Does my Child Need Bunion Surgery?

Foot pain? We typically don’t associate foot pain with children, but there are a number of foot conditions that cause pain in our young offspring. Our kids can have bunions too! Yes, I know we all think of bunions as a nasty bump that woman get after years of wearing bad shoes. However, shoes are not the primary cause of bunions. There is always an underlining biomechanical problem that is causing the common foot deformity. This deformity is genetic in nature. Shoes will often progress or aggravate the underling disorder. In a few unlucky individuals, the biomechanical imbalance is so severe that they have a bunion at a very young age. Now, what do we do for a child with a big, bad bunion?




First, how painful is the bunion? Yes bunions are ugly, but they are not always painful. Often, we see this deformity and assume it must be the most uncomfortable thing in the world. Frequently, the bump looks worse than it feels. Children are young and resilient and most likely have very healthy joints and cartilage. Adults have years of wear and tear on their joint and some degree of associated arthritis with the bunion. Children are typically spared from joint pain; though, bunions are common among children with juvenile rheumatoid arthritis.

Second, are the child’s bones still growing? There are a number of surgical procedures to correct the deformity. These procedures rely on breaking the bone and resetting it with plates and screws. Growing children have open growth plates that would often interfere with these procedures. Every child is different, but the growth plate typically closes between the ages of 10-14 years old. Some procedures can be done without the disrupting the growth plate, but these procedures are not always the best option for correcting the deformity, thus surgical treatment is typically delayed until after the growth plates are closed.

There are no therapies that will turn back time on a bunion. It will not get better. It will only get worse. Surgery is not a treatment to jump into, but when severe deformities are present at a young age, more often than not, one will need surgery at some point in their life time. It is not recommended to have surgery if there is no pain associated with the deformity. Anybody with a bunion, even children, should take preventative measures to decrease the rate of progression of the deformity. Orthotics are always a crucial portion of the treatment plan both before and after surgery. Bunions, as mentioned, are caused by a biomechanical imbalance. Custom made orthotics gives your foot a functional advantage and decreases the deforming forces on the foot.

Bunions can be very unsightly for a child and a parent, but it is important to remember all of your treatment options. Conservative treatment always comes first. Many children are scared to undergo surgery and it is important to make sure they are prepared for the recovery time. Children are active and foot surgery takes some time to heal. Yet, many children stop participating in activities because of foot pain from bunions. That is unacceptable and treatable.

Do all Flat Feet Need Surgery?

Studies suggest 20-30 percent of all people suffer from flat feet. Duck feet, as some may call it, is medically describes as pes planus. Though flatfoot is a well recognized diagnosis, its cause is not as well defined. Flatfoot can be seen in young children and is actually considered normal up to the age of two or even five years old. Some flatfoot conditions occur much later in life and in reality; flatfoot can be encountered at any age and cause a broad range of pain from absolutely none to physically debilitating.

The most basic way to describe a flatfoot is rigid or flexible. A rigid flatfoot is flat all the time. Whether standing or sitting, the foot never appears to have an arch. A flexible flatfoot on the other hand looks and appears normal when non-weight bearing but as soon as one stands up the arch disappears and the foot collapses to the floor. Generally, those with a rigid flat foot experience more pain. Those with flexible flatfoot have a wider range of discomfort. Some experience no discomfort at all.

Whether experiencing pain or not, the general public and many of patients are quite concerned about their flatfeet. As if the flatfoot is a ticking time bomb that will ruin their life, everyone wants to know what they can do for their flat feet! There is truth to when your feet hurt your whole body hurts, but often, the trick to keep your feet happy is not taking them under the knife. With that said, there are a considerable number of people who benefit greatly from surgical reconstruction of their foot. These people have exhausted all conservative treatments that have all failed to bring them relief.

Where to start? If you are asymptomatic, don’t worry so much. There is nothing you can do short of surgery that will recreate an arch. When you have a flatfoot, it is often a combination of soft tissue failure and boney alignment dysfunction. The biomechanics of your foot becomes compromised. You can still walk but for some, it is not without discomfort. Simple measures such as orthotics and bracing are often all that is needed to rid the discomfort. This also means that shoes play an important role. Every day of the summer I have patients strolling into my office in flip flops and other poor excuses for shoes. Low and behold, this only creates problems for flatfooters.

