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!

Treatment for Plantar Fasciitis: ESWT

C.J. Watson's plantar fasciitis surgery at the Weil Foot and Ankle Institute was all over the news, blogs and Twitter last week. Many fans did not know that C.J. Watson struggled with plantar fasciitis, and others did know that it bothered him so much that he needed surgery! As noted in Dr. Weil, Jr.'s blog post on plantar fasciitis, patients have several treatment options. While patients can utilize conservative treatment to alleviate symptoms, if pain persists, patients can opt for either non-invasive and/or minimally invasive treatments for plantar fasciitis, both of which have been pioneered by Weil Foot & Ankle Institute physicians.

The non-invasive procedure that Weil Foot and Ankle Institute physicians employ is called Extracorporeal Shockwave Therapy more commonly know to us as ESWT. ESWT has been FDA Approved since 2000 and uses sound waves to stimulate healing in some physical disorders, such as plantar fasciitis and Achilles tendonitis. "Extracorporeal" means "outside of the body" and refers to the way the therapy is applied. Because there is no incision, ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity. 

There are two different types of ESWT that can be performed including:

Low Energy ESWT

Low energy ESWT is performed in three sessions over three weeks. Low energy ESWT sessions are performed in the clinic setting, take approximately 10 minutes and are generally done without anesthesia or sedation. Patients can return to normal work and life immediately after their treatment.

High Energy ESWT

High energy ESWT is performed in one session. Anesthesia/sedation is required for this procedure, which takes approximately 30 minutes. Someone will need to be present to drive you home afterwards.

The surgeons at Weil Foot & Ankle Institute can discuss the risks and benefits of each procedure with you so that.

If you would like to learn more about ESWT, and to find out if you are a candidate for treatment, visit here and call our office at 847-390-7666 to schedule your consultation now!

Diabetes and Manifestations in the Foot and Ankle

By: Zacharia Facaros

According to the American Diabetes Association, over 25 million people in the United States, roughly 8% of the population, have Diabetes, however, there are many more who are undiagnosed.  Diabetes can have a huge impact on the health of your feet and ankles. The Diabetes Association of America notes that 60-70% of people with diabetes develop peripheral nerve damage, and up to 29% of these patients may develop a specific type of fracture/dislocation in the foot or ankle, referred to as Charcot Neuroarthropathy.

Nerve damage, or neuropathy, is a well-known complication of diabetes, as well as other conditions, which leads to a loss of sensation in the feet. Patients with nerve damage can no longer feel when something has irritated or even punctured the skin. An irritation or puncture to the feet commonly creates a wound as small as a blister, but the wound can progress to a serious infection in a matter of days.

If you have diabetes, you need to be aware of how foot problems can arise and how to treat them.  Outlined below are important steps to take for close monitoring and management of your lower legs and feet:

CONTROL YOUR DIABETES

• ·         Work with your doctors to keep your blood sugar within a good range and to keep all other medical illnesses closely monitored.  The more stable your blood sugar remains, the less likely you are to succumb to neuropathy and/or infection.

INSPECT YOUR FEET DAILY

• Look at your bare feet every day to check for scratches, cuts, blisters, open wounds, red or warm spots and swelling.  If any are present, the risk of getting an infection is increased, and you should contact a Weil Foot and Ankle physician for an evaluation.
• Check the bottoms of your feet daily with a mirror. Checking the bottoms of your feet will reveal any potential at-risk areas that one may not appreciate if their sensation is not intact. If you have trouble bending your leg or seeing, ask a family member for help. 
• Contact a Weil Foot and Ankle physician immediately for evaluation if one foot is swollen or warmer than the other. This swelling or warmth may represent a potential urgent medical condition.

WASH YOUR FEET WELL DAILY, PARTICULARLY IN BETWEEN YOUR TOES

• Wash your feet daily in the shower or in lukewarm, not hot, water with mild bath soap. This provides a stable, clean, non-toxic maintenance.  Test the water temperature with your hand first to avoid a potential skin burn.
•  Do not soak your feet. Soaking your feet can weaken the skin, and this weakened skin will not maintain as strong a barrier against bacteria and/or fungus infections.   
• Dry your feet well, particularly in between the toes, to avoid a damp/moist environment that makes skin prone to infections.

KEEP YOUR SKIN SOFT AND SMOOTH

• Rub a thin layer of skin lotion over the tops and bottoms of your feet to prevent dry, cracked skin. Ask your Weil Foot and Ankle Physician for recommended products. Avoid putting lotion on the area between your toes. By avoiding this area, you will avoid making the skin susceptible to bacterial and/or fungal infections.
• Do not use strong antiseptic solutions, drugstore over the counter medications or heating pads.  Do not put your feet on or near radiators, nor to close to a fireplace or heating lamp. All of these actions may cause skin compromise and rapid drying of the skin.

