Children’s Foot Medical Health Problems
Pre Teen

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Club feet - (Talipes Equino Varus)
This deformity is when the lower leg, ankle and foot are twisted out of normal position. Commonly the foot appears as a small rigid internally rotated foot. The cause is unknown, and may be related to increased pressure in the uterus.

Congenital dislocation of the hip (CDH) This condition is described as an unstable, subluxed or dislocated hip joint. On examination  a clicking sound occurs when rotating the hips. As the child starts to walk an unstable gait is seen. CDH can be caused by: hip joint irregularities, ligamentus laxity, a breech delivery, a Malposition inutero, heavy winter clothing or the carrying position of the newborn.

Congenital vertical talus
Congenital vertical talus is a rare disarticulation of the navicular talus joint at birth. It is associated with an abnormal neurological and skeletal system. Symptoms often seen are flat feet, ankle equinus, tight Achilles tendon and a vertical talus.

Accessory bones
Accessory Bones are present at birth. They are a result of a  bone producing a small bone adjacent to another or a result of a non-union fracture. They can be caused by trauma or unknown growth abnormality. These bones are commonly located in the foot adjacent to the talus, navicular, sustentaculi, cuboid and first metatarsal bones.

Congenital digital deformities
These are toe deformities present at birth due to an abnormality in development. Corns and callus are common concerns with digital deformities. Examples of these deformities include: Varus digit, DQMV, Polydactyly, Ectrodactyly, Syndactyly, and Macrodactyly.

Varus digit
This is the most common congenital condition visually it appears as a digit plantar medially rotated (curled toe). The cause is unknown, perhaps hypoplasia of intrinsic muscles. The digit and metatarsals are usually painful.

Digitus Quintus Minimi Varus (DQMV)
This is a congenital familiar condition caused from a hyper extended adducted 5th digit (small toe) overriding and lying across the base of the fourth digit.

This is when extra digits are present, syndactylization may also be present. The cause is an inherited autosomal dominant trait, or mutant genes.

This is the absence or 2nd and 3rd metatarsals and digits. The cause is an inherited autosomal dominant trait. The foot presents as a lobster claw foot or split foot.  Hallux valgus, and medial deviation of 4-5 digits are common.

This is when two or more toes fuse together. The condition happens in 1:1000-3000, and is more common in boys than girls. The cause is heredity, or a developmental defect at week 4-5 of pregnancy. The toes appear webbed, most commonly in the 2nd and 3rd toes, usually skin and nail fusion occurs. 

This is a grossly enlarged digit (gigantism). The cause is unknown, possibly from peripheral nerve enlargement. The enlarged digit, grows out of proportion to forefoot.

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Metatarsus adductus is a curvature of the forefoot toward the midline of the body. The condition occurs in 1 in 1000 births. The cause could be due to In utero position, a short medial cuneiform bone, a tight Adductus Hallucis muscle or abnormal insertion. The foot appears in a ‘C’ shape, where the medial side is concave, a prominent styloid process, a space between the 1-2 toes, and plantar medial wrinkles are present.

This condition is common with children. It is an inflammation of the skin to an irritant, internal or external. The cause is often unknown. The presentation of this condition varies greatly, therefore making it difficult to diagnose. In the acute phase it presents with vesicles and blisters, redness and itching are common signs more chronic conditions present as dry skin with scaling and fissures.

Femoral torsion 
This is a twist in the femur (upper thigh) bone shaft, usually the femur unwinds by 18 months, but can take up to 14 years old . This can be caused by tight soft tissue (hamstrings, ligaments, adductor muscles), sleeping or sitting position.

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Tibial torsion
This is a twist with in the tibia (lower leg) bone.  It is considered internal if the ankle is rotated less than 18 degrees, and externally rotated if the angle is greater than 23 degrees. The cause may be related to stomach sleeping with feet tucked in, or sitting with the feet tucked in. The presentation is an early heel lift, intoe or out toe gait and flat feet.

