Pediatric and Orthopedic Foot Problems

Foot problems in infants and small children generally respond well to pediatric orthopedic procedures, ranging from external manipulation to surgery. The type of treatment depends on the severity of the problem and the chance of recurrence. According to Pediatric Orthopedics, manipulation alone rarely brings true permanent correction to a severe deformity, and parents who insistent on corrective exercises could allow their child’s condition to worsen or put the child at risk for bone dislocations.

Causes

• Some foot deformities at birth have no genetic cause but rather come from pressures inside the womb. The deformities will either correct themselves naturally over time or respond to external manipulation. Other conditions, however, occur due to a genetic flaw that programs the feet to seek the malformed positions as the “normal” ones. Feet with these genetic predispositions sometimes return to their malformed state even after completing a course of corrective manipulation, making surgery necessary for permanent improvement.

Types

• Common genetic foot deformities seen in children include club foot, Valgus foot, macrodactyly and ectromelia. Club foot describes a condition in which one or both of the child’s feet bend inward, forcing the child to walk on the outer sides of the feet instead of the soles. Valgus foot presents with the feet rotated outward rather than inward. Macrodactyly causes one toe to grow significantly larger than the other toes of the foot, deforming the bones of that toe and the surrounding toes. Ectromelia prevents the bones in the middle part of the foot from forming normally.

Manipulative Treatments

• External manipulation can successfully treat pediatric orthopedic conditions such as club foot, especially when performed as soon after birth as possible, according to Johns Hopkins Medicine. Corrective casting applies external pressure to gently manipulate the bones of the feet into the correct position. The surgeon then applies a series of followup casts to the feet over the following two to three months. Ongoing use of night splints, corrective shoes and stretching exercises may provide additional benefits.

Surgical Treatments

• Johns Hopkins Medicine notes that while casting corrects foot deformities about a third of the time, severe or recurring cases require surgical intervention. Surgeons lengthen the tendons connecting the bones to the muscles so that the foot can settle into a normal position permanently. Pediatric Orthopedics adds that a procedure called a talo-calcaneal intussuseption reshapes the bones to aid in normal walking. The choice of surgery for other conditions, such as ectromelia, depends on what stage of growth the patient has reached.

Considerations

• Parents looking at the correction options for their children should decide what degree and permanence of correction constitutes a successful outcome. Manipulation alone may prove sufficient for the goal of avoiding amputation, but “success” in terms of feet that look normal and function well usually implies a surgical approach. According to Pediatric Orthopedics, even the most conservative pediatric orthopedic surgeons recommend surgery over manipulation for 40 percent of their patients.