Parents often get very anxious when they see their child flopping around on archless feet. Studies have shown that athletic performance or injury rates have zero correlation to flat feet. If the flat feet are asymptomatic, no treatment is eminent through research is lacking to really determine the value of an orthotic on long term symptoms. For children that have symptoms, they may have an underlying coalition, meaning they may have bones in their foot that are fused that shouldn’t be. These children improve significantly with surgical procedures to correct this deformity.

Generally, my rule of thumb is pain needs to be treated and concerns of your health should always be addressed. Flatfoot does not mean you need a complex surgery. Though surgical procedures for flatfoot can greatly improve one’s symptoms it is not for everyone.


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Baby Foot Advice

Your bundle of joy enters the world and dad quickly checks to make sure he/she is strong. Ten toes!!! Great, now what do we do? When you have a healthy baby, all you want is to keep them healthy. Here are a few tips to keep your baby’s feet happy.

Many new parents are alarmed when they see discolored, wrinkled, and peeling skin on their new born. This is a normal finding and is not a reason to rush to the emergency room. One must not forget that a baby spends months trapped in a fluid filled sack in mom’s stomach. Imaging what your feet would look like after lying in the bath tub for only a couple of hours! It takes time for the skin to get use to the new world.

Toenails are the obvious foot chore on babies. The nails should be kept short to prevent scratches and sores. Use a baby nail clipper and be sure not to cut the nails too short. If cut too close to the skin, an ingrown nail can develop. It is a good habit to check your baby’s feet regularly after a bath. Look at the nails and the general appearance of the foot. Also, make sure to dry the feet off completely. Bacteria and Fungus can easily accumulate on a moist foot.

Shoes for babies and toddlers have become very popular and stylish. Though we think we are helping our children by putting them in shoes, it is actually better for development for a child to walk around barefoot. It is recommended to always have your children wear shoes outdoors since rough surfaces and outdoor debris can easily puncture the skin. Yes, of course the shoes are adorable and we love to buy them and try them on and put them with their cute outfits, but honestly you’re better off letting them run around in just socks. Pediped’s are a great alternative. They are hand stitched shoes that allow plenty of room for healthy growth.

Your pediatrician will check the feet for any major deformities or problems. It is normal for your child’s feet to look flat up to the age of two. You may think they look funny, too flat, or without an arch. The bones in the foot do not fully mature until 18-23 years of age. Some bones have not even started to grow yet when the baby is born! When you look closely the foot does not really look like a mini adult foot. Pediatricians are trained to look for common abnormalities and to refer you and your child to a podiatrist if a problem is suspected. If you are worried or have questions about your child’s feet, a podiatric physician can evaluate and treat children.

Will My Child Outgrow Flat Feet?

Flat feet can also be referred to as pes plannus, pes planovalgus, valgo plannus, or pronation syndrome. It is commonly described as a foot without and arch. Flexible and Rigid flatfoot are the two basic forms. A flat foot is rigid when the arch appears flat when the child is sitting and when the child is standing. The flexible flatfoot is when the foot appears normal when the child is sitting, but the arch collapses when the child bears any weight on the foot. The flexible form is less severe and much more common.

Flatfoot is normal in children under three years old. Young children are very flexible and will appear to have flat feet. It is normal for the child’s foot to appear as it is rolled in and pointing outward until they past their toddler years. You may need to see a podiatrist if you child still appears flat as they near the age to attend school.

The podiatrist will evaluate the entire lower extremity to determine if the child is experiencing any weakness or pain. The child may complain of pain in the foot, ankle or the knee. The child may also have a history of clumsiness, or a voluntary decrease in activity. The doctor will take x-rays to evaluate the joints and alignment of the bones.

A tight calf is a common finding in all flatfoot patients. This may be a significant component to the patient’s present and future pain. Thus, it is common for children to undergo physical therapy to learn stretches and exercises that target the calf muscles.

