Foot Pain Diagnosis
Common foot and leg abnormalities in kids
Parents often ask me if it is normal that their child has flat feet, or walks on their tip- toes, or that their toes overlap. Some parents want a foot pain diagnosis. These are all common conditions which I will describe below.
There is a wide variety of normalcy in children’s feet and legs, with most problems temporary and completely resolving with no treatment.
First, some terminology:
1 in 1,000 kids – It is more common in girls than boys and tends to occur with greater frequency on the left foot than the right. The foot has a convex lateral border, but the foot has a normal range of motion and can be manipulated to be straight without much difficulty. Ask your doctor if you are concerned, but most kids grow out of this by age 1. Parents are instructed to perform simple stretching exercises with the foot to move it into normal position. Affected children very rarely need casting or surgery to correct the abnormality.
Internal Tibial Torsion
This is the most common cause of intoeing. Males and females are equally affected, and the left side is more common than the right. A child with tibial torsion walks with their knee cap (patella) facing forward, and the feet pointing inward. Most cases will resolve on their own by 7-8 years. Children may have faster resolution if they avoid sleeping on the stomach and sitting on their feet. Children still exhibiting persistent tibial torsion by age 8 years should be seen by an orthopedic surgeon.
Increased Femoral Anteversion
A child with increased femoral anteversion walks with the knee cap (patella) and feet pointing inward. They may be clumsy and trip often. Many will prefer sitting in a ‘W’ position with legs behind them when sitting on the buttock. It peaks at age 4-6, with 80% of cases gradually resolving. If it is persistent after age 8, we refer them to an orthopedic surgeon.
Intoeing occurs when children walk with their feet turned inwards so that their toes are closest together. In the first year of life, this is usually caused by metatarsus adductus, alone or along with internal tibial torsion. In toddlerhood, internal tibial torsion alone is usually the cause. In childhood, femoral anteversion is the culprit.
Flat feet are very common in children, although most kids gradually develop the arch in toddlerhood. If the foot is ‘flexible’ (when the child stands on the toes, there is an arch present), we are less concerned.
The greater number of kids with flexible flat feet have ligamentous laxity, which allows the foot to sag when bearing weight. Most flat footedness gradually resolves within a year of walking. When older children with flat feet have foot, ankle, knee or hip pain, I often recommend trying an orthotic to see if this improves symptoms.
Most children will appear bowlegged when they begin to walk till age 2-3 years
Most children will walk with knock-knees between 3-7 years or age with gradual resolution as the pelvis widens.
The most common toes that override are the second and fifth. Though this can look funny, it is usually of no consequence and will stop overriding as the foot grows. Surgery is generally unnecessary. Some children have curling of the third or fourth toes, which is usually harmless as well.
In summary, there is a wide variety of normalcy in children’s feet and legs, with most problems temporary and completely resolving with no treatment. If you are concerned, please see your doctor.
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