Is Your Child Pigeon Toed?

No, I don’t mean that your child’s foot comprised of claws designed to hang on branches. I am talking about toes that point inward, commonly referred to as in-toeing. This is a common concern of parents especially when a child is having frequent falls when learning to walk.

In-toeing is more common than you think and is often a normal part of your child’s development.

There are three common causes of in-toeing, which almost always resolve on their own with time.

1) The femur bone of the child’s upper leg is rotated inward
2) An inwardly rotated tibia or shinbone in the lower leg
3) A foot which is bent inward likes a kidney bean

All Children are born with their legs turned in slightly inward. With time the bones begin to derotate to the normal slightly outturned foot position that you see in adults.

Intoeing that is severe enough for treatment in newborns it should be recognized by your pediatrician and sent to a qualified physician for evaluation.

When in-toeing starts in the foot it is known as Metatarsus Adductus (Metadductus). The foot will look kidney bean shaped if this is the cause. Gentle stretching and in some cases plaster casts or braces are used to reduce deformity when treated as an infant, usually before 12 months of age. In the rare cases where casting is not successful, surgery may be indicated to release contracted ligaments allowing movement of misaligned bones.

As the child grows parents often diagnose condition after they notice their child continually tripping over their feet. I remember when I was a child? I used to trip and fall all the time. I always had a scratch or two on my knees or elbows. Most children do not develop good coordination until about 8 or nine years old, so falling and tripping is a normal part of being active and young.

While in-toeing in most cases resolves before the age of 8 years old, some children continue to have toes that turn slightly inward. Orthotics can be helpful in stabilizing feet and helping kids to turn the foot outward slightly to reduce tripping, as well as reduce the risk of future foot problems. A podiatrist can have an orthotic made that addresses in-toeing specifically and help your child walk more normally.

Love the Right Shoes For Tennis

Tennis is a great activity especially for youngsters developing coordination along with cardio fitness. The body movements in tennis required start and stop actions along with side to side movements. Wearing the right shoes for the game is important to overall foot health.

Tennis shoes are much different than running shoes in that tennis shoes have specific qualities to support the foot type and protect feet. Tennis shoes have more cushioning along the sides of the shoe for added stability for side to side movements. To assist in moving players serving to moving up toward the net, the shoes have a thicker sole.

For those starting out in the game, cross training shoes may be an option. If however the athlete progresses in the sport, tennis shoes ultimately would be a better choice.

Running shoes should not be worn while playing tennis. A running shoe is meant for forward propulsion as with the action of running. Running shoes have a narrower base and cannot adequately support side to side movements resulting in ankle instability. Injuries such as ankle sprains, tendonitis, and stress fracture as well as growth plate injuries are common when running shoes are worn for tennis activity.

There are many tennis shoes on the market. First, start by visiting with your local Podiatrist or Certified Pedorthist to know your foot type, shoe size and the type of support needed based on your level of activity.

Next, shop around from local pro shops to sporting stores to try on different brands. Tennis shoes vary based on the manufacturer. The shoes you select should give you proper support and feel comfortable on your feet and not what fellow players are wearing. Remember, your feet are unique.

Based on the amount of play will determine how often you replace your tennis shoes. Anywhere from three to six months is typical. Inspect your shoes weekly for proper wear of the treads. While wearing the shoes, make sure you untie your shoes after use and tie your shoes when putting on the shoes. Tennis shoes should never be slipped on and off as support is weakened.

Keeping your tennis shoes in check will let you feet love the game!

Kids Have Foot Pain Too!

School is barely in session and already my Grapevine office is overrun with kids. Lots and lots of kids! We joked Wednesday afternoon that I think I saw the entire 4th, 5th, and 6th grade in one afternoon. It really did seem that every patient that day was around 10 years old! As I was giggling with another patient, who thought she had mistakenly walked into a pediatrician's office, she really made me aware that most adults don't realize that kids have foot issues. She asked why they were all there and what kinds of things kids come in with, then laughingly suggested that they couldn't all have ingrown toenails!

After I stopped laughing, I thought I would enlighten my readers on the kinds of problems kids have with their feet. In fact, if you happen to have kids, a great way to educate yourself and them is to ask for a copy of our free coloring book with fun bunny pictures and lots of information about childhood foot issues. Here is a good summary to tide you through until you get your free coloring book.

Kids have foot pain just like adults, but because of their rapidly growing bones and tendons, they often have confusing symptoms and need to be treated in different ways.

Some kids are just born with, to put it simply, jacked up feet. Arches that are really high (caves feet) or practically non-existent (flat feet or calcaneal valgus) are common, with varying symptoms. Some kids walk and run really strange, often tripping and falling. Some kids have severe problems fitting shoes or wearing them out rapidly. Many kids experience "growing pains" or cramps in their feet and lower legs - these are never normal despite what many pediatrician's are taught to believe. Heavier kids have more foot related issues, but skinny kids have foot pain too.