Knee rotation / Tibial Varum/ Valgum
Tibial varum or valgum is described as when the lower third of the tibia bends toward or away from the body midline. The cause may be sleeping on the stomach with feet tucked in, sitting on the feet. This condition can lead to an in-toe/ out-toe gait.

In toe / Out toe / Toe walker
When feet are turn in or out during walking. Signs and Symptoms include a pigeon toe type walking, with the toes pointing inwards.  Frequent tripping, or a waddling gait are commonly seen. The cause can be a rotation of the foot or leg, In uterus position, tight hamstring muscles, sleeping and lying positions. Flat feet can form if left untreated.

Genu varum  (Bowlegs)
This condition presents as a medial curvature of the tibia and femur possibly due to a disturbance of the growth plate, soft tissue muscle problems, early walking with unstable knees. Flat feet and frequent falling and tripping while walking are common with this condition.

This condition presents as an inverted knee with a hyperextension of the knee greater than 10 degrees. It can be caused by a restriction of ankle movement.  Flat feet and frequent falling and tripping while walking are common.

Digital deformities
(a) Mallet, (b) Claw, (c) Hammer
These may be familiar in nature. The most common cause is an imbalance of flexor and extensor or intrinsic muscles.

Congenital valgus foot
This condition is when the foot is in a dorsiflexed everted abducted position. The incident is 1:1000 and more common with 1st born children. The symptoms include flat feet, overlapping digits, dorsal lateral foot wrinkles, Achilles Tendon contracture, with no plantar flexion ROM available. The cause of this condition can be related to an abnormal increase in uterine position or high birth weight.

Subungal exostosis
This condition presents as a small outgrowth of bone underneath the nail at the distal portion of the nail.  As the bone continues to grow in size the nail is pushed away from the nail bed.  The nail plate becomes destroyed and the nail thickens. This condition is usually caused from trauma to the digit and is most commonly seen in the big toe.

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Pes planus (Flat Feet)
Flat feet can be described as when there is no arch present.
If the heels are raised and an arch forms it is functional flat foot, if there is no forming of an arch then it is a rigid flat foot. There are many possible causes for flat feet. The common symptoms seen are pain, foot fatigue, night cramps, abnormal shoe wear and a pronated gait.
Pes cavus
This is when the arch of the foot is higher than normal. The cause can be from tight musculature of the arch, a muscle imbalance in the foot or an inclined heel bone. The high arch can also be caused by a rotation of the ankle and foot outwards (supination). The problems that occur from the high arched foot are poor shock absorption and increased stress on the foot.

Forefoot varus
This condition is when the forefoot in inverted (supinated) compared to the rearfoot. Pronation or a plantar flexion of the first ray (big toe) occurs during walking in order to walk properly.

Genu valgum  (Knocked knees)
This condition presents as a lateral curvature of the tibia and femur possibly due to a disturbance of the growth plate, soft tissue muscle problems, early walking with unstable knees. Flat feet and frequent falling and tripping while walking are common with this condition.

Ankle equinus
Equinus of the ankle is a limited range of motion at the ankle, with dorsiflexion movement less than 10 degrees. It can be muscular, or osseous in nature. The cause can be tight muscles, irregular bony structure of the ankle or a soft tissue compensation for rearfoot /forefoot varus.

Osteochondritis- Kohler’s disease
Osteochondrosis is an aseptic necrosis of a bone followed by re-growth in a more flattened shape. In Kohler’s Disease this occurs between the navicular and tarsal bones. The cause is unknown and may be related to trauma of the area. The signs and symptoms are a painful limp, warm possibly swollen area over affected bones. This condition usually occurs unilaterally.

This condition is described as an inflammation of the sesamoid bones located below the first metatarsal joint. The cause is increased pressure on the ball of the big toe. It is a common condition with athletes. The symptoms are pain in the toe as the foot toes off.

This is a general term that refers to pain in the ball of the foot. It could be related to stress fractures, bone misalignment, digital neuritis, or just increased pressure to the area. It is important to determine the exact condition and origin of its cause to treat this condition properly.

