The Podiatric Approach

One of the more common complaints made to parents by children is that of, “my legs are tired.” Or in the more extreme cases, pain in legs that keeps children up at night causing pain and no doubt distress to parents. Commonly, this occurs in children around 9-14. They generally complain of pain in their heels and knees. The majority of these pains are avoidable and easily treated with minimal intervention of a conservative nature.

Podiatrists at Karak and Wilson Podiatry Group manage many paediatric conditions. Our Podiatrists understand lower limb mechanics of gait, which are generally the cause of the pain/ tiredness. Physical activity, muscular overuse and tightness of the muscle groups, are other aetiological factors along with poor footwear and excessive rear-foot pronation, hence placing load on the growth plates of the lower limb and foot creating a painful scenario for the child.

Biomechanical assessment, followed by an orthotic therapy are often the main treatment options with adjunct therapies of massage and stretching advised. Footwear recommendations are also made.

Common Foot and lower limb conditions managed by our podiatry team include: Severs Disease (osteochondrosis) of the heel General leg soreness and fatigue:

• Severs Disease (osteochondroses of the heel)
• Arch Pain
• Knee Pain
• General leg soreness and fatigue
• In-toeing
• Claw toe

1. Severs disease (heel pain):

Severs disease, or Osteochondroses of the Calcaneus as it's technically known, is a common condition causing pain in the heels, typically in growing children. It tends to affect children between the ages of 8 to 14.

The condition is due to excessive strain on the growth plate (or apophysis) of the heel bone.

SYMPTOMS:

Typically the symptoms come on after some form of physical activity such as running or jumping. The pain can be quite uncomfortable which makes it very hard for a sufferer to walk for some time after the activity. However, with the pain here is usually very little to see for the symptoms, ie there is no swelling or redness and often the area is only slightly tender to pressure.

Usually however the symptoms settle with rest, only to be aggravated again with activity.

CAUSES:

The cause of the symptoms is due to strain on the growth plate of the heel bone.

When a child starts to go through a "growth spurt" their bones go through quite an active change so that new bone may develop to enlarge the skeleton. The area of growth in a bone is called the apophysis. The apophysis in the heel bone is at the back of the bone.

For new bone to develop in this area the bone must utilise nutrition from the blood, so the blood supply to this area increases during a growth spurt.

Along with this the leg bones are getting longer and the calf muscles are getting shorter. The calf muscles attach to the back of the heel bone via the achilles tendon, just behind the apophysis. This means that when a child is going through a growth spurt, any contraction of the calf muscles can tend to pull at the area of the growth plate.

The result is, the growth plate (with an already increased blood flow) is irritated by the pulling at the back of the bone. This causes a further increase in blood flow, leading to swelling within the bone itself and pain.

The extra blood to the bone is squeezed in and out of the bone during activity. However after resting for a while more blood has a chance to enter the bone and stay there, thus it swells within the bone itself. Thus the first few steps after rest cause considerable discomfort because the now engorged apophysis is again being strained by compression of the bone and pulling of the achilles tendon.

The area shows no inflammation or swelling because the problem is deep and within the apophysis and not close to the skin.

Often symptoms reduce as a child warms up into an activity. This is due to much of the extra swelling in the bone being squeezed out during movement. However symptoms will usually return quickly after a short rest.

Symptoms are often worse in children who put more strain on their calf muscles. This includes more active, overweight or children with unstable feet.

TREATMENT:

Because the symptoms are due to strain on the growth plate via the achilles tendon, the treatment should be aimed at reducing this strain. This can be achieved in a number of ways including orthoses, stretching rest etc... Contact our clinics for an appointment for further information, guidance, and management.

WHAT TO EXPECT:

Severs disease will settle after a growth spurt has finished, however some children put up with symptoms for between 6 months to 3 years. The episodes tend to be periodic, usually offset by sporting activities.

Podiatry treatment tends to improve symptoms enough to allow a child to play sport with minimal to no discomfort in most cases. Arch supports (orthoses) improve the condition in unstable feet in often required.

If the pain is initiated by an injury such as a kick to the back of the heel or if other symptoms occur such as swelling, inflammation or severe pain during activity, then stop activity immediately and consult our podiatry team. Further investigation such as x-rays are rarely needed but at the discretion our podiatry team.

For further information on this or any other foot, ankle or lower limb related problems see your Podiatrist at Karak and Wilson Podiatry Group.

Langwarrin 9776 5576

Warragul 5622 1111

Mornington 5976 2899

Cranbourne 5996 1688

Consisting of the patella, three condyloid joints, twelve ligaments and several bursae, the knee is one of the most complex joints in the human body. The developing knee through childhood and adolescence is particularly vulnerable to injury and chronic pain.

Through biomechanical association, the knee is intimately connected to the complicated and often adverse motions of the foot and its numerous joints.

Children are often susceptible to the many forms of injury associated with the knee due mainly to their increased activity levels when compared to most adults, and the developing nature of bone and musculoligamentous structures involved in such activity.

Complex foot motions of an excessive nature are often adversely absorbed by the knee, consequently setting off a chain of events that can lead to injuries such as patella tendonitis, bursae inflammation, Osgood Schlatters disease, and a myriad of other conditions. Conversely, lack of foot movement can also cause various knee injuries.

Your Podiatrist is an expert at diagnosing and testing foot anomalies which often cause such injuries. It is therefore important to look at the knee not in isolation, but as part of the whole lower extremity when considering appropriate management options.

5. In toe / Pigeon Toe Gait

Intoeing of the feet commonly referred to as “pigeon toed”, is a common torsional plane deformity of the lower limb in children and is often a common cause for concern in parents.

Children with an intoeing gait may complain of fatigue in their legs or feet and often will trip over more often when running or during exercise.

Apart from being intoed, parents may also notice their child has “knocked knees”, flat feet or that they are just walking awkwardly.

Podiatrists understand the function and mechanics of the lower limb, and they can give advice, exercises or other treatment to rectify this condition.

Intoeing can be caused by rotational or positional problems in the hip, knee or foot. There may also be movements in the foot and leg to compensate for an intoed gait, and these compensatory movements may lead to further problems.

Treatment options for an intoed gait include biomechanical assessment with orthotic correction, a personalised stretching program, change to sitting or sleeping position and gait plates that encourage an out-toe gait.

This condition is a common complaint that has very successful results when treated early.

Also known as claw toe or spondactyly, this condition is found widely throughout all populations over the world. It is characterised by the apparent curling of one or several toes.

The condition is often first noticed at birth or is quick to form in the first year or two of an infant’s life. The curling of the toe is generally apparent because of uneven pull at the connecting tendons to the phalanges (bones) of the digit in question.

Through exercise, splinting and massage of the affected area, the toe can be straightened over a period of months. Occasionally in severe cases, surgical intervention is required.

Podiatrists at Karak & Wilson podiatry group can diagnose and present a treatment program devised to correct this common deformity, pre-empting the further retraction and possible adult complications associated with this condition.

Growing pains aren’t just something children have to put up with. They are manageable. Make an appointment with our Podiatrists to investigate your child’s complaints. Please refer to our “Contact Us” link.