Kids with abnormal feet and gait issues often suffer from traveling pains and overuse sports injuries.

The most common is calcaneal apophysitis, a.k.a. Sever's disease, a.k.a. pediatric heel pain. These kids have pain in their growth plate that worsens with activity. I saw a lot of this in the last few days due to early season football and soccer. The cleats and the increases activity are the beginning of the perfect storm of pediatric heel pain. Add to that the love of barefoot and flip flops, we have an early Fall epidemic of heel pain. The good news is that pediatric heel pain is often pretty easy to treat if you focus on the cause, improper biomechanics, or simply said, jacked up feet.

Other common foot type related ailments seen in kids are posterior tibial tendinitis (pain and swelling in the largest tendon that holds up your arch), Achilles tendinitis (pain in the largest tendon on the back of your heel), shin splints (pain in the front of your shin bone or lower legs), and Osgood-schlatter's disease (pain and swelling in the growth plate just below your knee). These are also treated primarily by realigning the biomechanics of the child's foot.

Kids with gait issues may in-toe or out-toe causing muscle and joint imbalances. Some kids are even chronic toe walkers. These types of issues can be foot type related or can be caused by some underlying nerve issues. Orthotics (shoe inserts to balance abnormal foot function) and physical therapy are usually very helpful.
Of course, kids also can suffer from traumatic sprains and strains as well as stress fractures and fractures. No one is immune to fall down and go boom!

What else do we see in kids? Lots and lots of ingrown toenails and pesky warts. Skin and nail issues are abundant and seem to be ignored all summer long. I implore all parents to take a look at their kid's feet and nails. Little problems become big headaches when not addressed. A simple ingrown toenail can become a huge abscess when picked at repeatedly by your child.

So while I replenish my kids treat drawer and balloon stash, remember that kids have lots of foot issues too and at Foot and Ankle Associates of North Texas, we treat lots of kids! Request a free coloring book for your kids and don't ignore their feet!

PS. Just so Moms and Dads don't feel left out, we have a free book for you too. Just request a copy of Got Feet for yourselves. No pictures to color, but lots of great information!

Children's Back to School Shoes Tips

In keeping up with school demands and the latest trends in threads, let’s not forget to update their treads! Ok, I had to go there! Dr Seuss is still alive and well at my house!

As a podiatrist mom of three kids, you can only imagine how obsessed I can get about the shoes they wear at school! And here I am sharing my obsession with other obsessed parents!

Fortunately, I do not know of a school that allows flip flop. Hooray for that! Sandals are still permitted and if you must, please know that every year I see stubbed toes, broken toes, blisters, arch and heel pain, tendinitis and sprained ankles from unsupported sandals. At the very least, if you must go there as a shoe option, choose a sandal with a good arch support and one that straps around the back of the ankle. Still will have the stubbed and broken toes though!

Let’s not forget the shoes for those older kids playing a sport! Your best bet with them is a sport-specific shoe with a sport-specific support in their shoes.

Remember, it’s not how the shoe looks, but how it feels!

I am guilty as charged on this one! The shoe is too cute pass up and go figure, she says they hurt! Bummer! Then there is the other half of the coin where your child loves the shoe and swears up and down they are a perfect fit only to come home from school with blisters! Bummer!

Most of us have feet that are slightly different in size, and kids are no different. When sizing the shoe, always buy the shoe to fit the larger. Always have your child’s shoe size measured. One summer can mean one half to full size of foot growth. I recommend measuring the foot while your child is standing and allowing about a half-inch of growth room at the end of the shoe. You should allow one thumb width from the end of their toe to the end of the shoe. And don’t forget to measure the width of your child’s foot as well. Having a shoe their foot swims in is just as blister-causing as one that is too tight!

Look at the shoe and observe where the seams are. Run your hand on the inside of the shoe for any rough spots or irregularities. You may have the correct size and width, but if a seam is rubbing on the wrong spot, that particular shoe may not be the best style. Try different brands or styles of athletic shoes before settling on any particular one.

If your child is having trouble with their feet and you know the shoe fits and style is seems fine, don’t hesitate to have us check them out! It may be the way your child’s foot walks or the type of foot they were born with that makes them so difficult to shop for. Let us help sort it out! Nothing like a little piece of mind for a new school year!

Children's Summer Shoe Tips

Summer means new ground for little feet to cover. Whether it's sand, water, dirt or grass, kids will be busy running, swimming, climbing and jumping.

Improper foot support can lead to aches, pains and sprains.