NEVER TRIM OR SMOOTH CORNS AND CALLUSES YOURSELF OR CUT YOUR OWN TOENAILS IF IT IS DIFFICULT TO DO SO

• Following evaluation by your Weil Foot and Ankle physician, and if your feet are at low risk for problems, you may be allowed to use a pumice stone or emery board to smooth corns and calluses, but it is IMPERATIVE that you do not rub the skin too vigorously. Vigorous scrubbing may create an open wound.
• See a Weil Foot and Ankle physician right away if you have an ingrown toenail, especially if it has turned red, hot and swollen.  This condition requires expedited treatment for proper healing.
• Cut toenails straight across to limit the possibility of the corners becoming ingrown. Due to the high risk of causing a skin cut that may also lead to a potential infection, never dig into the corners of your nails. 

WEAR PROTECTIVE FOOTWEAR AT ALL TIMES

• Never go barefoot, or limit times when you do.  This will ensure proper protection of your skin or at-risk pressure points.
• Wear comfortable shoes that fit well and protect your feet. Walking or running shoes may be helpful for some diabetics, whereas others require specific therapeutic shoe gear. The Weil Foot and Ankle Institute has a great selection of shoes and can create custom shoes for diabetic patients. Be sure to ask your Weil Foot and Ankle physician about diabetic shoe options.
•  Purchase new shoes at the end of the day when your feet have natural swelling and are typically larger. Doing this will enhance a proper fit.  Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes because your foot will change shape over the years.
•  Wear new shoes for only 2 hours or less at a time, particularly if you have neuropathy. New shoes will cause increased pressure points until they are adequately broken in.
• Do not wear the same shoes everyday. Alternating the shoes that you wear will allow them to dry completely and to limit the quantity of potential infectious organisms. It will also allow your feet to maintain adaptation and functioning capacity.
• Feel the inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside, such as small pebbles or other foreign objects.
• Do not lace your shoes too tightly or loosely. Lacing your shoes comfortably will help to avoid increased friction or pressure points that may lead to blistering or even ulceration. 
• Choose socks and stockings carefully. Wear clean, dry socks every day and avoid socks with holes or wrinkles. Avoid stockings with elastic tops. Seamless socks are available for those with neuropathy, and therapeutic compression stockings are recommended if your feet and legs swell often.  In socks and stockings, certain materials are recommended over others, so check with a Weil Foot & Ankle physician for further recommendations and advice.
• Wear socks at night if your feet get cold to avoid possible irreversible abnormal sensations.
• Wear protective footwear at the beach, swimming pool or on hot pavement to avoid potential cuts or abrasions.

KEEP ACTIVE TO PROMOTE MUSCLE STRENGTH AND GOOD BLOOD FLOW TO YOUR FEET

• Wiggle your toes and move your ankles up and down for 5 minutes, 2-3 times per day. This will aid in maintaining strength and flexibility.
• Keep awareness on long walks and remember to periodically remove your shoes and socks, checking for signs of redness or bruising.
•  If you smoke tobacco products, you MUST stop. Smoking damages blood vessels by decreasing the ability to deliver oxygen to your skin. When combined with diabetes, smoking significantly increases your risk of amputation.

If you have any questions regarding good foot health practices for your specific needs, contact the Weil Foot & Ankle Institute right away to schedule an evaluation. Our doctors can make sure that you take the right steps to monitor and treat your feet, and help you to maintain your foot and ankle health for years to come.

Joakim Noah: The Real Prognosis

By: Lowell Weil Jr., DPM 

Last Friday, when the Bulls’ starting center Joakim Noah turned his ankle under his leg in a gruesome position, and the typically classless Philadelphia fans (I know...I did my residency there) cheered his injury, the Bulls’ hopes of progressing through the playoffs may have died. Bulls fans around the country held their breaths as they watched yet another star player go down in excruciating pain.

Fortunately, X-rays did not find an ankle fracture, but we can be sure that he suffered a severe sprain.

So, what exactly is a “sprain” you ask?

A sprain occurs when ligaments (tissues that connect bone to bone) are injured.  This injury can take the form of a stretch or a tear.

In Joakim Noah’s case there are many ligaments around the ankle that could have been injured, however, it was most likely the lateral (outside) ankle ligaments and/or the syndesmotic ligament (high ankle sprain). 

Regardless, I know this injury is going to take a while to get better.  While Bulls staff members keep telling the media that whether or not Joakim Noah will play will be a “game time decision,” his chances of playing in the foreseeable future do not seem likely. He is still limping with a walking boot on his foot and ankle.

I have had an opportunity to get to know Joakim a little bit, and I will say that he is a very tough guy.  As most Bulls fans may already know, Joakim will do anything possible to get himself ready to get back on the court and help his teammates win.  I have also found him to be a very nice and thoughtful person.  Once when I saw him, my nine-year-old son was with me and Joakim couldn’t have been nicer to him. My son still talks about it to this day.

You can be sure that under the direction of the Bulls’ head trainer Fred Tedeschi, Joakim is getting around-the-clock care to try and get him ready to play as soon as possible. 

So, here’s hoping that Joakim can make a quick recovery to what appears to be a very tough injury and help propel the Bulls further in the playoffs.  If it doesn’t turn out to happen this year, Joakim will certainly be ready to help the Bulls achieve their goal of an NBA Championship in 2012-2013.