Common Foot Problems in Pediatric Patients

By: Erin Klein, DPM

I have had the pleasure to treat many children here at the Weil Foot and Ankle Institute and have found that the problems pediatric patients face can be very different than those of adults. Much like children’s shoes, pediatric foot problems come in all shapes and sizes. The physician that treats children’s foot problems needs to be attuned to the way children communicate, as well as the special needs of our littlest patients.

The six common problems we see in our pediatric patients here at the Weil Foot and Ankle Institute are: flatfeet, intoeing, gait problems, heel pain, infected ingrown toenails and warts. I have provided an overview of each condition, as well as treatments that we use to solve these common pediatric foot problems.

Infected, ingrown toenails:

An ingrown toenail is a toenail that has curved in at the medial and lateral sides of the nail. It digs into and can cause a break in the skin. Bacterial infections of the ingrown toenail are a potentially serious condition that requires medical attention. When children with infected, ingrown toenails come to see me, many have already seen at least one other medical professional and may have already been placed on antibiotics that really didn’t help. Infected, ingrown toenails are one of my favorite problems to treat in pediatric patients because with a small procedure done in the office, children can be back on their feet rather quickly.

In order to do this small, in-office procedure, we inject the toe with local anesthetic. Pediatric patients, young and old, may yell, scream and carry on while we perform the injection. I’ve seen that this can be a bit embarrassing to parents – but – I don’t blame the kids for screaming. If you stuck a needle in my toe, I’d have to scream too! The reason we do this is not to torture kids, but to rid the cause of the bacterial infection (the ingrown nail) and irrigate the area. This will help the infection to clear and have the child pain and infection free in little to no time.

Flatfeet, intoeing and gait problems:

I see pediatric patients with complaints of flatfeet and gait problems everyday. Sometimes, this is a medical problem that needs to be treated, other times – not so much. It is perfectly normal for children to have flatfeet or walk slightly intoed. Many times this is painless and will resolve (somewhat) with age. There is no evidence in medical literature to suggest that flatfeet or a slightly intoed gait will prevent a child from being able to walk, run or live a full and healthy life.

Flatfeet and intoeing become problematic when they cause children to have pain in their feet, feel that their legs tire easily with activities such as walking, running or playing with their friends, or have excessive wearing on the soles of their shoes. Children that refuse to walk or “don’t wanna” walk may be experiencing pain in their feet or legs, and just don’t know how to communicate that to their parents. If you would like to find out whether or not your child’s flatfeet, intoeing or gait problem is problematic to his/her overall foot health, be sure to contact one of our Weil Foot and Ankle physicians to schedule an evaluation.

Heel pain:

Pediatric heel pain is not a condition to take lightly. Although children rarely experience heel pain in the same way adults do, it is still important to have the area examined and properly diagnosed.  Please contact your Weil Foot and Ankle physician immediately if your child is experiencing heel pain, as this may be a serious condition that requires treatment. Most of the time, pediatric heel pain is related to inflammation of the growth plate in the heel bone. This is easily treated with rest, ice and stretching. There is the possibility, however, of a more serious condition in which pediatric heel pain is caused by an infection in the bone.

Warts:

Warts are tricky and can be very frustrating to treat in pediatric patients. Warts are a dermatological manifestation of a virus that can be acquired at the pool or beach in the summertime, or on any wet, damp surface that is used by multiple people (i.e. locker rooms). Warts can be extremely painful as they are often located at pressure points in the foot and have their own blood and nerve supply. There are many options for treatment of this problem – the most important part of treatment being, keeping the area of the wart dry. Why? Warts prefer warm, moist environments. If you remove the moisture (sometimes it is hard to remove the elevated temperature), the warts will not grow as readily and the body can start to help remove them from the area.  We have some wart removal products (Pedinol and Plantarstat) available in our online store that may assist in drying and ultimately removing the wart.

Challenges unique to treating children.

Treating children is quite fun, however, it can also be extremely challenging. Kids don’t think, feel or communicate the way adults do. They get scared that they won’t be able to walk again, they won’t be able to play with their friends again or, most commonly, that “it’s gonna hurt.” Kids also get worried that I, as a physician, won’t believe that they are in pain. They fear that if they admit that they are in pain or hurting, their parents will feel bad – and kids don’t want that.

My personal approach is to listen. Kids can communicate – in their own, uniquely kid way – and, if you listen, you will hear. I also enjoy playing with some of my youngest patients (pretty much anyone under the age of 3). This way they don’t realize that I am examining them and learning about their problems, and they don’t have to sit in the scary grown-up examination chair.

The best part about treating kids is their unique ability to brighten just about any day. I mean, how can you be that big of a grump when a 4-year-old hands you a hand-drawn picture of a dinosaur, or when a 6-year-old colors you a picture of a goofy looking doctor, or when one of your teenagers makes you a duct tape stethoscope and medical bag just for fun, or when a 2-year-old decides that you need a hug? You can’t be grumpy after that! J

Erin’s Top 10 Things She Loves about Treating Kids:

1. They say thank you.
2. They WANT to get better
3. They can be so cute!
4. They do goofy things like draw you pictures and make you duct-tape stethoscopes – and this really makes my day.
5. They speak simply, in terms that actually make sense to me.
6. They smile, giggle and make funny faces.
7. They give good hugs – especially kids in the 2-year-old age range.
8. They are amused by the simplest things – like head, shoulders, knees and toes…. which little piggy went where…. playing ball in the hallway…(They have no idea that I’m examining them while I’m doing all of this either!)
9. Lollipops and suckers can cure anything.
10. I think I might just be a little kid in a grown up’s body!