Plantar fasciitis
Plantar Fasciitis (heel pain) is the most common injury that occurs at the heel. It is caused by an over strain of the plantar fascia band, a ligament like structure that supports the arch of the foot.   The symptoms of this condition are pain on the bottom of the heel. Commonly the heel is more painful in the morning and gradually wears off as the body starts moving.

Achilles tendonitis
Over use or sudden movement of the Achilles tendon can result in an inflammation of the tendon called tendonitis. This inflammation can result in degeneration or even a rupture in severe cases. The strength and position as well as the alignment of the ankle, leg and knees play a major role in this injury. Excessive pronation of the foot, and high arches are predisposing conditions for this injury. The symptoms of this condition are a burning/pricking pain at the back of the heel and pain as the heel lifts off the ground.

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Apoptosis-Sever’s disease
Sever’s disease is caused from a traction injury from chronic strain at post calcaneal apophysis during a growth period. The Achilles Tendon is commonly strained with this condition. Pain is felt on the plantar aspect of the heel and sometimes at the Achilles tendon insertion to the heel bone.

Tarsal coalition
This is defined as fusions between two adjacent tarsal bones during ossification. The bones may be joined by projections between the cartilage and fibrous tissue. Most common the coalition is seen in calcaneus -navicular, talus -calcaneal joints. It can also be seen in the navicular -talus, navicular -cubiod, navicular -cuneiform joints. The cause can be related to genetic mutation, and failure of tissues to separate in embryo development. Signs and symptoms are usually asymptomatic until full fusion occurs and joint range of motion is disrupted causing pain.

Juvenile arthritis chronic (JAC)
This is a general term referring to a group of joint diseases that are at lease three months in duration before the age of 16 with no associated medical conditions. The cause is unknown, there may be a genetic predisposition. The condition usually occurs between the ages of 2-5 and 10-15 years old. Signs and symptoms can include a fever, rash, anaemia, weight loss, swollen stiff joints and a decrease range of motion. Foot deformities associated with this condition include rearfoot valgus, forefoot varus/valgus, bunions and toe deformities.

Fungal infection
Athletes foot is a fungal infection (Tinea Pedis) of the skin, it is most commonly seen between the toes. Fungus grows in dark, warm, moist areas of the skin; inside the shoes is an ideal setting. Symptoms that usually occur are pain, itching, redness, cracking blisters and scaling of the skin.

Ingrown toe nails
An ingrown toe nail occurs when a piece of the nail becomes embedded into the skin around it.  The skin around becomes inflamed and can become infected. The toe is usually sore when walking and wearing shoes.

Apoptosis - Osgood-Schlatter disease
Apoptosis is a change in bone shape. Osgood Schlatters is an over use injury caused by strain of the patellar tendon on the tibial tubercle just below the knee on the lower leg. This condition is common in boys 10-14 years old. The tibial tubercle on dorsal upper third portion of the tibia bone becomes enlarged and painful with activity. There may be muscle imbalances causing the overstrain.

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Ingrown toe nails
An ingrown toe nail occurs when a piece of the nail becomes embedded into the skin around it (usually the big toe). The skin around becomes inflamed and often infected. The toe is usually sore when walking and wearing shoes.

Osteochondritis - Freiberg’s infraction
Freiberg's Infraction an aseptic necrosis of a metatarsal bone followed by re-growth in a more flattened shape. Most commonly this condition occurs in the second metatarsal head. The cause is unknown, possibly due to trauma. Symptoms include a painful limp, warm possibly swollen area over affected bones. On X-ray  a decreased joint space, flat navicular, flat metatarsal head are noted. On examination a bony lump is present and on palpation the area is tender to touch.

Pitting keratolysis
This condition is an infection of the skin on the bottom of the foot due to a breakdown of the keratin layer of the skin. The skin appears a light brown clour, moist with pits or craters present.  This condition can be associated with a bacterial infection, which causes an odour to occur. There is often a burning painful sensation of the skin surface.

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