Black Swan Osteopathy & Podiatry

Paediatrics

Podiatry for Children

Children’s feet are different to that of adults. When they are young, their bones are still very soft and are therefore more easily affected by abnormal pressure and forces. It is important to nurture our children’s feet as most of the issues we see in adults have stemmed from issues as children. The younger a child is assessed and diagnosed, the easier it is to treat and manage the issue.

 Foot and Lower Limb Issues in Children

 Flat feet/fallen arches/rolled-in feet
 In-toeing (pigeon toed)
 Out-toeing
 Walking on tip-toes
 Slow to begin walking
 Knock-kneed
 Bowlegged
 Leg length difference
 Clumsiness or poor balance
 Growing pains
 Limping
 Low muscle tone
 Oddly shaped toes (curly/clawed)
 Ingrown toe nails
 Bunions or other deformities
 Callous/corns
 Warts

Treatment Options

Podiatrists provide all sorts of different treatment options for the lower limbs. The treatment that is required depends on the injury/condition we’re treating as well as the individual being treated. Just because something might work for one person, does not necessarily mean it is the best option for someone else. That’s why we’ll always do our best to provide you all the necessary information and a variety of suitable treatment options so that as a parent, guardian, or child… you may choose a treatment option that you feel comfortable with and which best suits you (or your child!).

 Orthotics

chiropodist

Orthotics are in-shoe devices commonly used to correct gait (walking) abnormalities, among other conditions. Orthotics are highly specific to the individual and as such at Black Swan Podiatry we customize all of our in-shoe devices. Given that no two feet are the same, it seems unrealistic to expect that two people could wear the same orthotics. At Black Swan we work closely with a laboratory to see that the devices are made to our specific needs.

Customised In-Shoe Padding & Strapping

chiropodist

In-shoe padding &/ strapping is often a good, economical alternative to orthotics. Strapping may be used to either alter the alignment of the foot/lower limb or it can be used to splint and protect painful or injured areas. In-shoe padding may be combined with strapping, or be used alone in the shoe(s) for minor corrections to the foot/lower limb.

 Stretching & Strengthening Regimes

At Black Swan we recognise that stretching and strengthening activities can be difficult for children to stick to! That’s why we attempt to make all of our prescribed activities fun, interactive and child-friendly. After all… there’s no use prescribing something that just won’t get done! Stretching and strengthening exercises are commonly overlooked by many therapists. There are so many little muscles deep within the feet and legs, and we believe that it’s vital to acknowledge these… especially because it can often be due to little muscle instabilities and weaknesses that we’re considering orthotics in the first place!

 Gait Analysis & Retraining

Many children present with in-toeing, out-toeing, tripping, ataxic movements and other atypical gait patterns which may be brought about by developmental delays, neurological or movement disorders. In these instances, it is a major focus in the clinic not to just put a device in the shoe or underneath the foot without addressing the causative factors. Our podiatrists are trained professionals who are able to assist with ambulatory issues by way of gait assessment and retraining.

What is Normal?

Walking

One of the most important milestones in your child’s life is their first steps. All children develop at their own pace and will all commence walking at different ages. Most children will take their first steps between nine and twelve months. For some children, this may take a little longer. If at 15-16 months your child is not yet walking, it is recommended they are assessed. When your child begins to walk, they will generally hold their arms high and their feet out wide for balance. As his/her balance improved, their feet should gradually close in and their arms should drop to their side. Children may develop abnormal walking patterns such as in-toeing (pigeon toed) or out-toeing and in some cases tip-toe walking. If you begin to notice an abnormal pattern, have your child’s feet assessed by a podiatrist. Many adult foot and lower limb issues begin in childhood and are therefore more easily managed if they are addressed sooner rather than later.

Children’s Footwear

When children first begin to walk, for most children it is recommended that they are kept barefoot for the first 6-8weeks. This allows for their important sensory system which aids in balance and movement coordination to develop. Shoes however should be worn for protection of the feet when outside the home.

 Healthy Shoes

Fitted properly

• Too short/narrow – causes abnormal pressures to the bones in the feet
• Too long/broad – causes clawing of the toes to grip the shoe and may cause tripping

Adjustable (laces/Velco/buckle)

• Secures the shoe to the foot so the toes do not claw to grip the shoe
• Allows you to adjust the shoe when your child grows

Firm heel cup

• You should not be able to squeeze the sides of the back of the shoe together
• Aids in supporting their feet
• Sandals should preferably have an enclosed back

Bend at the ball of the foot

• The foot bends just before the toes to push off the ground so the shoe should be flexible across this section
• The shoe should have a “last” which means you should not be able to bend the shoe anywhere else

Light in weight

• The heavier the shoe the hard their little feet and legs have to work
There is no one brand whereby all their shoes will have these characteristics. Also, expensive shoes aren’t necessarily any healthier for your child’s feet. Therefore it is important to assess each individual shoe on these merits.
• Make sure not to forget to check the size of their socks for appropriate fit regularly. Children’s socks tend to be forgotten about however wearing socks which are too small can apply excess pressure to the toes and may cause them to claw.

Flat Feet

Very young children appear to have less of a visible arch due to the fatty pad underneath their feet. As they grow, their arch should appear more obvious. The term flat feet is used to describe the condition where more of the arch comes in contact with the ground than is considered normal. It may also be termed…

• Fallen arches
• Pronation
• Rolled in feet
• Pes planus

Not all flat feet are considered abnormal and pain is not the only indicator that their flat feet are problematic. Particularly with young children, their perception of pain is very different to that of adults. Things to look out for are…

Change in Arch Height

  • Sometimes feet will appear to have an arch when they are non-weight-bearing and then appear to lose some or all of the arch height when standing.
  • This is called functional flat feet.
  • This flattening of the arch and change in arch height can damage the soft tissue structures (such as muscles, ligaments and tendons) and allow the bones of the feet to move in directions that they are not designed to do.

Rolled in Ankles

  • Your child’s ankles appear to tip in towards each other when looking from behind. This is call rearfoot pronation.

Other signs that there may be issues with your child’s feet or walking pattern are…

• They complain of tired legs
• They ask to be carried or pushed in the stroller
• Reluctant to walk
• They appear clumsy or uncoordinated
• Unwilling to participate in sport
• Unusual wear pattern on their shoes
• Morning stiffness

Contrary to popular belief, children do not “grow out of” having flat feet. In fact, some flat feet, if not managed in childhood can develop into pathological, often painful, flat feet in adults. This is why if you have concerns with your child’s feet, legs or walking pattern, to have them assessed and treated earlier rather than later.
Remember their little feet have to walk them through life.