Developmental Disorders of the Young Foot

Flatfoot: Flatfeet are very common and typically genetic (inherited) in nature. It is caused by lax ligaments and/or tendons in the foot. The most common childhood flatfoot is supple, not stiff, and usually not painful. An additional underlying cause for a stiff flatfoot must be sought. Shoe wear has not been shown to promote arch development. An arch is usually present on standing by age 5. Arch supports (orthotics) are indicated for painful, supple feet and for patients with additional symptoms related to the feet (certain gait, knee, and back disorders). Arch supports are also indicated for those who wear out shoes extremely quickly. Surgery can tighten the ligaments or tendons but is reserved for the most severe flat feet.

In-toeing: In-toeing ("pigeon-toed") is typically not related to the feet but to lower extremity rotation. Tibial (shin bone) torsion (twist) is the most common cause of in-toeing in children aged 1­2. Femoral (thigh bone) torsion is the usual culprit in children aged 3-15. Bracing is controversial for tibial torsion, and fully ineffective for the femur. Surgery is performed only on asymmetric limbs or those with debilitating torsional abnormalities

Knock-knees: Knock-knees are typical in children aged 3-7. Knock-knees come after bowlegs and usually improve by age 11. Bracing is rarely required as resolution is typically dramatic. Surgery is rarely required.

Bowlegs: Bowlegs are typical in infants to age 12­14 months, and may be normal to age 2. Most bowlegs are symmetric, stable, and spontaneously resolve. Bracing has shown benefit to age 3­4. Surgery is most often indicated for those with an abnormality of the growth plate, a condition known as Blount's disease.

Please contact Dr. Vail for an evaluation of your child's feet - especially if you notice any of the problems mentioned above. Prevention is the key to helping your child to develop properly.

www.vailfoot.com
419-423-1888