The gold standard in treating flatfoot is orthotic therapy. Orthoses are custom made shoe inserts that assist in foot function. Since the orthoses are custom made, they are design to address the child’s specific foot structure and associated problems. These devices will help prevent the flatfoot from progressing and decrease the current pain that the child is experiencing.

Surgery is a treatment of last resort. In rare cases, a child will continue to have pain or disabling fatigue after all conservative treatments are attempted. Surgery is invasive and often unnecessary to control flatfoot pain, so it is not attempted until the doctor and parent have exhausted all other treatment options.

In these severe cases, where the child’s flat foot is flexible, an implant can be placed in the rear part of the foot. One type of implants is the Hyprocure. The procedure takes only seven minutes and is made with a tiny incision. The implant causes an immediate arch and rarely needs to be removed. This procedure is done in children with severe pain in the arch or where the arch is so collapsed it will lead to an arthritic condition when they get older.

Many parents worry about their children’s flat feet, but in most cases the children grow out of them by the time they reach kindergarten. At this age, we begin to worry that the child may actually have a flatfoot. Generally these feet are easily managed and the child can have a normal and active life with no limitations. Be aware of children’s feet and their pain. It is common for children to fall and cry, but it is not common for a child to have foot pain or fatigue. It is always better to treat the flat foot immediately on a conservative basis because once they reach the age of three it might be very difficult to correct.

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Child Limping May Be Sign of Bone Infection

We have all had are falls and bruises. It is part of growing up. My boys are constantly horsing around upstairs, downstairs, outside, and inside. It is impossible to keep my eye on them 24/7. Sometimes they fall and sometimes they get hurt. But sometimes your child’s pain is more than just an ouchy from clowning around. Is your child limping and complaining of pain? Could your child be at risk of a bone infection?

Our bodies are constantly fighting off infection. Every time we take a breath, we are breathing in pathogens. We are coved in bacteria! Our immune system keeps these bacteria in check so there are not too many pathogens that will cause damage to the surrounding tissues. It is hard to believe but there is not one individual on earth that is bacteria free. You can use as much antibacterial soap available but there will always be something growing on you. How does this turn into an infection or disease?

Bacteria can sometime out power our immune system and grow out of control. This damages the tissues and creates an illness. Thus, we use antibiotics to help assist our immune system in the battle against bacteria. Children have an over abundance of blood vessels because of their high demand for nutrients for growing. Children, especially those under the age six, have more blood vessels in the bones. These vessels twist and turn and bacteria flowing through can sometimes get caught up, congregate, and begin an infection that kills bone. Imagine a windy river or creek. Some parts look crystal clear but in other areas twigs, moss and algae build up on the banks. Because of the way the water flows, some areas have rapids and others are a bit stagnant. The same happen with our blood flow and as long as our immune system constantly cleans up the mess there are no problems.

About 1/5,000 children suffer from a bone infection or osteomyelitis because the bacteria count becomes too high in the bone that the immune system cannot control the rising numbers. Children will complain of aches, pains in a generalized area of the infection. Children will also guard their pain by avoiding certain movements that aggravate them. When the infection is in the legs or feet, the child will often limp to avoid pain. Some infections are obvious from a puncture wound, but some just happen with no apparent injury because of the child’s intricate vessel system being overwhelmed.

When caught early, the infection will cause little damage, but the symptoms develop very slowly and thus medical attention is often not reached until the infection has become more sever. The infection can spread to joints and cause arthritis. If the infection causes severe damage to the growth plate it can cause deformities and underdevelopment. Though these are possible outcomes, it is often that the body walls off the infection and does not allow it to spread. To fight off the infection our body will need the assistance of appropriate antibiotics. Occasionally, the body needs even more help, and surgical removal or reduction of the infection is necessary.

Though osteomyelitis is rare, it is a possible. Thus, it is important to listen to your child when they are complaining of pain. Do they remember falling or getting hurt? Do they have fever? Are they irritable and unable to sleep well? Children are always whining, but sometimes the whines are important and need medical attention.