Shoes to avoid

As a mom with three girls, I know it's hard not to buy all of the cute shoes that are out for summer! However, in order to prevent tripping and maintain good contact with the footbed of the shoe to improve support, it is best to avoid flip-flop type of sandals unless they have a built in arch support..

Flip-flops as I have previously discussed in another blog, can lead to problems including stubbed toes, broken toes, blisters, arch and heel pain, tendinitis and sprained ankles.

Flip-flops do not offer kids enough protection or support for daily wear. They are fine for brief periods of time at the pool or beach. I see many children with foot pain after a long summer of walking barefoot or wearing unsupported sandals as well as injured toes and feet from sandals and flip-flops that lack protection.

Barefoot is not a good alternative. We live in a concrete jungle. Puncture wounds can really ruin a summer vacation!

Shoes to consider

There are better alternative to your traditional flip flop. Sport-style sandals offer more coverage and support than flip-flops and are also a better choice than open-toed sandals for balance and support.

Crocs can be an option if worn correctly. Crocs tend to be worn loose on the foot and therefore offer less support and stability. However, when they fit snug, they do offer good flex of the sole as well as being closed-toe and having a back strap.

Shoes for toddlers

Toddlers and new walkers, because at this stage in development flat feet are usually normal, do not need arch support from a shoe, but instead require a shoe that provides a substantial amount of flex to allow their feet to move freely.

Toddlers benefit from closed-toe shoes that are relatively close-fitting (don't allow a lot of wiggle room side to side). Open-toed shoes do not provide the amount of stability that a closed-toe shoe does. They are learning many new gross motor skills and require good support for all of the challenging new balance activities, as well as learning to walk in the grass, mulch or sand.

Shoes for older children

School-age kids need more support and cushioning, and flexibility at the ball of the foot from their shoes. Preteens and teenagers' feet are nearing maturity and for those who play sports will require sport-specific support from their shoes.

The right fit is essential

Once you've found the right shoe for your child's need, you need to find the right fit.

Because kids have feet that are slightly different in size, the larger foot should determine the shoe size. I recommend measuring the foot while your child is standing and allowing about a half-inch of growth room at the end of the shoe. You should allow one thumb width from the end of their toe to the end of the shoe.

Always use the store's measuring stick to obtain the length and width of their child's foot as a starting point to finding the right fit. The number may be irrelevant if the shoe company has sized them slightly off, but it is a good starting point. You may be amazed how much your child has grown!

Matching the right shoe to each summer activity is also important in protecting growing feet.

I recommend that children wear sneakers during the summer for daily walking, running and jumping. There are many lightweight, breathable and washable options, with proper heel cushioning, mid foot support, flexibility, good traction and rounded edges to decrease stumbles and falls. If you do want a sandal for summer heat and splashing in the water, choose a sneaker type sandal with cutouts and mesh - a much better choice than flat, non-cushioned flip-flops.

If your child is having trouble with their feet and you know the shoe fits and is correct for their activity, contact our office and we can take a look. Many children's foot problems are due to poor shoes, but gait problems can also occur. A short office visit may sort it out and get your child running, jumping and playing with the other kids, pain free, this summer!

Children's Footwear: The Importance of the Design and the Fitting

Most parents don't know the first thing about selecting the right shoe or fit for their children's shoes. The answers that they may receive from a shoe salesman or a in store-fitter can also be varied. I have heard everything from it does not matter what type of shoe they wear when they are toddler age, to buy a shoe that is one size to big, it will last longer and you can stuff the toe box with paper. Even your pediatrician may have trouble answering the correct way a shoe should fit and it is no surprise... After century's of fitting children with shoes there is still no standardized approach to pediatric footwear.

Many studies in the recent years have been performed and this is what has been concluded.

We as parents put shoes on our children to protect their cute toes, keep their feet warm, clean and dry. But research suggests that shoes really do influence children's feet as they grow. "It is a child's first steps that determine their gait pattern-good or bad into adulthood."

Unlike other parts of the body, the bones in the feet continue to develop well into the child's early teen years. All the reason why the correct shoe is so important. Even at a young age the wrong shoe can cause the onset of juvenile foot deformity.

Studies have shown that most shoes are advertised to be a certain size but turn out to measure smaller. Without enough space in the front of the shoe, children do not have adequate toe movement forward as they step. If the shoe is to big then the flex point of the shoe will not match up with the flex point of the foot.

Experts advised that the tip of the longest toe should be 10-12mm from the shoes inside tip while weight bearing and looking straight ahead. They also warn about shoes that are labeled "wide" but in reality do not have a wider sole, just more material sewn into the shoe.

Many parents will use hand me down shoes. It makes sense since children outgrow everything so fast. But researchers believe that this is detrimental to a child's foot. The sole of the shoe develops its own memory and any gait abnormalities the primary wearer has will be passed on to the next recipient. Which means if one child has a very flat flexible foot and pronates, this can cause the next child to have more instability in the shoe, fall more and also walk differently then they would if they were in a new shoe of their own.

