Pediatric Foot Problems - Types & Causes

Warts (Verrucae)

Warts are contagious lesions caused by direct contact with the human papilloma virus. They are usually found on the sole (plantar surface) of the foot. Warts bleed easily and may or may not be painful. They often can be identified by their well-defined borders and little black spots (Figure 1). With time, they can enlarge and multiply. Warts are easier to eradicate when they are small and few in number.

Over the counter medications contain salicylic acid to eat away at warts. These preparations are more successful with warts that occur on areas of the foot with thinner skin than the soles. If the warts do not respond to over the counter medications, stronger topical medications applied by the podiatrist will be indicated. Surgical techniques are rarely used by the doctors of North Shore Foot & Ankle to treat warts.

Athlete's Foot (Tinea pedis)

Athlete's foot is a fungal infection of the skin. It is contagious and is commonly contracted walking barefoot in locker rooms and around swimming pools. The fungus thrives in a dark, warm, moist environment like the inside of a shoe. For that reason, feet that perspire excessively are more susceptible to athlete's foot.

Athlete's foot lesions can appear in many forms. If you have cracks between the toes, raised red spots, or small blisters on your feet (Figure 2), suspect athlete's foot. The lesions are usually, but not always itchy.

Treatment starts with good hygiene. Wash your feet daily, and dry carefully, especially between the toes. According to the doctors of North Shore Foot & Ankle, the best over the counter fungicides are Lamisil® and Lotrimin®. Use them twice daily for at least two weeks, even if the condition improves sooner. If the infection has not improved after a few days, consult a podiatrist immediately. Stronger topical medications can be prescribed. On occasion, an oral fungicide will be necessary treat resistant cases of athlete's foot.

Metatarsus Adductus and Clubfoot

These two conditions are usually diagnosed in infancy. In both, the feet turn inward (Figure 3). In clubfoot, the soles actually face each other. Initial treatment can include serial casting, in which a series of casts are applied to the infant's foot, increasingly influencing it to move into normal alignment over an eight to 16 week period. In more severe cases, surgery is performed to realign the bones of the feet.

In-Toeing

Also called "pigeon toed", the presence of in-toeing means that the bones of the foot, leg, or thigh are pointed inward, or there is excessive internal rotation at the joints in the foot, ankle, knee or hip. Sometimes, the condition is outgrown as the child develops. Treatment becomes necessary if the condition persists, and causes difficulties with walking or running. For example, children who in-toe often trip and fall frequently. Depending on the cause and severity of the in-toeing, the doctors of North Shore Foot & Ankle treat the condition with stretching exercises, orthotics (custom supports), or surgery.

Out-Toeing

Out-toeing is normal in toddlers who are beginning to walk, because a wide, out-toed stance provides better balance and stability. If the condition persists, it means that the bones of the foot, leg, or thigh are pointed outward, or there is excessive external rotation at the joints in the foot, ankle, knee or hip. Out-toeing responds more readily than in-toeing to orthotics (custom supports).

Curly Toes

This is a condition in which one or more of the small toes overlap or underlap the adjacent toes (Figure 4). Simple toe splints (Figure 5) are effective when treatment begins at an early age. Older children may require surgery to relocate the toes.

Pediatric Heel Pain (Calcaneal Apophysitis)

At about 10 years of age, a growth plate in the heel (Figure 6, arrow) separates into two growth centers. The smaller growth center (the apophysis) is a wafer of bone that is very prone to injury from sports and other activity. This is a common and often undiagnosed cause of heel pain in the pre-adolescent. After a few years, the growth center will close and the pain will disappear. But, there is no reason to allow the child to be in pain during that time, since calcaneal apophysitis responds to orthotics (custom supports) that cushion the heel and reduce the pull of ligaments and tendons on the heel bone.

Night Cramps in the Legs (Growing Pains)

Many young children complain of leg pains, especially at night. These are often called "growing pains" by parents and physicians when no other diagnosis is apparent. The muscles that support the feet are located in the legs. When the feet flatten more than they should, these muscles work overtime in an attempt to "hold up" the arches. The result is muscle strain, which is most noticeable at night. Night cramps in the legs respond to orthotics (custom supports).

Flat Feet (Pronation)

This is the most common cause of general foot pain and fatigue, arch pain, leg cramps, and awkward gait. Flat feet are also the precursors of bunions, hammertoes, heel spurs, and other structural deformities. Pronation is treated with orthotics (custom supports). In severe cases, an implant is surgically placed into a joint beneath the ankle to restrict pronation. The doctors of North Shore Foot & Ankle may not recommend treatment if the child has no symptoms and there is no family history of structural deformity.

Toe Walking

Children who walk on their toes usually have a tight heel cord (Achilles tendon). Uncommon neurologic conditions can also cause toe walking. Treatment begins with stretching exercises to lengthen the Achilles tendon. In cases that are unresponsive to conservative care, surgery is performed to lengthen the heel cord.