Is it Normal for a Toddler to Have Flat Feet?

Every parent that has a painful flat foot is afraid that their child might inherit their foot type. It is normal for a child's foot to appear flat up to about the age of 2 due to a thick layer of baby fat that fills the arch area. As long as the child is otherwise healthy, and the foot is flexible and free of pain, then no treatment is necessary even if you think it may look "too flat" to be normal. Many times they actually inherited your spouses or grandparent's feet and got lucky!!

A child's arch becomes much more obvious around the age of 3 when that baby fat pad disappears. At this age it is still normal to see a "low" arch when standing, but their foot should have a good arch when sitting or lying down.

When a child has a severe flat foot, you will usually notice not only a low arch but an inward bowing of the inside of their ankle and their Achilles tendon. They look like they have a nice arch when non-weight bearing but it completely flattens out when standing. This is usually a flexible developmental flat foot and can lead to postural complaints, "growing pains" and poor muscle development.

In rare cases, some children are actually born with a malformation of the ankle bone that causes a rigid flat foot with the appearance of a "rocker-bottom" foot. These are usually evident within the first few months of life with a rigid foot.

If you are worried that your child has an inherited flat foot or is complaining  of foot and leg pain; time to visit the podiatrists at FAANT for an opinion. Contrary to popular belief, foot and leg pain in children is never normal; and most kids will not grow out of flat feet! There are simple changes in shoe gear and inserts as well as physcial therapy that may help your child run, jump and play with their friends without pain!

Divorce Affects the Injured Child

I have been seeing a little boy with heel pain for the last several weeks. When his progression was slower than what I anticipated with this sort of injury, I started to review the treatment protocol with his mother. I noticed her nodding while she confirmed she was indeed reinforcing these treatment steps. When we finished, she said under breath “I just wish his dad was doing the same”. I have seen many children of divorced parents and sympathize all too well with the negative impact this can have on a child’s ability to heal from injuries. Injuries can become chronic when parents are not communicating effectively about their child's needs. It is the child who ultimately suffers the most because of it. This has affected my ability to help heal your child so much so, that I am hoping some simple tips can help in communication between parents who are not communicating.

1. Keep the lines of communication focused only on your child’s needs. Remember that just because one parent may not want to talk to you, you are speaking only to pass on the information your doctor has given you. Your ex may have no interest in your opinion about what is best. Simply state that you are calling because you took your son/daughter to the doctor and, knowing that you both “want what is best” for him or her, you want to pass on the information “while it is still fresh” in your head. This puts focus on the information, rather than the person dispensing it.

2. Make copies of whatever information was given to you in our office. Even the notes you took during your visit can be very beneficial in enforcing treatment. Send them with your child when you drop your child off.

3. Speak to you child about what is condition is, in the simplest form a child their age can understand. Draw pictures if this helps. Try to impart to them what having this condition means to their ability to play sports, PE, go barefoot etc. and why doing certain activities can make it hurt worse. We all know children do not like to be told what to do. But they do want to get better. Let them tell you what makes their foot feel better by asking questions that are “yes” driven. For instance, rather than say “the doctor says you can’t …”, you can ask “Doesn’t your foot feel better now that you are doing…?” Ask them what else they think will help their foot feel better. It helps them focus on what helps. Make them the expert in their condition. This will give them the power to say what is best when they visit their mom/dad.

4. Give your doctor knowledge of your child’s situation. May times I have written instructions in the form of a prescription in these instances. This helps to impart a stronger sense of the importance of the treatment rather than a generic information sheet, even if the information written is identical to the information sheet!

5. When all else fails, ask the other parent to take his/her child to the next appointment. Nothing could be better from our stand point! Hearing about their child from the source is sometimes what snaps things in place.

We all want what is best for your child. I hope these tips make communication and healing a little smoother for all!

Does Your Child Have a Flat foot?

Parents are constantly asking me whether their child’s flat foot should be treated or if they will “grow out of it”.

This is one of the most controversial current topics in pediatric foot care and the debate is really over how to decide when treatment is warranted for pediatric flatfoot. The controversy rages most loudly when the flat foot in question is without pain. Many pediatricians tell parents that their child will indeed “grow out of it.” If this was true, why are we treating so many symptomatic flat feet in adults in our Grapevine, Texas office?

   It is easier to get agreement that a child with a symptomatic flatfoot should receive treatment. No one thinks a child in pain should be left untreated, especially given the myriad of options we have to relieve that pain. In that subgroup, the controversy is often over what type of treatment — off-the-shelf devices or custom orthotics — the child should receive.

The greater challenge for today’s podiatrist is having the ability to discern when treatment is necessary for children with painless flatfoot. Bear in mind that a painless flat foot does not imply an asymptomatic flat foot. Children often express their symptoms without reporting any pain. They may be lazy, frequently ask to be carried, prefer sedentary activities or have trouble keeping up with their peers. This can lead to childhood obesity issues and life long disability.

Only doctors who discuss these issues with the parents will uncover subtle manifestations of the flat, poorly supportive foot that are already contributing to changes in activity level and functional ability. The first step in identifying flat feet that require treatment is to uncover the subtle changes in activity level and performance that may well be caused or aggravated by foot misalignment and dysfunction. After one has started treatment, parents often report a significant change in children’s activity levels, which is often to the great satisfaction of the parent. The children themselves are happier, healthier and more active as well.

Powersteps had come out with a great pre-fabricated device that can get a symptomatic flat foot under control quickly. They are inexpensive and a great first line therapy for these children. They are also readily available at Healthy Steps! Some kids still need a custom functional orthotic, but at least we can get them on the road to recovery much quicker with these devices.

If your child has low arches or flat feet, bring them in for a biomechanical exam and ou doctors can talk to you more about the long reaching problems that can be avoided by treating their flat feet.

Can You Get a Infection From Going Barefoot?

Yes! Going barefoot can lead to puncture wounds, foot infections, fungus, warts and all kinds of nasty things if you aren't careful. Watch this child discuss her foot pain with her teacher who gives her good advice about protecting her feet from nasty dirty floors at school!

Is Your Child Hiding Their Foot Pain?

Children often hide their foot pain. Is your child having this conversation in the locker room with their friends? Ask them! Relief for childhood foot pain is right around the corner at Foot and Ankle Associates of North Texas in Grapevine, TX. For more go to www.faant.com or call (817)416-6155. Listen in on this conversation.....

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!