All pediatricians have heard worried moms or dads who come to consultation with phrases such as 'I think my son has flat feet' or 'My son walks with bowed legs', and it is that the alterations in children's feet They are more common than we think, so I invite you to join me in this article to get an idea of how to identify the pathologies of more frequent foot problems in children.
The feet are one of the most important parts of the body: they allow us to walk, jump, run, and perform all daily activities. Walking differently can translate an orthopedic alteration, so as parents we have to observe from the moment our little one takes the first steps how his development is and, in the face of anything that we see strange, go to a specialist to try to prevent greater evils. Do you want to know the type of foot deformities that exist and which are more frequent in childhood?
1. Flat foot
It consists of the loss of the natural arch of the sole of the foot. The longitudinal arch of the foot develops progressively during the first years of life, reaching its maximum height around adolescence. During the first 2-3 years of life, the child's foot has a flat-foot appearance, due to the great elasticity and presence of fatty tissue. After 5 years the arc is already apparent and will continue to increase progressively. In fact, up to 20% of the population never develop a clear longitudinal arch and have painless and functional flexible flat feet throughout their lives, which are considered normal.
It has been shown that the use of footwear is a factor that predisposes to the non-formation of the arch of the foot, for that reason it is recommended that children go barefoot most of the time, since it favors the development of the muscles of the foot, unlike the use of rigid footwear that, on the contrary, interferes with the formation of said musculature, for which it is advisable to wear flexible footwear.
There are two types of flat feet, the flexible flat foot and the rigid flat foot. The first is characterized by being a foot with a normal bone structure and great flexibility in its joints. It is the most frequent in children, and is considered a normal variant, which does not cause discomfort or pain and which is corrected spontaneously.
Rigid flat feet, on the other hand, are characterized by abnormal unions between the bones of the foot, causing arch deformity and outward deviation of the heel.
Flexible flatfoot does not require treatment, as it evolves spontaneously; in the case of rigid flat feet if it causes discomfort, rehabilitation is indicated and, in the case of constant pain or sprains that do not improve with rehabilitation, surgery may be considered.
2. Feet turned inward or clubfoot
Clubfoot, also called clubfoot, is a birth defect that causes the baby's foot to turn inward or downward, pointed (equinus) and with the sole turned inward (varus). Its cause is not known, but there are different theories that try to explain why it occurs: by inheritance, by mechanical factor (little space for the fetus during pregnancy), growth arrest of the foot during pregnancy, and sometimes, accompanies other genetic diseases.
The diagnosis can be made from the 20th week of gestation. At birth, the deformity is evident, inward and pointed, and can occur in one or both feet.
Once diagnosed, the treatment should be carried out immediately, the first days of life, since at this age the bones of the feet are moldable and with a great capacity for remodeling. It is done through the weekly placement of corrective casts, the so-called Ponseti technique, to mold the foot. As the deformity has a great tendency to reproduce, upon completion of the corrective casts, splints are placed, which is a boot-like device that allows the feet to be kept in the correct position. The results are good, with no sequelae of lameness or functional limitation.
3. Talus or talo-valgus foot
It is a foot deformity in which the newborn presents the feet bent upwards, in such a way that the foot can touch the antero-inferior part of the leg (Talo Foot). If, in addition to this, the deformity includes an outward deviation of the heel, we call it the talus-valgus foot.
It is a deformity of the foot that occurs due to the position of the fetus inside the uterus, very common when there is little amniotic fluid (oligoamnion) or when the fetus is very large or comes in the presentation of the feet or buttocks; Newborns with this type of deformity should be investigated for a possible congenital hip dislocation, since it is usually seen in this type of patient, so they must be carefully evaluated.
Generally, the talus foot or talus valgus is corrected spontaneously, although there are cases in which the placement of corrective splints may be recommended.
4. Bow legs and X legs
When children begin to walk, it is common for them to adopt a leg position known as Genu Varo or bowlegged (usually occurs between the first and second year of life). It is a situation in which the ankles are together, the legs are separated from each other, forming an outward arch, like a parenthesis.
On the other hand, the bowed or X legs are characterized by the fact that the child has the knees together, his ankles are separated. Both situations are normal, they resolve spontaneously, without treatment, and disease should only be suspected when:
- The curvature is extreme.
- Bowlegged remains or worsens after 2 years of age.
- It affects only one leg.
- The knees are still together after 7-8 years.
- The distance between the femoral condyles is greater than 3 centimeters.
If the above described is present, the child must be evaluated by a traumatologist-orthopedist, who will perform an examination of the extremities and give a diagnosis and, through different tests, rule out any other specific disease.
5. Infant cavus foot
It is known as the 'internal arch augmentation' of the foot. It is not known what causes it, but there are certain diseases associated with pes cavus, such as spina bifida or muscular dystrophy. He boy with cavus foot adapts without difficulty to footwear and physical activity, usually without pain or movement limitations, but over time, in adolescence, tissues and joints can become more rigid and, in some cases, cause pain, limitations in activity , instability or repeated sprains.
It is true that cavus foot does not require specific treatment, unless during adolescence it is associated with pain with difficulty in footwear, in which case comfortable footwear, use of insoles or physical rehabilitation is indicated. In rare cases, if the pain is limiting or causes repetitive instability or sprains, surgery may be considered.
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