Our Podiatrists specialize in children's foot & ankle conditions
What is Pediatric Foot Deformity?
It is a term that includes a range of conditions that may affect the bones, tendons, and muscles of the foot. The most frequently treated at the Hospital for Special Surgery (HSS) are the cavus foot, tarsal coalition, clubfoot, accessory navicular, and juvenile bunion.
Treatment of pediatric foot deformities in children can vary significantly from that needed in adults. Fortunately, pediatric foot doctors who specialize in this field can bring to bear a range of non-operative and operative techniques specifically developed to address the distinctive needs of children, which include special attention to preserving the integrity of the growth plate, allowing continued growth and development of the foot.
Cavus Foot
It is a condition in which the child has an excessively high arch. In many cases, the heel of the foot is turned inward — this is known as cavo-varus foot. The condition frequently affects both feet and is often progressive.
Because the foot is not aligned correctly, patients experience pain and develop calluses owing to uneven weight-bearing. Pediatric podiatrists also warn that ankle sprains or even stress fractures may occur.
Cavus-Varus Foot
A cavo-varus foot that develops over time (as opposed to that which can appear with a club foot) can indicate the presence of a neurologic problem, the presence of a cyst, or possibly a tumor in the spinal cord.
More commonly, however, it results from Charcot-Marie Tooth disease, a hereditary disorder in which the conduction speed of nerves slows over time and causes weakness of the distal muscles of the hands and feet.
While Charcot-Marie Tooth disease is not life-threatening, the foot problems that accompany it can be disabling. Because other symptoms may be mild or non-existent, the cavo-varus foot may be the key to diagnosis.
Tarsal Coalition
Children with this may require specialized pediatric foot care as they develop an abnormal connection between the bones in the midsection and the back part of the foot. It is typically diagnosed during late childhood or early adolescence when the coalition restricts foot movement, leading to pain and occasional stiffness.
Symptoms may be particularly noticeable when walking on an uneven surface, such as sand or gravel, an action that requires constant adjustment of the foot. Frequent ankle sprains may also signal the presence of a coalition.
Most tarsal coalitions may be classified as one of two types — a calcaneonavicular coalition, in which the tissue develops between the calcaneus (heel bone) and the navicular (one of the foot bones), or a talocalcaneal or subtalar coalition, in which the coalition develops between the calcaneus and the talus (the ankle bone), often requiring evaluation and treatment by a pediatric foot doctor.
The coalition may be composed exclusively of bone, a combination of bone and cartilage, or even fibrous tissue. Tarsal coalitions occur in both feet in about half of all cases.
Clubfoot
It describes a condition in which the foot—or sometimes both feet—are turned inward and are pointing down. Immediately apparent at birth, clubfoot is known to develop during intrauterine life, at between 9 and 14 weeks gestation. In fact, in many cases, the deformity is detected on routine ultrasound.
Occurring in about one in 1,000 births, this foot condition is statistically seen more frequently in boys than in girls. Although family history may play a part, many infants with it have no known relatives with the condition.
In the majority of cases, clubfoot can be successfully treated by a pediatric podiatrist without surgery using the Ponseti technique, which employs gentle manipulation and casting of the feet at weekly intervals.
Our foot doctor will use treatment that begins shortly after birth when the newborn's foot, including tendons, ligaments, joint capsules, and bones, is most responsive. Following this first phase of treatment, a brace is used for an extended period to maintain proper alignment. When applied correctly, the Ponseti technique yields excellent results.
In some instances, it does require surgery — the approach that was used historically before widespread acceptance of the Ponseti technique. While this approach can yield good correction of the deformity, the procedure may result in a stiff and arthritic foot later in life. When this occurs, additional surgeries may be necessary to alleviate the arthritic pain.
Accessory Navicular
It describes the presence of an extra bone growth center on the inside of the navicular and within the posterior tibial tendon that attaches to the navicular. The primary symptom of this additional bony prominence is pain and tenderness.
This congenital defect (present at birth) is thought to occur during development when the bone is calcifying. Because this accessory portion of the bone and the navicular never quite grow together, it is believed that, over time, the excessive motion between the two bones results in pain.
The initial treatment approach for accessory navicular is non-operative, with options such as orthotic support or a brief period of casting to rest the foot, often recommended as part of pediatric foot care.
However, in cases of chronic pain, the orthopedic surgeon may opt for a relatively simple surgery to remove the extra bone, which typically entails a brief rehabilitation period and boasts a very good success rate.
Juvenile Bunion
In this condition, the joint at the base of the big toe (the metatarsophalangeal joint) moves out of alignment in such a way that the big toe angled inward to the second toe.
However, unlike adult pediatric bunion, which usually results from ill-fitting footwear or has a hereditary component, it occurs most often in children who are ligamentously lax or loose-jointed. The problem is more common in girls than in boys.
Surgical treatment for juvenile bunions is typically limited until the end, or close to the end, of growth due to concerns about potential damage to the growth plate and the likelihood of recurrence, which often necessitates consultation with a pediatric foot doctor.
Non-operative treatment includes the use of wide shoes or sneakers and avoidance of narrow dress shoes and high heels. Usually, this sufficiently alleviates symptoms to avoid or defer the need for surgery.
In younger patients who do not respond to non-operative treatment and who have pain that interferes with their daily activities, surgery to realign the bone and straighten the toe can be performed. A number of different approaches are used, depending on the type of pediatric bunion, the extent of the deformity, the age of the child, and how much growth remains.