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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