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.

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.