Archways podiatrist Louise Stores was instrumental in setting up the podiatry paediatric service in central manchester, she developed the scope of orthotics, clinical conditions treated and advice leaflets to parents. she worked along side paediatric physios and appliance lab technicians to provide the best treatments. She was lead paediatric clinician and taught many students on their paediatric MSK clinical placements. She has now put her expertise into private practice now and treats a wide range of conditions that affect the developing child.
Children are not young adults and will be assessed by Louise using her knowlege of their developmental stages which are usually age related, taking into effect any familial medical conditions, and physchosocial development.
Intoeing Gait - This is a common childhood problem and estimated to affect 10% of children between the ages of 2 - 5 years. In most cases this is developmental and completely benign and is usually pain free
There are 3 main causes Internal tibial torsion, metatarsus adductus and excessive femoral anteversion.
Tibial torsion is a twist in the tibia ( shin bone ) usually present in the growing infant and resolves in most cases by age 5 years of age.
Metatarsus adductus is a twist in the foot which is present from birth in some babies, if flexible usually resolves with passive stretches by age 8, in some cases a gait plate may be necessary only after 4 years of age and certain footwear.
Excessive femoral anteversion is a twist in the femur ( thigh bone ) and is usually present in girls and is usually the cause in children older than 3 years of age. It usually resolves by age 8, but can be present in older children and can be linked with hypermobility.
Toe walking - This is common gait anomally affecting children under the age of 4, after this age there could be underlying causes such as cerebral palsy, bony ankle equinus. It is often seen in autistic children as a sensory issue.
Developmental flat foot - This is a normal part of development if flexible and is seen in the younger child often associated with hypermobility ( laxed ligaments ) it usually is pain free but in some cases it can cause pain and affect the childs level of activity daily, and may require treating with orthotics. In some familial cases there is structural changes in the foot which may require early intervention. In rigid flat foot it can be associated with tarsal coalition which in the developing child may cause symptoms as an adolescent which can be treated with orthotics or may require surgical intervention.
Clubfoot ( talipes equinovarus ) which affects 2 in 1000 live births and can just affect one foot, usually boys more than girls. In around 30% it is flexible and resolves soon after birth, in 70% of cases the condition is stiff and requires stretching and casting using the Ponsetti Treatment
Apophysitis - This occurs at the insertion of a tendon attaches to a bone, caused by micr-avulsions at the bone cartilage junction. There are 2 types that affect the knee and a few types that affect foot in a growing child.
Severs - Calcaneal apophysiitis in the heel is the most common in the foot affecting children age 7 to 11 years of age causing a painful heel in the affected foot and limitations to activities and sometimes difficulty in weightbearing and the child may limp.
Iselins - Fifth metatarsal apophysitis often linked with overuse affecting children age 8 to 13 years of age, seen in dancers, gymnasts, basketball and football players.
Osgood schlatters - Tibial tuberosity apophysitis in the knee joint, usually affecting boys more than girls age 11 to 15 years of age, commonly seen in very active children.
Sinding-larsen-johansson - Distal patella (knee cap) apophysitis in the knee joint, usually affecting boys more than girls aged 12 - 14 years of age, associated with activities.
Kohlers - Avascular necrosis of the navicular bone in the foot, usually affecting boys more than girls, is self limiting, the child may limp and if severe and continuous my require a short period of immobilisation.
Friebergs - Affects the metatarsals usually the second but it can be the third or fourth. There is pain in this area and the child may limp, affecting girls mainly age 12 - 15 years.
Buschkes - Affects the cuneiform bones in the mid foot usually in a cavus type foot, age 4 - 6 years, worse with activity and the child may limp. These can be assessed by Louise and appropriate treatment management implemented.
Cavus foot ( high arched ) - this is usually congenital where the arch of the foot is high and the ball of the foot may be dropped causing abnormal pressure points on the foot, intervention with an orthotic may be beneficial to the child .
Bowed legs and knocked knees - All children are bowed legged at birth, known as infantile tibial varum, and most grow out of it up to age 18 months to 2 years. After this age it is abnormal, and may be a sign of vitamin D deficiency or Blounts disease. Over the next year the legs rotate into knock knees peaking at age 3 - 4 years of age, and can be present until age 7, and reduces until age 8 - 10 years.
Knock knees or genu valgum is often seen in older children who are obese or have turners syndrome .
The Hypermobile child - Hypermobility in a child is usually familial and can affect many joints including the feet and can abnormal gait patterns, foot deformities in changes of the foot structure, generalised leg pain, reduced activity levels, tiredness, abnormal wear on shoes, falls and clumsiness.
A full biomechanical assessment will be necessary to treat these children.
Treatment may include orthotics, strengthening programme, proprioception exercises, certain footwear and appropriate activity advice