Flexible Flatfoot in Children

Flexible Flatfoot in Children

Article Featured on AAOS

When a child with flexible flatfoot stands, the arch of the foot disappears. Upon sitting or when the child is on tiptoes, the arch reappears. Although called “flexible flatfoot,” this condition always affects both feet.

Flexible flatfoot is common in children. While parents often worry that an abnormally low or absent arch in a child’s foot will lead to permanent deformity or disability, most children eventually outgrow flexible flatfoot without developing any problems in adulthood. The condition is usually painless and does not interfere with walking or participation in sports. If your child’s flexible flatfoot does not cause pain or discomfort, no treatment is needed.

Flexible flatfoot

Flexible flatfoot, showing the absence of an arch when standing. The arch reappears when the patient is sitting or on tiptoes.

Description

A flexible flatfoot is considered to be a variation of a normal foot. The muscles and joints of a flexible flatfoot function normally. Most children are born with very little arch in the feet. As they grow and walk, the soft tissues along the bottom of the feet tighten, which gradually shapes the arches of the feet.

Children with flexible flatfoot often do not begin to develop an arch until the age of 5 years or older. Some children never develop an arch. If flexible flatfoot continues into adolescence, a child may experience aching pain along the bottom of the foot. A doctor should be consulted if a child’s flatfeet cause persistent pain.

Doctor Examination

To make the diagnosis, your doctor will examine your child to rule out other types of flatfeet that may require treatment. These include flexible flatfoot with a tight heel cord (Achilles tendon), or rigid flatfoot, which may be a more serious condition.

Tell your doctor if anyone else in the family is flatfooted, as this may be an inherited condition. Your doctor will need to know about any known neurological or muscular disease in your child.

Your doctor will look for patterns of wear on your child’s everyday shoes. He or she may ask your child to sit, stand, raise the toes while standing, and stand on tiptoe. In addition, your doctor will probably examine your child’s heel cord (Achilles tendon) for tightness and may check the bottom of your child’s foot for calluses.

Flexible flatfoot

The arch disappears when standing (left) and reappears when the child is on tiptoes (right)Reproduced from Sullivan JA: Pedatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg 1999;7:44-53.

Treatment

Nonsurgical Treatment

Treatment for flexible flatfoot is required only if your child is experiencing discomfort from the condition.

Stretching exercises. If your child has activity-related pain or tiredness in the foot, ankle, or leg, your doctor may recommend stretching exercises for the heel cord.

Heel cord stretch

Heel cord stretch.

  • Heel Cord Stretch
    Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds. Keep both heels flat on the floor. Point the toes of your back foot toward the heel of your front foot.  This stretch should be performed three times on each leg.

Shoe inserts (orthotics). If discomfort continues, your doctor may recommend shoe inserts. Soft-, firm-, and hard-molded arch supports may help relieve your child’s foot pain and fatigue. They can also extend the life of your child’s shoes, which may otherwise wear unevenly.

In most cases, there is little benefit to using custom-molded arch supports.  Over-the-counter arch supports, which are available at most sporting goods and running shoe stores, can be just as effective and are much less expensive to replace as your child grows. Online retailers often have inserts in difficult-to-find sizes.

Additional treatment. Your doctor may prescribe physical therapy or casting if your child has flexible flatfoot with tight heel cords.

Flexible flatfoot corrected over time

A child at age 3 years (left) with flexible flatfoot. The same child at age 15 years (right) has a normal arch despite having received no treatment. Reproduced from Sullivan JA: Pedatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg 1999;7:44-53.

Surgical Treatment

Occasionally, surgical treatment may be recommended for an adolescent with persistent pain. Surgery is typically performed to create an arch in the foot and lengthen tendons that may be tight and causing pain. The surgery is usually performed in stages. One foot is corrected then, after several months of recovery, the second surgery takes place.

In a small number of children, flexible flatfeet become rigid instead of correcting with growth. These cases may need further medical evaluation.

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Are you feeling post-run pain in your arch, top of foot, toes, heel, side of foot, toenails, or maybe more than one spot? Foot pain is a common ailment among runners and also one that can be confusing because the causes and treatments for the pain can vary widely.

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How to Tell if Your Toe is Broken

How to Tell if Your Toe is Broken

Is it a sprain or a break?

If you’ve ever stubbed your toe hard, the immediate, severe pain can leave you wondering if your toe is broken. In many cases, the injury winds up being a sprain. This is painful, but it means the bone itself is still intact.

If the toe bone breaks into one or more pieces, then you have a broken toe.

Learning to recognize the symptoms and treatment of a broken toe is important. If a broken toe is left untreated, it can lead to problems that may affect your ability to walk and run. A poorly treated broken toe may also leave you in a lot of pain.

Symptoms of a Broken Toe

Throbbing pain in the toe is the first sign that it may be broken. You may also hear the bone break at the time of injury. A broken bone, also called a fracture, may also cause swelling at the break.

