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Foot and ankle disorders

Foot and ankle disorders

Foot and ankle disorders

Clubfoot

Clubfoot, known to doctors as talipes equinovarus, is a congenital (present at birth) abnormality of the foot. Clubfoot describes a variety of foot abnormalities in which a newborn's foot is twisted inward. 

Clubfoot can be mild or severe, affecting one or both feet. Clubfoot can inhibit a child's ability to walk, but with early treatment the appearance and overall function of the foot or feet should show improvement.

The most important aspect of care is early diagnosis and treatment. If your child's doctor identifies a clubfoot, starting treatment as soon as possible is a key factor to ensuring the most successful outcome.

Treatment options

  • Stretching and casting (also known as the Ponseti method): Stretching and casting involves manipulating the foot into the proper position and then casting it to maintain the position. This process occurs weekly for several weeks until the shape of the foot has been corrected. Once the shape has been aligned, the foot is maintained through stretching exercises, special shoes or splinting with braces at night, for up to three years.
  • Stretching and taping: This treatment includes daily manipulation of the foot and taping to maintain the correct position until the next day. Usually after two months, the treatments are reduced to three times per week until 6 months of age. Once the shape of the baby's foot is corrected, daily exercises and night splints continue until they are walking.
  • Surgery: Surgery is sometimes necessary in more severe cases or if the stretching and casting approach does not correct the clubfoot. A pediatric orthopaedic surgeon can lengthen tendons and properly position the foot. After surgery, the child may need to wear a brace to prevent any recurrence of the deformities.

Flat feet

Flexible flat foot, also known as pes planus, is a condition where the arch of the foot disappears when the foot comes into contact with the ground. As the arch disappears, the ankle turns or rolls inward, also called pronation. When the child is sitting or on their tiptoes the arch reappears.

Treatment options

  • Exercises: The patient's doctor may recommend stretching exercises for the heel cord.
  • Orthotics: In some cases, orthotics or shoe inserts offer support and may relieve foot pain and fatigue.

In-toeing

In-toeing means the feet point inward instead of straight ahead or slightly outward. Also known as "pigeon-toed," in-toeing is a common gait (walking) abnormality that usually does not require treatment. In most cases, children outgrow in-toeing.

Most children with in-toeing do not exhibit any associated symptoms. Some children may have some pain around the knee area.

Treatment options

  • Most cases of in-toeing correct themselves and do not require treatment.

Tarsal coalition

The bones of the foot found at the top of the arch, the heel and the ankle are called the tarsal bones. A tarsal coalition is an abnormal connection between two or more of these bones. These coalitions can form across joints of the foot or can occur between bones that don't normally have a joint between them. Generally, the main symptom is pain and stiffness around the ankle, typically between the ages of 8 and 18.

Treatment options

  • Observation: Many children with the condition never need treatment. Of those who do need treatment, some don't need surgery, nonsurgical options include:
    • Casting
    • Steroid injection
    • Anti-inflammatory medications
    • Physical therapy
  • Surgery: A severe case of tarsal coalition can interfere with foot function and may alter a child's activity level. The surgical treatment is based on the type, severity and complexity of the tarsal coalition. Surgical options include:
    • Removal of the tarsal coalition
    • Joint preserving surgery

Bunions

A bunion is an enlarged bump located just behind the big toe, and is often painful. Juvenile bunions are congenital and can develop as the child grows. The bump affects the joint of the big toe and causes changes in the bony framework of the front part of the foot. As the deformity progresses, the entire structure of the foot can be thrown out of alignment.

Treatment options

  • Nonsurgical: Sometimes observation of the bunion is all that's needed. To reduce the chance of damage to the joint, periodic evaluation and X-rays may be recommended. Nonsurgical treatment options include: 
    • Insoles/orthotics may help balance the structure and function of the foot.
    • Changes in shoe wear: Choose shoes that have a wide toe box and avoid those with pointed toes or high heels which may aggravate the condition.
    • Medications: Oral non-steroidal anti-inflammatory drugs, such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Surgery: When nonsurgical treatments fail to relieve bunion pain and the pain interferes with daily activities, surgery may be recommended to realign the bone and correct bone structure.
   
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