Transcription:
Understanding Your Child’s Foot or Ankle Injury

Dr. Melanie Cole (Host): Children like to play, run, jump and play sports and their feet are the base of all that support they need as they grow. However, sometimes they’re slowed down by some common injuries that might have been able to be prevented. My guest today is Dr. Joshua Vest. He’s a podiatrist with Bryan Health. Welcome to the show, Dr. Vest. What are some of the most common injuries in the feet and ankle that you see with our kiddos?

Dr. Joshua Vest (Guest):  Well, thank you for having me. Certainly, injuries to children’s feet and lower extremities is a common thing that we deal with and treat. I think that there has been a growing trend of children participating in year round sports and competitive sports. We’ve seen a rise in kids participating in club team sports and with that there’s certainly been an increase in children’s foot pain and injuries as well. Most of the injuries that children experience to their feet are due to minor trauma or repetitive injury and those injuries typically tend to fall in one of two categories:  either overuse injuries or problems associated with skeletal immaturity in adolescent patients.

Melanie:  So, when we start with the base, let’s look at footwear. My goodness, the footwear that children are wanting to wear today is absolutely – some of them have no support. Some of these basketball shoes and things that the kids are wearing, is this contributing to some of the injuries that you’re seeing?

Dr. Vest:  Well, yes, it certainly can. I think you’re right. I think there has been kind of a tendency and a trend towards some of the more minimalist shoes and shoes that lack the adequate support that a skeletally immature foot needs as a child grows and as they develop. So, certainly, shoes that are very flat like you had described a basketball shoe or a skate shoe or a deck shoe certainly don’t give kids the support they need.  One of the more common things I’ll have patients come to me with is the concern about flat feet in children and children having feet that the arch appears to be flat. I think it’s important to realize that flat feet in children can be normal. Ten to twenty-five percent of kids will have a flexible flat foot with no pain. We define a flexible flat foot as a foot that appears to not have an arch when the child is standing but when the child is sitting or when the child raises up on their toes that arch kind of reappears. That can be a normal appearance of the foot. It’s when the foot is more rigid, when there’s pain associated with a flat foot, that’s when it’s a good idea to see a podiatrist or a specialist to take a closer look.

Melanie:  Dr. Vest, people, again, they’re wearing this footwear for maybe not the right activities that they’re doing. They wear them for gym class and such. Do you think parents, if they are seeing this flat foot, or if the children are experiencing pain can run out to Walgreens and get one of the Spankos or super feet orthotics and shove those things in there and take care of the problem?  Do you think that orthotics need to be a prescription?  Can we try that first line of defense?  What do you do when that child has that pain in their foot?

Dr. Vest:  That’s an excellent question. I think that there are lots of different kinds of orthotics and corrective devices and it can be a bit overwhelming for a lot of patients and their parents when you go to the store and see that entire aisle of foot care devices. So, sometimes it’s hard to know. Most over-the-counter or pre-made orthotics fall into one of two categories:  either accommodative orthotics which are kind of the squishy gel orthotics or a functional, more rigid orthotic. For most kids, a good supportive athletic or running shoe is adequate. Kids who are having increased pain, typically most of the pre-made devices or orthotics that you’ll see at the drug store or Walmart are not the kind of things that will be ideal in those children. Again, pain in a child’s foot is not normal. We hear people talk about growing pains and kind of associating that with a child’s pain but pain in the foot is not normal. As kids are complaining of pain or limping or walking differently, really a through examination and potentially orthotics specific to what the injury may be is necessary.

Melanie:  Dr. Vest, what is Sever’s disease?

Dr. Vest:  Sever’s disease is one of a number of problems we’ll see in pediatric patients associated with skeletal immaturity or with developing growth plates. So, Sever’s disease, although the term “disease” can be intimidating, is truly just an inflammation and injury associated with the growth plate in the heel bone, or the calcanean. It’s most common in children between the ages of seven to 14 and we see it most often in patients who are in sports that involve running or jumping. That’s very common in children who are playing cleated sports. So, sports like soccer and other sports where they wear cleated shoes, it’s typically a self-limiting injury meaning that as that growth plate begins to close, the patient’s symptoms will often subside. In the meantime, the treatment is typically supportive. So, that means orthotics or a heel cup in the patient’s shoe. There are some stretching exercises and physical therapy that can sometimes help with things like Sever’s disease as well.

Melanie:  What else do you see with children?  Are they twisting ankles and straining their ankles or spraining their ankles?  Are you seeing plantar fasciitis or what are you seeing in children that parents can hopefully prevent?  What would you like us to do about it?