If you’ve broken your toe, the skin near the injury may looked bruised or temporarily change color. You’ll also have difficulty putting any weight on your toe. Walking, or even just standing, can be painful. A bad break can also dislocate the toe, which can cause it to rest at an unnatural angle.

A sprained toe shouldn’t look dislocated. It will still swell, but will likely have less bruising. A sprained toe may be painful for several days, but should then begin to improve.

One other key difference between a break and a sprain is the location of the pain. Usually a break will hurt right where the bone has fractured. With a sprain, the pain may be felt in a more general area around the toe.

The only way to tell for sure if the injury is a break or a sprain is to see your doctor. They can examine your toe and determine the type of injury.

Causes

The two most common causes of a broken toe are stubbing it into something hard or having something heavy land on it. Going barefoot is a major risk factor, especially if you’re walking in the dark or in an unfamiliar environment.

If you carry heavy objects without proper foot protection, such as thick boots, you’re also at a higher risk for a broken toe.

What to expect when you see your doctor

A broken toe can usually be diagnosed with the use of an X-ray. If the pain and discoloration don’t ease up after a few days, you should definitely see your doctor.

A broken toe that doesn’t heal properly could lead to osteoarthritis, a painful condition that causes chronic pain in one or more joints.

Your doctor will examine your toe and ask for your medical history. Tell your doctor as many details as you can about the injury and your symptoms. Be sure to tell your doctor if you notice a loss of feeling or tingling in your toe. This could be a sign of nerve damage.

If there’s a chance the toe is broken, your doctor will likely want to get one or more X-rays of the injured toe. Getting images from different angles is important to understand the extent of the break.

Information from the X-ray will also help your doctor decide whether surgery is necessary.

Treatment of a Broken Toe

With most cases of a broken toe, there’s little your doctor can do. It’s mostly up to you to rest your toe and keep it stable.

Even before you know whether your toe is broken, you should ice the injured toe and keep it elevated. You may also take over-the-counter painkillers, such as acetaminophen (Tylenol), ibuprofen (AdvilMotrin), or naproxen (Aleve).

If you have surgery to repair the toe, your doctor may prescribe stronger pain medicines.

Splinting your toe

Typical treatment for a broken toe is called “buddy taping.” This involves taking the broken toe and carefully securing it to the toe next to it with medical tape. Usually, a gauze pad is placed between the toes to prevent skin irritation.

The non-broken toe is basically used as a splint to help keep the broken toe from moving too much. By taping the broken toe to its neighbor, you give the injured toe the support it needs to begin healing.

Surgery and additional treatment options

More serious breaks may require additional treatment. If you have bone fragments in the toe that need to heal, taping may not be enough.

You may be advised to wear a walking cast. This helps keep the injured toe stable while also giving your foot enough support to reduce some of the pain you may have while walking.

In very serious cases, surgery may be necessary to reset the broken bone or bones. A surgeon can sometimes put a pin or a screw into the bone to help it heal properly. These pieces of hardware will remain in the toe permanently.

Your toe is likely to be tender and swollen, even after a few weeks. You’ll likely need to avoid running, playing sports, or walking long distances for one to two months after your injury.

Recovery time can be longer if the break is in one of the metatarsals. The metatarsals are the longer bones in the foot that connect to the phalanges, which are the smaller bones in the toes.

Your doctor can give you a good estimate of recovery time based on the severity and location of your injury. A mild fracture, for example, should heal faster than a more severe break.

With a walking cast, you should be able to walk and resume most non-strenuous activities within a week or two after injuring your toe. The pain should diminish gradually if the bone is healing properly.

If you feel any pain in your broken toe, stop the activity that’s causing the pain and tell your doctor.

Outlook

The key to a good outcome is following through on your doctor’s advice. Learn how to tape your toe properly so you can change the tape regularly.

Carefully try to put more pressure on your broken toe each day to see how it’s recovering. Take any slight improvements in pain and discomfort as signs that your injury is healing.

Tips for recovery

Here are some things you can do to improve your recovery.

Footwear

You may temporarily need a bigger or wider shoe to accommodate your swollen foot. Consider getting a shoe with a hard sole and a lightweight top that will put less pressure on the injured toe, but still provide plenty of support.

Velcro fasteners that you can easily adjust can provide additional comfort.

Ice and elevation

Continue to ice and elevate your foot if your doctor recommends it. Wrap the ice in a cloth so that it doesn’t come into direct contact with your skin.

Take it slow

Ease back into your activities, but listen to your body. If you sense that you’re putting too much weight or stress on the toe, back off. It’s better to have a longer recovery and avoid any painful setbacks than to rush back into your activities too quickly.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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If there’s a recurring theme in the report, it’s that buying the right orthopedic shoeis an investment in foot health. But how do you find an orthopedic shoe that fits properly and provides adequate support, without falling prey to commercial claims by shoe stores and manufacturers that may have no scientific basis?

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