Tag: children

Clubfoot

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

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)

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.

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)

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 thos 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

Children Shoes

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The child foot is still growing, it is easy to mold, therefore the correct footwear to allow the growing foot to develop naturally is essential.

When fitting children’s shoes, the first thing to check is length and toe space. Children’s feet grow rapidly, so it’s important to have about a thumb’s width (roughly 1 cm) of space between the longest toe and the end of the shoe. This ensures that toes aren’t cramped and there’s enough room for natural movement and growth. Always measure both feet, since one is often slightly larger, and fit the shoes to the bigger foot.

The second step is width and overall shape. A child’s foot should sit snugly without being squeezed. If shoes are too narrow, they can cause rubbing and discomfort, while shoes that are too wide may lead to slipping and poor walking posture. Many children’s shoe brands offer different width fittings, so pay attention to whether the child’s feet are narrow, standard, or wide. Look at how the shoe hugs the midfoot and heel — it should feel secure without pressure points.

Next, consider heel and arch support. A good children’s shoe will hold the heel firmly in place, preventing excessive side-to-side movement. This helps with stability and reduces the risk of trips or ankle twists. The sole should be flexible enough to bend with the child’s natural walking motion, but still provide enough cushioning and support for everyday activities. Lightweight, breathable materials also matter — they keep feet comfortable and reduce sweat buildup.

Finally, do a practical fit test. Ask the child to walk, run, and even jump in the shoes to see how they feel in motion. Observe whether the shoes slip off the heel or cause them to adjust their step. Check for any red marks on the skin after a few minutes of wear, as these can signal tight spots. Since children outgrow shoes quickly, it’s a good idea to recheck their size every 2–3 months to ensure a proper fit and prevent foot health issues later on.

Most Useful Resources:
Children’s Shoes (Foot Health Forum)
Childrens shoes (Podiatry Arena)
Toning Shoes for Children (Toning Shoes Today)
Children’s Footwear (Child’s Shoes) (ePodiatry)
Children’s Footwear (Podiatry TV)
Footwear for Kids (Foot Health Friday)
Childrens Toning Shoes (Kids Shooz)
Childrens Shooz (Childrens Shooz)
Bunions and the Fitting of Children’s Shoes (Bunion Surgery)
The APMA are taking some heat for this advice on childrens shoes and its hard to defend (Its a Foot Captain)

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.

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)

Accessory Navicular

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The accessory navicular is an extra bone on the medial side of the navicular that can cause pain due to pressure on the lump from footwear (especially things like ice skates) and also be a factor in flat or overpronated feet due to changes in the pull of the tendon from the muscle that is the main supporter of the arch of the foot.

The accessory navicular (AN) is a common anatomical variation of the foot that can cause discomfort and pain in some individuals. It is an extra bone or piece of cartilage located on the inner side of the foot, near the arch.
What is an Accessory Navicular?
The accessory navicular is a congenital condition, meaning it is present at birth. It is estimated that around 10-15% of the general population has an AN, although not all individuals with this condition will experience symptoms. The AN can be classified into three types:
  • Type 1: A small, rounded ossicle (bone) within the posterior tibial tendon.
  • Type 2: A larger, triangular-shaped bone connected to the navicular bone by a synchondrosis (cartilaginous joint).
  • Type 3: A bony prominence that is fused to the navicular bone.
Symptoms of Accessory Navicular
While many individuals with an accessory navicular do not experience symptoms, others may develop pain and discomfort due to various factors, such as:
  • Overuse or repetitive strain: Activities that involve repetitive stress on the foot, such as running or dancing, can cause irritation and inflammation.
  • Poor foot mechanics: Abnormal foot pronation or supination can put additional stress on the AN, leading to pain and discomfort.
  • Trauma: A direct blow to the foot or a sudden injury can cause pain and inflammation in the AN.
Common symptoms of accessory navicular include:
  • Pain or tenderness: On the inner side of the foot, near the arch.
  • Swelling or redness: Around the AN.
  • Limited mobility: Stiffness or limited range of motion in the foot or ankle.
  • Difficulty walking: Pain or discomfort while walking or engaging in activities.
Diagnosis and Treatment
Diagnosis of accessory navicular typically involves a combination of:
  • Physical examination: A healthcare professional will assess the foot and ankle for pain, tenderness, and range of motion.
  • Imaging studies: X-rays, CT scans, or MRI scans may be used to confirm the presence of an AN.
Treatment for accessory navicular depends on the severity of symptoms and may include:
  • Conservative management: Rest, ice, compression, and elevation (RICE) can help alleviate pain and inflammation.
  • Orthotics and shoe modifications: Custom orthotics or shoe inserts can help redistribute pressure and reduce stress on the AN.
  • Physical therapy: Stretching and strengthening exercises can help improve foot mechanics and reduce pain.
  • Surgery: In some cases, surgical removal of the AN or repair of the posterior tibial tendon may be necessary.
Prevention and Management
While it is not possible to prevent an accessory navicular, there are steps that can be taken to reduce the risk of symptoms:
  • Wear supportive shoes: Choose shoes with good arch support and cushioning.
  • Use orthotics: Custom orthotics can help redistribute pressure and reduce stress on the AN.
  • Stretch and strengthen: Regular stretching and strengthening exercises can help improve foot mechanics and reduce pain.