Dr. Vest:  That’s an excellent question as well. I think that most commonly in children, we are seeing overuse injuries associated with either tendonitis or ankle sprains. Plantar fasciitis is typically a more common ailment that we’ll see in older individuals. It’s not quite as common in children but we will see it on occasion, too. I think that the big thing is, especially with ankle pain and ankle sprains, there tends to be a tendency to undertreat those type of injuries. So, when a child experiences an ankle sprain or is complaining of an injury to their ankle, there tends to be a tendency to undertreat the injury. Oftentimes in children, the growth plates in the ankle can be injured as well. This is something that doesn’t routinely show up real well on an x-ray and can be missed by someone who doesn’t specialize in treating these kinds of injuries. The pediatric ankle fractures are the second most common growth plate fracture in children--second only to wrist fractures. Oftentimes they can be missed. In a child who has pain or an ankle sprain that is impeding their ability to bear weight or having pain that’s not getting better relatively quickly, further evaluation for those types of injuries by a specialist is almost always warranted.

Melanie:  Dr. Vest, do these kinds of injuries cause trouble later in life?  People say, “Oh, well, if you’ve ever sprained your ankle, you’re going to have arthritis in your ankle when you grow up.”  Is that true?

Dr. Vest:  Well, typically, with ankle sprains, when treated correctly, they should not be a long-term and a lifelong injury. There are three primary ligaments that support the ankle and when a child experiences an ankle sprain that’s bad enough to involve swelling and bruising, these are some of the warning signs that those ligaments have been injured or possibly even disrupted or torn. When we treat these type of injuries initially and aggressively with immobilization and removing the child from athletic activities or things that can exacerbate it, their bodies are able to heal those ligaments and are able to repair the ankle on their own. It’s in cases where we have neglected ankle sprains or these types of injuries that don’t receive adequate treatment that we could end up with chronic instability. We can end up with injuries that can be long term and nagging injuries. Again, I think early intervention on these type of injuries is the type of thing that can prevent those lifelong or chronic injuries.

Melanie:  Because you’re a podiatrist, Dr. Vest, what about children’s toe nails?  Getting them to keep them clipped?  They get ingrown toenails. They have all kinds of problems because of it. What do you tell parents about keeping their children’s toenails in check?

Dr. Vest:  Well, that’s an excellent question. I think, for most kids, toenails and proper care of the toenails doesn’t involve anything more than making sure the toenail is cut to a reasonable length and that the trimming of the toenail is not overly aggressive. Typically, I’ll tell parents and patients that the toenail should be kept short but you should still see the white tip, the white line at the tip of the toenail, to know that we’re not cutting that toenail back too far. Unlike our fingernails, our toenails live in a dark, moist environment which tends to harbor a lot of bacteria and fungus and so sometimes, if we’re overly aggressive, it can be a situation that’s ripe for infection and kids can get ingrown toenails. Shoes that are too tight in the toe box are also something that can predispose kids to ingrown toenails. I think the important thing is when there are signs of redness, drainage, any signs that may be concerning for infection, it is important to get the child and to have that addressed. Some kids, because of the fear of going to the doctor or seeing a doctor, will sometimes try to hide some of these symptoms from their parents and that’s when infection and some more serious problems can occur.

Melanie:  So, give us your best advice about healthy feet and ankles that parents can do and think about for prevention for their kids.

Dr. Vest:  I think the most important thing when considering a child’s overall foot health and well-being is to make sure that the child has properly fitted shoes, that the shoes are not overly worn and that the child is comfortable in those shoes. With increased activity and kids participating more and more in year round sports, I also think it’s important to watch for early signs of pain and discomfort. Sometimes, kids don’t always reveal that they’re having pain and I think the important take-home message is that pain in the foot, pain in the ankle in children is not a normal part of growing, a normal part of adolescence.  In children who are experiencing pain, they should certainly see a podiatrist or a specialist to get to the root to that cause of pain because oftentimes, it is a simple solution that can lead to them not having further problems with their feet.

Melanie:  Why should they come to Bryan Health Podiatry for their care?

Dr. Vest:  I think at Bryan, we’re fortunate to have a situation where we have multiple foot specialists and podiatrists on staff who have a history of being kind of at the forefront of treatment of foot and ankle injuries. The quality of care that we have is very unique to Bryan and I think it puts us in a situation where we’re very fortunate to have specialists who can prevent injuries to the feet and ankle for children and, certainly, help with better outcomes for kids who are experiencing problems.

Melanie:  Thank you so much, Dr. Vest. It’s great information. You’re listening to Bryan Health Radio. For more information you can go to bryanhealth.org. That’s bryanhealth.org. This is Melanie Cole. Thanks so much for listening.