Category: Children

Metatarsus Adductus

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Metatarsus Adductus is a problem in children (and occasionally adults) in which the forefoot is excessively adducted on the rearfoot

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Metatarsus Adductus (MTA) is a common congenital foot deformity where the forefoot is adducted, or curved inward, relative to the hindfoot. It usually presents at birth or within the first few months of life. The condition affects the metatarsal bones, which are the long bones in the foot leading to the toes, causing them to angle medially. While the heel remains in a normal position, the forefoot appears curved like a “C-shape” when viewed from the bottom. It’s considered one of the most frequent foot abnormalities in infants, with a higher prevalence in first-born children and those with a family history of foot deformities.

The cause of Metatarsus Adductus isn’t entirely clear, but it’s believed to result from intrauterine positioning—essentially, the baby’s foot being pressed into an abnormal shape due to space constraints in the womb. This explains why it’s often bilateral and more noticeable in full-term infants. There are two main types: flexible, where the foot can be manually straightened, and rigid, where the deformity is more fixed and less responsive to gentle manipulation. A flexible MTA usually resolves on its own, while rigid forms may need intervention.

Diagnosis of MTA is typically clinical and based on physical examination. The “V-finger test” is a quick, informal method where the examiner uses their index and middle fingers to assess the curvature of the forefoot. X-rays are rarely needed unless the diagnosis is unclear or the deformity is rigid and persistent. It’s crucial to distinguish MTA from more serious conditions like clubfoot (talipes equinovarus), which involves multiple planes of foot deformity and generally requires more aggressive treatment.

Management of Metatarsus Adductus depends on the severity and flexibility of the deformity. Most mild and moderate flexible cases resolve spontaneously by 6 to 12 months of age without any treatment. For persistent or more severe cases, especially rigid ones, options include stretching exercises, serial casting, or orthotic bracing. Surgery is rarely needed and typically reserved for older children with significant residual deformity that impairs function. Early identification and monitoring are key to ensuring that the condition does not interfere with the child’s walking or foot development.

Most Useful Resources:
Metatarsus Adductus (Podiatry Arena)
Metatarsus Adductus (PodiaPaedia)
Metatarsus Adductus (Foot Health Forum)
Metatarsus Adductus (Podiatry ABC)

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Clubfoot

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Clubfoot is a congenital condition in which the foot at birth is in a plantarflexed, inverted and adducted position

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Clubfoot, medically known as congenital talipes equinovarus (CTEV), is a birth defect in which one or both feet are twisted out of their normal position. The condition affects about 1 in every 1,000 live births, making it one of the most common congenital deformities. In a clubfoot, the foot typically points downward and inward, and the soles may face each other. This abnormal positioning is due to a combination of bone, tendon, and muscle abnormalities present at birth, though the exact cause is often unknown. It can occur as an isolated condition or be associated with neuromuscular disorders like spina bifida.

There are two main categories: idiopathic clubfoot, which occurs in otherwise healthy babies with no known underlying condition, and non-idiopathic clubfoot, which is associated with other syndromes or neurological disorders. The deformity isn’t painful for infants but, if left untreated, can lead to significant mobility issues and lifelong disability. Children may walk on the sides or tops of their feet, resulting in skin breakdown, pain, and difficulty with shoes. Fortunately, early diagnosis—often via prenatal ultrasound or at birth—allows for prompt intervention.

The gold standard treatment is the Ponseti method, a non-surgical approach that involves a series of gentle manipulations and casting to gradually move the foot into the correct position. This process usually starts shortly after birth and continues over several weeks. After achieving the desired alignment, a minor procedure called a tenotomy is often performed to release the tight Achilles tendon. Once corrected, the child must wear a brace (foot abduction orthosis) for several years during sleep to maintain the correction and prevent relapse. Compliance with bracing is critical for long-term success.

In more severe or resistant cases, or when initial treatment is delayed or fails, surgical intervention may be necessary. Surgery can involve lengthening tendons, repositioning bones, or even joint fusion in complex cases. However, surgery is typically considered a last resort due to potential complications like stiffness and reduced foot flexibility. With proper and timely treatment, most children with clubfoot go on to lead active, pain-free lives, participating fully in physical activities and sports. The key is early recognition, consistent follow-up, and a treatment plan tailored to the individual child’s needs.

