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The Differing Approaches to Treating Kids and Adults Feet

Treating a child’s foot is very different from treating an adult foot. The reasons for this are both physical and psychological.

The most obvious difference, of course, is that feet are still growing! While adult feet do tend to widen and change shape very slowly over time, kids under age 12 might outgrow their shoes three or four times per year.

Child on tiptoes Toe Walking Pediatric EquinusBut that’s not the only physical difference. Much of a young child’s skeleton is still made from relatively soft cartilage; bones don’t fully harden until around their mid-teens. This makes them more resilient in some ways and less resilient in others. It also means, for example, that a child’s foot arch may completely flatten underweight but spring back to its usual shape when standing on tiptoes.

Furthermore, even in cases where conditions and even treatments are very similar, the experience can be very different for a child. Going to the doctor can be scary and confusing. At Pediatric Foot and Ankle, we work hard to make our office welcoming and our care warm and gentle, especially for our youngest patients.

In the rest of this blog, we’ll look at some specific similarities and differences between young and old feet.

Heel Pain Differences Between Children and Adults

When a child or teenager is suffering from heel pain, many parents (mistakenly) attribute it to plantar fasciitis, the most common form of heel pain in adults. Unfortunately, this assumption is almost always wrong. Children are much more likely to suffer from a condition called Sever’s disease, which is also called calcaneal apophysitis.

Plantar fasciitis, which adults get, comes from chronic overloading of the plantar fascia—a band of tissue that connects the heel to the arch and toes. Usually, factors like bad shoes, poor biomechanics, or frequent “ground and pound” physical activities are to blame.

Severs disease diagram showing heel painBy contrast, Sever’s disease is an injury (traumatic or chronic) to the exposed growth plate of the heel. This makes it a condition unique to children since the growth plate will eventually be covered by hard bone once the skeleton reaches maturity. The pain can be nearly crippling for a child, especially one who loves to run and play sports.

Although the symptoms may be nearly indistinguishable between adult and childhood heel pain, the differing causes lead to very different treatment approaches. For kids, we treat Sever’s disease successfully, aggressively, and most of all conservatively using custom orthotics. These orthotics are equipped with a deep heel cup, which neutralizes the pressure on the growth plate even during activity.

What does that mean? It means your son or daughter can go right back to their sports and activities without missing a beat, while the growth plate completes the healing process.

Approaching Ingrown Toenails

ingrown toenail diagramHere’s a subtler example: ingrown toenails. To begin, I’d like to tell you a personal story from my own childhood.

You see, I used to get ingrown toenails a lot. After years of performing “surgery” on my own kitchen table, my mom finally took me to see a podiatrist when I was around 12 years old. He cut out the nail, and that helped … until it grew back, and the problem returned.

It wasn’t until my third visit in less than a year that he recommended a permanent nail procedure to stop the ingrown edge from growing back. I still remember my mom’s incredulous response:

“Why was this not an option initially!?”

Now, if you’re an adult and you’ve never gotten an ingrown toenail until now, there’s a decent chance it’s a “one-off.” Maybe you stubbed your toe or dropped something on it. In that case, we might just cut it out and see what happens—like my old podiatrist did for me the first two times.

When a young child gets an ingrown toenail, however, the odds are much higher that bad genetics are responsible, and ingrown toenails will chronically recur. And while three visits to the doctor for the same problem in a year is frustrating for an adult, it can be even more traumatizing for a young child.

That’s why we always do a permanent procedure if there are any signs that the problem is chronic, especially with kids. Essentially, we remove a small chunk of the nail matrix along the ingrown border, preventing the new nail from growing back along that edge. Only a sliver of the matrix needs to be removed, so your child’s nail should not look disfigured or unnatural to any significant degree.

Other Common Childhood Foot Conditions and Treatment Options

Many other foot and ankle conditions are associated with kids. This includes conditions that appear at a young age (or at birth), as well as those that are just especially common during childhood. Common childhood foot conditions and care options include:

  • Congenital deformities and gait abnormalities. Children often suffer from painful flat feet, especially flexible flat feet which collapse under the weight. They may also walk with toes pointed inward (pigeon toes) or outward (femoral retroversion), walk on their tiptoes constantly (equinus), or be born with clubbed feet. Usually, these conditions can be treated non-surgically.
  • Fungal, bacterial, and viral infections. Kids get into all kinds of messes, and their immune systems aren’t fully developed yet. As a result, they frequently pick up infections such as athlete’s foot and plantar warts. We recommend immediate treatment to contain and reverse these conditions, especially with young children. This minimizes the risk of transmission and increases the likelihood that the gentlest, most conservative treatments will be successful.
  • Orthotics and inserts. Just like adults, orthotics are often an effective treatment for biomechanical problems with the feet and ankle. However, while an adult might be able to wear the same pair of orthotics for several years if they’re well cared for, kids’ feet grow too quickly for this to be an option! Although sometimes custom orthotics really are necessary, we also provide a range of specialized prefabricated orthotics specially designed for children that can often resolve the problem at a fraction of the cost.

Keep an Eye on Your Child’s Feet

Doctor examining child's foot Kids, unfortunately, don’t always know how to verbalize their discomfort. They may not think to tell you if something hurts—or they may even avoid telling you if they think it’ll earn them a trip to the doctor or time away from their favorite sport or activity.

Take your child seriously if he or she complains about foot or ankle pain. Watch your child closely as well. Kids are natural athletes, and if they suddenly lose interest in running, playing, or being active, there’s a good chance they’re experiencing pain (even if they aren’t telling you about it).

Have fun learning about proper foot health! Download our most recent kid’s coloring page here!

Dr. Mikkel Jarman is a Phoenix-area pediatric podiatrist who specializes in gentle, compassionate care for children’s feet. From infants to active teenagers, we specialize in keeping children active and pain-free! Give us a call today at (480) 497-3946, or contact us.

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All content on PediatricFootAnkle.com is written by or collaborated with Dr. Mikkel Jarman and meets our strict editorial guidelines which include fact checking and peer review.

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