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Ballerina Feet Or Fred Flintstone’s Feet? – Common Foot Problems in Children
From the moment our children are born, we expect them to be perfect and beautiful. We count toes, fingers and love for them all. However, as most of us understand, perfection is not always the case. Some children have foot problems from birth, while others may develop problems in the early years.
Walking on the toes “Ballerina’s feet” or walking on the toes is one such problem. Causes of toe walking include strain on the heel cords at birth, habitual toe walking, or neurological conditions such as cerebral palsy or Duchenne muscular dystrophy. Although many children who learn to walk tend to tiptoe, if this continues after 18 months, a medical consultation is necessary to determine the causes and treatment options. You may think that the child looks cute walking on his toes, but that ballerina look will be the focus of teasing when that child reaches school age. Treatment options can be as simple as stretching tight calf muscles. Other options include serial casting, orthotics, or surgery. If a child only has a habit of tiptoeing, but can change this behavior on command, it may still be necessary to intervene with serial casting or orthotics. The child may change this habit when repeatedly told, “Don’t walk on your toes… don’t walk on your toes,” but before long both parent and child will tire of this necessary annoyance.
While serial casting or bracing may seem extreme, don’t let the title scare you; it’s just a short-term treatment to provide a slow, sustained stretch to tight muscles. Serial casting is the application of a cast to the lower leg to allow for prolonged stretch on the tight calf and Achilles tendon. The cast is removed weekly and reapplied in a more optimal stretched position until it is adequate for the child to walk with heel strike on initial contact during the gait phase. After the braces are removed, it may be necessary to put some type of orthotic on the shoes to reinforce the heel strike and continue the child’s progress. Other orthotic options can be discussed with a certified orthotist. Some may include orthotic inserts that go inside the shoes. These can help support the arch and also provide some stiffness to prevent toe-off or plantar/equinus flexion and ensure correct foot position. For a more supportive option, an orthotic device called an AFO (ankle foot orthosis) can be custom made and worn for as long as needed to prevent toe reoccurrence. If there are no neurological diseases, this period is approximately 3 to 6 months. Flat feet Another foot problem is flat feet (pes planus) or “Fred Flintstone feet.” This is something that can be and usually is normal for young children. Arches develop over time. The muscles of the feet are actually exercised and strengthened better when walking barefoot. Flat feet may be considered a problem when the child complains of pain in the feet or lower legs after walking. Children may not always give you a clear picture of what they are feeling. So, as a parent, one must be aware of the way a child’s shoes wear out over time; paying special attention to heel position.
If the wear of the shoe is more on the inside edge and the heel seems to be more outward, then you may have a child who has flat feet. Another basic test is to see what a wet footprint looks like. If you think Fred Flintstone, you might have a child with flat feet! The most important thing is to pay attention to your complaints of pain after walking. Flat feet without pain do not necessarily indicate the need for treatment. Just like walking on your toes, there can be many reasons why flat feet are not arched that do not develop normally, such as Down syndrome, hypotonia (low tone), or developmental delay. If your child has any of these diagnoses, you may also need to discuss this with your doctor and decide whether orthotics are needed as adjunctive treatment. Orthotics for flat feet are used to support the arches and provide a better mechanical advantage so that the foot can walk properly. The feet are the structural foundation of the body, so supporting the feet in optimal alignment allows the leg muscles to be activated to their maximum potential. If you have questions about orthotics, talk to your doctor and then find a certified orthotic that specializes in children.
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