Most Useful Resources:
Clubfoot (Podiatry Arena)
Clubfoot (PodiaPaedia)
Clubfoot in the Newborn (Foot Health Friday)
Clubfoot (Foot Health Forum)
Clubfoot (DPM Podiatry)
Clubfoot (~ talipes equinovarus) (ePodiatry)

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Kohlers Disease

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Kohlers disease is a growth problem with the navicular bone in the foot that is most common around the age of 5 years.

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Köhler’s disease is a rare bone disorder that primarily affects children, typically between the ages of 3 and 7, and more commonly in boys. It involves the avascular necrosis (loss of blood supply leading to bone death) of the navicular bone in the foot. The navicular is a small bone in the midfoot that plays a key role in maintaining the arch and allowing smooth foot movement. In Köhler’s disease, this bone temporarily loses its blood supply, which can cause it to become flattened, fragmented, or sclerotic (hardened), leading to pain and discomfort, especially when weight is placed on the foot.

The exact cause of Köhler’s disease isn’t fully understood, but it’s believed to be linked to mechanical stress placed on the developing navicular bone during a period of rapid growth when the bone is still forming. Because the navicular bone is the last of the foot bones to ossify (harden into bone), it’s more vulnerable to pressure and trauma. As children grow and their bones solidify, the temporary loss of blood flow seems to resolve on its own in most cases. There is no strong genetic or systemic disease association, which sets it apart from other conditions involving bone necrosis.

Clinically, children with Köhler’s disease often present with a limp, localized swelling, and pain over the top of the foot or along the arch. The child may avoid putting weight on the affected foot and may walk on the outer edge to reduce discomfort. Diagnosis is typically confirmed with X-rays, which reveal characteristic changes in the navicular bone—such as flattening, increased density (sclerosis), or fragmentation. It’s important to differentiate Köhler’s disease from other causes of limping in children, like juvenile arthritis, infections, or other bone disorders, which may require very different management strategies.

Treatment for Köhler’s disease is usually conservative and focuses on symptom relief. This may include limiting physical activity, using supportive footwear or arch supports, and in more painful cases, applying a short leg cast for a few weeks to reduce pressure on the bone. The good news is that the prognosis is excellent: the condition is self-limiting and typically resolves on its own within 6 to 24 months. After the healing period, the navicular bone returns to a more normal shape and function, and long-term complications are very rare.

Most Useful Resources:
Kohlers Disease (Podiatry Arena)
Kohlers Disease (PodiaPaedia)
Kohlers Disease (Podiatry TV)
My Advice for Kohlers Disease (Running Injury Advice)
Pain on child arch ? (Podiatry Experts)
Kohlers Disease (Foot Health Forum)
Kohlers Disease (Dr the Foot Without the Dr)
Kohler’s Disease in Kids (Podiatry Ninja)

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Growing Pains

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Most cases of growing pains in the child are benign and they come right, but on rare occasions the symptoms are the same as some pretty nasty things, so for this reason all cases of growing pains have to be taken seriously and properly investigated.

Growing pains are a common, benign condition in children, typically characterized by aching or throbbing sensations in the legs, most often felt in the thighs, calves, or behind the knees. These pains usually occur in children between the ages of 3 and 12 and often strike in the late afternoon or evening, sometimes waking the child from sleep. Despite the name, growing pains are not directly caused by growth spurts—bones grow gradually and don’t cause pain themselves. Instead, the discomfort may be linked to muscle fatigue or overuse from physical activity during the day.

The pain is typically bilateral, meaning it affects both legs, and is not associated with swelling, redness, or limping. That’s an important distinction because if the symptoms are persistent, occur in only one leg, or are accompanied by fever or swelling, it may point to something more serious like juvenile arthritis, infection, or injury, which requires medical evaluation. Growing pains often go away by morning, and children usually don’t have any pain during the day. The condition tends to come and go over time and may be more noticeable after particularly active days.

