, in-toeing is not a normal developmental process and children do not usually ‘grow out of it’.
Assessment and diagnoses is recommended by a podiatrist and physiotherapist to determine the best course of management. Often conservative exercise programs, footwear changes and orthoses are all that is needed to correct this gait abnormality.
In any instance of a child’s foot and leg pain, it is important that the signs are not ignored and diagnosis is attained through thorough assessment of a qualified health professional.
Treatment pathways for common paediatric musculoskeletal conditions such as Sever’s disease, Osgood-Schlatter, poor postural control, and growing pains are often conservative and tailored to be easily accepted by children and adolescence.
Our ultimate aim is to have your child pain free so they can get off the couch and get back out playing the sports and activities they love.
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