Hello, my name is Dr. Jairo Cruz Jr. of Advanced Podiatry, and I would like to talk to you today about pediatric foot problems. Specifically, I’ve seen a lot of parents coming in with their small children ages five and under, and they have concerns regarding their child’s intoeing of gait where their toes point inwards as opposed to pointing straight or a little bit outwards.
This is actually a fairly common occurrence with children four and under. In 1990, they did some research and it showed that 30 percent of children four and under showed some signs of intoeing gait, and that in later years of life as an adult, only 4 percent showed this intoeing type gait.
This shows that it is some concern for the future but typically the pathology or the change in gait is short-lived and outgrown with time. The problem is, is that the 4 percent that carry on as adults could avoid a lot of problems in the future if the diagnosis was made during the child developmental years.
That’s where the podiatrist comes in. So, when a family member or a parent or guardian brings in their child and we assess whether or not the intoeing gait is something that they should be worried about or of some concern, we treat it very carefully. We don’t just pass it off as something they’ll grow out of, we actually analyze the child’s gait, their flexibility of their musculature, their strength, how they stand. We attain a very thorough history in physical so that we can determine if there’s any underlying causes of this type of gait and therefore give the parents and of course the child peace of mind.
The common complaints that the patient and/or the parent or guardian come in with is that aesthetically they do not like the way their child is walking or they’re dissatisfied with the way they are walking with their abnormal gait.
The other problems that the child actually exhibits when observing their gait is that they frequently trip, and looking at their gear there’s consistent scuffing in certain places.
The child, if they’re of any kind of sporting activity age, around the age of 5 or between 5 and 7 will show fatigue or signs of fatigue while performing those activities. They’ll complain of tired legs because they’re making more of an effort in running and walking and whatever activity it is as compared to their peers.
Some other theories that have been talked about over the years regarding intoeing of gait is that it actually starts when the child is in the womb if they’re in a certain positon where their toes and inward pointed and they’re in that positon for a long period of time, they can develop an intoe gait since the development of that child during the early development of their life is in that position.
Also, what I see a lot of is the way that a child sits or kneels and also sleeps. Some children actually sleep in a contorted position where their legs are underneath their bodies or they sit with one leg underneath their body and therefore they’re placing a lot of stress and a lot of strain of the foot in an intoeing type direction.
Over time, if the position is held for long periods of time and the patient doesn’t stretch out the foot in a normal type way, then a deformity can occur and the intoeing gait can be prevalent. If this is the case, usually if the patient is sitting in a resting position and their feet are out, their toes will automatically drift inward and you can see the intoeing gait even when they’re not walking. But nonetheless, the symptoms are usually seen during gait where the patient again is tripping and has lack of endurance and is just not performing physical activities like their peers.
So when the patient comes in for a visit, again we analyze their date, we look at their musculature, we check their flexibility, we check their range of motion of the hips, knees, foot and ankle. We analyze these to see whether or not they’re within normal limits. If they’re within normal limits, then we can say okay, we have a few choices.
Number one, we can still try to support the child with some kind of orthotic device, a custom orthotic device, in order to place the position of the foot in a more corrected position and not have it exhibit those intoeing characteristics when performing their gait cycle.
Or we can say let’s give it a couple of years and have the parents purchase shoes with some kind of arch support and proper shoe gear so that the foot can be supported in such a way that the intoeing of the feet is not as prevalent as it is without those types of supportive shoes.
In a child of walking age, I will typically place the child in custom molded orthotics in order to preserve the function and the shape of the foot. I think this is the easiest method and the most non-invasive method you can utilize in order to correct any kind of foot deformity or intoeing or mechanical deformity of a child.
The orthotic is simple, it’s a molded piece of plastic that’s applied to the foot, and what it does is it shapes the foot in its proper position based on again the measurements of the foot during the exam and also when placing the foot in the final product, seeing whether or not it is effective in decreasing the intoeing deformity of the gait.
Typically, the patients will tolerate this very easily since it is able to be put in shoes, again supportive shoes not sandals or flip flops, but supportive shoes, be it dress shoe or a gym shoe, and the child can switch the orthotics from shoe to shoe depending on the activity that they are performing.
Again, the orthotic is quite simple. It’s made in the office and it’s able to be adjusted in the office at any time. In my opinion, in having children of my own, I suggest the orthotics get fabricated for the child with any kind of foot deformity. If intoeing is the case, then the custom orthotic will be modified in order to correct intoeing.
I treat the orthotics kind of like corrective lenses. With corrective lenses, you usually get an eye exam once a year and you have your prescription adjusted or it remains the same. Typically, the orthotics is the same principles, you have the orthotic fabricated when the child is young and over the years their foot will grow, so the prescription or the shape and length of the orthotic will change with the child as they progress through life.
In an ideal world, I would suggest that everybody goes into orthotics in order to prevent any kind of abnormal motion of the foot since research shows over the many years of orthopedic literature that correction of the abnormal foot position will lead to less morbidity or less foot problems in the future.
This is quite a simple concept, if we put the foot back where it’s supposed to be, it causes less strain over the years, and less strain on the foot creates less strain on the ankle, the knees, the hips, the back, the neck since everything is connected.
If I feel that the custom orthotics are not going to be effective as a single line of therapy, then I will definitely refer the patient to physical therapy, specifically a pediatric physical therapist who can better assess the musculature and range of motion of the child and therefore can create a care plan in order to correct for these types of muscle imbalances or decrease in flexibility.
The patient will typically also have the assistance of their parents in order to stretch the patient at home if flexibility is an issue. If they’re above five, obviously they’re easily able to follow the instructions or should be able to easily follow instructions and therefore physical therapy can be completed at home as well with frequent visits to the physical therapist, maybe up to three times a week.
Physical therapy is a very good line of therapy for correction of muscle imbalances and lack of flexibility since again it’s not invasive and it is very effective in the treatment of certain conditions such as intoeing.
If physical therapy is not efficient or effective for the matter, then we may also begin the use of certain types of bracing. There are many different types of bracing of the foot and ankle in order to prevent certain deformities from being exhibited by the patient.
Therefore, we also have resources and close relationships with bracing facilities and prosthetics facilities in order to fabricate these custom braces or over the counter braces in order to correct for these problems.
If you or a loved one has a child or a pediatric patient that has these types of problems or any kind of pediatric foot problem that you may notice throughout the years or in early development, please do not hesitate to come in and ask for an appointment or call for an appointment for your child to be assessed. It is very important that we do diagnose problems early in order to avoid larger problems as an adult.
Some people get lucky in the adult years where they do have a pathology as a young child but then never exhibit symptoms later as an adult but this is not common.
If you’d like to make an appointment, please call (813) 875-0555. The doctors at Advanced Podiatry will be willing to help any pathology of the foot and ankle and lower extremity. Again, that number is 813-875-0555. Feel free to call and ask any questions. We look forward to treating you and getting you back on your feet.