No single test can diagnose growing pains, so healthcare providers usually base the diagnosis on symptoms and physical exam findings, while ruling out more serious conditions. There’s no specific treatment, but symptoms can be relieved with gentle massage, stretching exercises, or warm baths. Some parents also find that applying a warm heating pad or giving a mild over-the-counter pain reliever like acetaminophen or ibuprofen (under a doctor’s guidance) helps. It’s also reassuring to explain to the child that the pain, while uncomfortable, is not dangerous or permanent.

Although growing pains are not harmful, they can be distressing—both for kids who experience them and for parents trying to comfort them. Open communication, reassurance, and a consistent bedtime routine can help ease the emotional and physical discomfort. It’s a good idea to keep a symptom diary if the pains are frequent, just in case patterns emerge or the doctor needs more context. And while growing pains are normal, anything unusual—like pain in one specific spot, persistent or worsening pain, or other symptoms like joint stiffness—should be evaluated to rule out other causes.

Most Useful Resources:
Growing Pains (Foot Health Forum)
Growing Pains (Podiatry TV)
Growing Pains (PodiaPaedia)
Growing Pains (Podiatry Arena)
Growing Pains in Children (Podiatry Arena)
Night-time foot pain in children (Foot Health Forum)
Growing Pains? (Podiatry Experts)
Growing Pains in Children (iPodiatry)
Take Growing Pains in Kids Seriously (Foot Health Friday)
Growing Pains (Foot Health Guide)
Growing Pains in the Leg: Throwing the kitchen sink at growing pains

Congenital Vertical Talus

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Congenital Vertical Talus is a severe cause of flat foot (or overpronation) in kids. The talus is almost vertically, pointing plantarly so that the navicular bone is articulating with the top of the head of the talus. Surgery is usually the only satisfactory treatment.

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Congenital Vertical Talus (CVT), sometimes referred to as “rocker-bottom foot,” is a rare but serious foot deformity present at birth. It is characterized by a rigid flatfoot where the talus bone is abnormally positioned in a vertical orientation instead of its normal horizontal alignment. This abnormality causes the midfoot and forefoot to dislocate dorsally (upward) over the talus, resulting in the distinctive convex shape of the sole. Unlike more common flexible flatfoot in children, CVT is a rigid deformity that does not improve with growth, making early recognition essential for effective treatment.

Causes and Associations
The exact cause of congenital vertical talus is not fully understood, but it is generally thought to arise from disruptions in fetal musculoskeletal development. CVT can occur in isolation or be associated with neuromuscular and genetic conditions such as arthrogryposis, spina bifida, or other syndromic disorders. In some cases, it appears as an isolated idiopathic deformity without underlying systemic disease. The condition affects both feet in about half of the cases and is slightly more common in males than females. Its rarity often contributes to delayed diagnosis unless clinicians are specifically familiar with the condition.

Clinical Presentation and Diagnosis
At birth, CVT is typically recognized by the distinct “rocker-bottom” appearance of the foot, with a rigid upward bend in the midfoot and a prominent heel. Unlike flexible flatfoot, manipulation does not restore the arch. Radiographic imaging confirms the diagnosis, showing the talus bone in a vertical position and misalignment of other midfoot structures. X-rays taken in both plantarflexion and dorsiflexion are especially helpful in distinguishing CVT from other similar deformities, such as calcaneovalgus foot or oblique talus. Early diagnosis is critical, as untreated CVT can lead to severe disability, impaired walking, and chronic pain.

Treatment and Prognosis
Treatment typically involves early, structured intervention. Historically, surgery was the mainstay, but current best practices favor staged correction through serial casting (often similar to the Ponseti method used for clubfoot), followed by limited surgical procedures such as tendon lengthening or soft-tissue releases to correct residual deformities. In some cases, subtalar or talonavicular joint stabilization may be necessary. With timely intervention, most children achieve good functional outcomes, including near-normal walking and foot appearance. However, delayed or inadequate treatment can result in permanent disability, making early recognition and multidisciplinary care essential for long-term mobility and quality of life.

