It has been observed that childhood patients frequently apply to orthopedic doctors regarding foot problems. The most common foot problems in children are; Flat feet can be listed as in-toeing, crooked legs, heel pain, tip-toe walking, and clubfoot.
It is possible to generally divide flat feet in children into two.
• Flexible Flat Feet
• Rigid Flat Feet
It would be wrong to expect flat feet to improve by using insoles because the relationship between flat feet and insoles can be likened to the relationship between eye disorders and glasses.
Flexible Flatfoot
Flexible flatfoot is a type of flatfoot that is widely seen in society and does not cause any problems for a significant part of life. In this case of flat feet, the foot arch becomes flat when the child steps on it, but it is possible to see that the foot arch is formed when there is no load on the foot or by pulling the big toe backwards. This type of flat feet can improve over time, by the age of 8-10, as the foot muscles develop and the bone structure becomes clear. In addition, since flexible flat feet do not cause problems such as pain or wounds in the foot, there is no need for treatment, but insoles can still be used to provide psychological relief to the family or to benefit the pain that occurs in rare cases.
Rigid Flatfoot
Hard flat feet is a problem that can cause serious problems and pain in the foot. In this type of flatfoot, there is a flattening of the foot arch whether there is a load on it or not. Pain, pressure sores and calluses may occur on the soles of the feet due to the disorder in load distribution. This type of flatfoot may have different causes such as oblique talus, vertical talus, tarsal coalition. Hard flat feet� It is not possible to fix this with insoles. In case of a complaint, it may be necessary to perform different surgical procedures depending on the cause.
Creeping In Children
Intoeing in children is a common condition. In fact, the problem here is not a foot problem, but a hip or shin bone problem. Since the foot is only the last part, it is the affected organ. The problem here is the excessive forward rotation angle of the hip or the increase in the inward rotation of the shin bone. This problem is congenital and usually genetic. It does not cause any problems for the child except in very rare cases, but since it creates visual discomfort, families seek solutions.
Most children prefer to sit in a frog or W shape. For this reason, our advice to families and children is to avoid this sitting position and to encourage cross-legged sitting. Introversion usually improves or decreases considerably as the child approaches adolescence. Surgical correction may be required in very rare cases that persist even after adolescence and cause the child's feet to become entangled and fall while running.
Crowd Legs in Children
Crooked legs in children 0- It is physiological between the ages of 2, that is, it is an expected situation. Between the ages of 2 and 4, the legs begin to open outwards and regain their normal appearance after about the age of 4. Since this change in the legs is normal, no treatment is needed. However, not every crooked leg may be physiological, even in the 0-2 age range. Blount's disease, a rare disease, has a greater than normal curvature in the growth cartilage at the upper end of the tibia and is a serious condition. Its treatment includes the use of knee braces and surgical correction surgeries.
Heel Pain
Heel pain in children is a common problem between the ages of 9-12, when activity is intense. It especially occurs in children who are interested in sports such as basketball and volleyball that require jumping. The problem here is that the growth cartilage behind the heel does not fully connect to the main bone and ossify before puberty, leaving it as a weak area. As a result of the Achilles tendon attached to this area putting too much load on it during jumps, the weak attachment point becomes overloaded and may cause pain.
In its treatment, it is important to stop the physical activity that caused it for a while. Since there will be edema and inflammation in the heel area during straining, ice therapy and anti-edema medications are important. After the acute painful period has passed, it is necessary to perform Achilles tendon stretching exercises in order to prevent its recurrence.
Toe Walking in Children
Toe walking in children is always considered pathological. and therefore it needs to be treated. In 90% of cases, there is no underlying cause, but the remaining may have central nervous system problems. Therefore, necessary research should be done. In cases where there is no underlying cause, it is recommended that families do Achilles tendon stretching exercises until the age of 3. If the condition persists despite stretching exercises, serial casting is performed. In stubborn cases, a simple operation, Achilles tendon release, is performed.
Clubfoot in Children
Clubfoot in children (kev pes equino-varus) is a serious problem. It is a problem that occurs during development in the womb. It definitely needs to be treated. The sooner treatment is started, the easier and more effective it is. Therefore, if detected, treatment should be started immediately after birth.
In delayed cases or In cases that do not improve despite plaster treatment, release surgeries must be performed until the age of 2-3. As the age progresses, the procedures become more complicated and correction may be required with bone surgeries.
Foot and Ankle Problems in Children with Cerebral Palsy
Children with cerebral palsy also have the most problems. Common foot problems are introversion and forward bending deformities.
If the introversion deformity is flexible and can be corrected manually, muscle and tendon transfers are performed. However, if it is a hard deformity that cannot be corrected manually, correction is made with bone surgeries.
Forward curvature deformity is generally of the flexible type. Achilles tendon lengthening surgeries or Achilles tendon loosening surgeries can be performed to correct this deformity.
The Earlier Cerebral Palsy Treatment Starts, the Higher the Success Will Be...
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