Introduction
When addressing pediatric foot and ankle
deformities, the podiatric physician
understands that managing a child is
different than an adult, not just in the
physical appearance but also due to the
differences in emotional and social
development. The physician also takes into
consideration the nurturing relationships
between the child and his or her family.
There is a wide spectrum of deformities
that are encountered when treating the
pediatric population, most are not serious.
However, some of the congenital and
developmental abnormalities do require
extensive surgical intervention and
prolonged periods of treatment. Pediatric
disorders can be broken down into four basic
categories: developmental, congenital,
overuse, and traumatic.
Pediatric Flatfoot: A Developmental
Disorder
The pediatric flatfoot describes a foot
in which the inside border of the foot
appears flatter
 than
normal. This is a deformity that could
progress to an adult flatfoot, which is
normally arched and painless. However, other
adults may experience pain with this
condition, otherwise known as collapsing Pes
Plano Valgus.
Between 9 and 18 months, when a child first
begins to walk, the foot has less bony
architecture and a very chubby or fat
appearance. It is a difficult stage to
determine whether or not the child has a
pathologic flatfoot. At 2 to 4 years of age,
the foot has less fat and more prominent
bony structures when flatfeet can become
more noticeable. This is a critical time
because at this age the foot is primarily
composed of cartilage, and because cartilage
is very soft, the abnormal forces caused by
a flatfoot may cause permanent structural
damage to the foot.
A flatfoot deformity in a child will
cause numerous changes to the structure and
hence, the appearance of the foot. The
inside of the arch becomes flattened, the
front part of the
 foot
appears to point outward, and the ankles
appear to be rolling inward. Since the
flatfoot deformity causes some instability
of the foot during walking, the child
usually complains of pain in the arch, heel,
or ankle as well as cramping in the legs.
These symptoms are often increased with
excessive standing, walking, or running, and
may lead to compensatory alterations in
lifestyle.
Frequently, parents voice concern about
the child’s ankle rolling inward, constant
stumbling/tripping over feet, or the
subjective complaints of leg pain after
activity. A visit to a foot and ankle
specialist (podiatrist) will involve X-rays
of both feet while standing, a thorough
physical exam of the patients’ deformity,
standing and sitting, as well as a gait
analysis. This will provide the podiatric
physician a better understanding
of the underlying pathology, and a treatment
plan will be discussed.
Treatment plans could range from serial
X-rays and office visits every six months,
to casting custom orthotics for the patient,
to a discussion of surgical intervention
depending on the severity of the condition
and the pain level of the patient.
In Part II, I will touch on Congenital,
Overuse, and Ttraumatic pediatric foot
disorders.
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