Overall there is no perfect children's shoe. You will find different opinions from from everyone you ask. Important notes... Watch your child as they walk in their shoes. They should appear stable with good support to their feet and remember to check their shoes often... Kids at these ages grow fast and you will be surprised how fast those little toes will reach the end of the shoe!

Pain in my legs. Could it be Shin Splints?

It seems that these days children are more active then ever before. Most kids participate in multiple sports throughout the school year and are a part of a variety of teams. You may have a child that is complaining of pain on the front part of their legs. This complaint may be from children who have just started to become active or have recently increased their activity level. Don't just ignore the pain and blame it on "growing pains" because most of the time it isn't!

Shin Splints can cause pain in the lower leg usually due to overuse of the muslces, chronic and repetitive stress, and can also be the result of bad feet, muscle imbalance, bad shoes or improper training.

Early treatments for Shin Splints includes ice, rest, anti-inflammatory like Advil, stretching exercises, over the counter arch supports, custom orthotics, and physical therapy.

Making sure that your child's shoe fits correctly is the first and most important step. The shoe needs to be the correct type of shoe for your child's foot structure to insure that they are getting enough support. Shoes that allow to much flexibility of the foot are more likely to cause shin splints.

Some children may need an orthotic that will be placed in their shoe for extra added support. Your child's gait can be evaluated by a podiatrist who can recommend the correct shoe type and orthotic type for your child.

Shin splints are very common in children and are an over use injury. Make sure your children are listening to their bodies and taking time off sports to keep them pain free.

Itchy, Stinky Feet in Kids

Hyperhydrosis, or excessive sweating is caused by over active sweat glands on the bottom of the foot and is especially common in adolescent children who are going through hormonal changes or physical stress. It can also occur frequently with children who are involved in a lot of sports and are stuck in gym shoes and socks the majority of the day.

Excessive sweating of the feet can lead to blister formation, athletes foot, skin breakdown, and painful calluses. With lingering moisture, inevitably, foot odor becomes a real problem for the child.

Treatment of Hyperhydrosis:
Treatment can include powders, creams and antiperspirants. Using an over the counter antiperspirant on your feet daily can help reduce moisture and odor. There are also prescription topical medications to prevent the sweating at a cellular level.

It is very important to remind your child to change socks frequently, and air out shoes and liners of the shoes each night. Teach your children about the importance of wearing socks in all of their shoes and how they can prevent the spread of infection and odor. The ideal sock for your child to be wearing is a synthetic cotton/poly blend.

Tinea Pedis, or Athletes Foot, commonly affects children after puberty. It is easily contracted due to the prolonged use of closed toe shoes, resulting in hot, sweaty feet which promotes the growth of the fungus. Athletes foot appears as itchy, scaly areas on the soles and sometimes will form painful cracks in between the toes.

Treatment of Athletes Foot includes topical or anti fungal medication or in severe cases a combination of both. Recurrence is common due to fungus being so common in the environment so make sure your child uses the medication as directed and does not stop as soon as they symptoms are gone.

Ankle Sprain's in Children: How to Treat

Ankle sprains are on of the most common injuries we see in children. Children these days are part of so many sport teams and don't forget gym class... What causes an ankle sprain??

Most of the time an ankle sprain is caused by a twist or blow to the ankle causing the ankle to turn at abnormal angles. There are three ligaments that are on the outside of the ankle that are commonly injured. The job of these ligaments is to hold the ankle in a neutral position. Once these ligaments have been injured the ankle can become weak and instability can occur.

Often times the first symptom of an ankle sprain will be swelling, often the size of a golf ball. Most of the time once the swelling goes away parents, children and even coaches think they are healed and it is okay to get back to activities. This is way to soon!!!

An ankle sprain affects the balance of your ankle and the ankle ligaments need time to heal and become strong again. Getting back to activities to soon makes re-injury more likely and you run the risk of having a weak and unstable ankle.

Other symptoms of an ankle sprain are pain, bruising, stiffness in the joint, and pin point tenderness.

So you think you have sprained your ankle.. How do you treat?

The treatment of an ankle sprain depends on the severity of the sprain. Initial treatment should always include rest, ice, elevation and compression. Anti-inflammatory can be helpful for reduction of swelling and pain. Most times the ankle is weak and needs to be immobilized. A lace up ankle brace or soft cast may be necessary to help the ankle rest, regain strength, and return to activities pain free. Long term instability can be prevented with physical therapy.

If you have fallen down and gone boom, make sure you have your child evaluated by a Podiatrist who can give you the recommendations on how to get your child back to full activity and participating in the sports he or she loves.