Most Useful Resources:
Accessory Navicular (PodiaPaedia)
Surgery for accessory navicular (Podiatry Arena)
Accessory navicular (Podiatry Arena)
Classification of the Accessory Navicular (Podiatry Ninja)
Accessory Navicular (Foot Health Forum)

Gowers Sign

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Gowers Sign is an indicator of several neurological problems such as Duchennes Muscular Dystrophy. It is due to the weakness of the proximal muscles. The child as to raise from the ground from a supine position and use the hands to climb up the legs.

Gowers’ sign is a classic clinical indicator of proximal muscle weakness, particularly involving the muscles of the pelvic girdle and lower limbs. It is named after Sir William Richard Gowers, a 19th-century British neurologist, who first described the maneuver in patients with muscular dystrophy. The sign is observed when a patient, asked to rise from a sitting or lying position on the floor, cannot do so directly. Instead, the individual uses their hands and arms to “walk” up their own body — pushing on the thighs and knees to achieve an upright stance. This compensatory motion reflects the weakness of the hip and thigh muscles that normally extend the trunk and hips.

The underlying mechanism behind Gowers’ sign lies in weakness of the proximal muscles, especially the gluteus maximus, quadriceps femoris, and hip extensors. In healthy individuals, these muscles provide sufficient power to raise the body smoothly. However, when they are weakened, as in conditions like Duchenne muscular dystrophy (DMD), the child cannot generate enough strength from the lower limbs alone. To compensate, they use their upper limbs to support and lift the trunk — a process often described as “climbing up the body.” This movement pattern is not only diagnostic but also provides insight into the severity and distribution of muscle involvement.

Clinically, Gowers’ sign is most commonly associated with Duchenne muscular dystrophy, but it may also appear in other disorders causing proximal weakness, such as Becker muscular dystrophy, limb-girdle muscular dystrophies, polymyositis, and spinal muscular atrophy. The presence of Gowers’ sign in a pediatric examination often prompts further diagnostic evaluation, including serum creatine kinase (CK) testing, genetic studies, and electromyography (EMG) to identify the underlying cause. Recognizing the sign early is critical because it may be one of the first observable manifestations of progressive muscle disease.

From a diagnostic standpoint, observing Gowers’ sign provides a simple yet powerful clue in neuromuscular assessment. It underscores the importance of functional testing in neurological examination, where careful observation of movement can reveal the nature of underlying pathology. In modern practice, though advanced imaging and genetic tools are available, bedside signs like Gowers’ remain invaluable in guiding clinical suspicion. Thus, Gowers’ sign not only serves as a window into muscle physiology but also as a testament to the enduring relevance of classical clinical observation in medicine.

Most Useful Resources:
Gowers’ Sign (PodiaPaedia)
Gower Sign (Podiatry FAQ)
Gowers Sign (Podiatry TV)

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.

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)