Most Useful Resources:
Congenital Vertical Talus (Foot Health Forum)
Congenital Vertical Talus (Podiatry Arena)
Congenital Vertical Talus (PodiaPaedia)
C is for Congenital Vertical Talus (Podiatry ABC)

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Calcaneal Apophysitis

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Calcaneal Apophysitis is also called Severs Disease and is a common condition of the growth plate at the back of the heel bone in kids.The pain is present at the back and sides of the heel, usually worse after sports activity. As it is a problem with the growth plate, it will come right on its own as the child’s growth in the heel bone stops. It is most commonly treated with a cushioned heel inserts and is a self limiting problem that eventually comes right by itself.

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This video from PodChatLive was a good discussion on Calcaneal Apophysitis with an expert in the topic for those who want a deep dive into the topic:

For other videos on Severs disease, see PodiatryTube.

Calcaneal apophysitis, more commonly known as Sever’s disease, is an overuse injury that primarily affects children and adolescents. It occurs at the growth plate (apophysis) in the heel bone (calcaneus), where the Achilles tendon attaches. During periods of rapid growth, especially between the ages of 8 and 15, the bones often grow faster than the muscles and tendons, creating tension at this attachment point. The repetitive stress from activities such as running, jumping, or playing sports can irritate and inflame the growth plate, leading to heel pain. Importantly, despite the name “disease,” it is not an infection or degenerative condition—it is a self-limiting growth-related issue.

The hallmark symptom of calcaneal apophysitis is pain at the back or underside of the heel, which worsens with physical activity and improves with rest. Children may limp, walk on their toes to avoid putting pressure on the heel, or complain of soreness after sports practice. The pain is usually bilateral (in both heels) but can occur in just one heel. Swelling and tenderness may also be present around the heel bone. Unlike plantar fasciitis, which is more common in adults and involves pain under the arch or heel, calcaneal apophysitis is specifically tied to skeletal immaturity and growth plate stress.

Diagnosis is generally clinical, based on history and physical examination. Imaging like X-rays is not always necessary unless there is concern about other causes of heel pain, such as fractures, infections, or tumors. Doctors often perform a “squeeze test,” applying pressure to the heel from both sides, which typically reproduces the pain. Since it’s strongly linked to growth spurts and high-impact activities, understanding the child’s sports involvement and developmental stage is essential. Differential diagnoses may include Achilles tendinitis, plantar fasciitis, or bursitis, but these are less common in this age group.

Treatment for calcaneal apophysitis is usually conservative and focuses on relieving symptoms while allowing the growth plate to heal. Rest and activity modification are crucial, particularly avoiding repetitive jumping and running until symptoms improve. Ice, stretching exercises for the calf and Achilles tendon, and heel cups or cushioned shoe inserts can help reduce stress on the heel. Over-the-counter anti-inflammatory medications may also ease discomfort. Most children outgrow the condition as the growth plate closes, meaning symptoms rarely persist into adulthood. The key is to balance physical activity with adequate rest, ensuring young athletes can continue participating in sports witho

Most Useful Resources on this topic:
Calcaneal Apophysitis (Foot Health Forum)
Calcaneal Apohysitis or Stress fracture (Podiatry Arena)
Calcaneal Apophysitis (Podiatry Arena)
Calcaneal Apophysitis (PodiaPaedia)
Heel Pain in Children (Severs Disease; Calcaneal apophysitis) (ePodiatry)
Severs Disease or Calcaneal Apophysitis? (Croydon Total FootCare)

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Oscon for Severs Disease

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Severs disease or calcaneal apophysitis is a common problem causing pain in the heel of kids; it is an overuse type injury to the growth plate at the back of the heel bone. It is a self limiting problem that always comes right eventually when the growth in the heel bone stops. Several treatments have been advocated for it treatment. One of these is a dietary supplement called Oscon which consists of selenium and vitamin E. It is only supported by the use of testimonials and no clinical study has been done on it. It is not clear if it is worth trying or not as most children do get the minimum dietary requirements for Vitamin E and Selenium from their normal daily intake.

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The best treatment for Severs disease is generally managing the activity levels and using a cushioned heel raise.

Most Useful Resources:
Oscon Supplements for Severs Disease (PodiaPaedia)
Discussion on Oscon and Severs (Podiatry Arena)
Does Oscon work for Severs disease? (Podiatry Experts)

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