Orthopedics and traumatology

Consequences of foot disorders in children

The foot can be the cause of a postural problem and is also responsible for adapting a dysfunction found in another body area, perpetuating it over time. For this reason and, to avoid deformities in other parts of the body and consequences in the alterations of the feet of children, it is necessary that we know their functions and know that having one foot or the other can lead to a series of consequences for the child's health.

We have a posture regulation system that allows us to orient ourselves spatially and stay upright with maximum energy efficiency. This system uses information from the areas that report on the variations in positions, the situation of our joints and the head, so that we can be able to adjust our muscle tone and our movements precisely.

The most important entry gates or postural sensors are: the eyes, the feet, the TMJ (bite) and the ears. The skin of the sole of the foot has pressure sensitive receptors and is responsible for informing the brain of the type of soil we are treading on (if it is smooth, paved, etc). It also reports the global position of the body in space.

The way in which we support our feet influences the alignment of the lower limbs and the spine. Poor plantar support will create an imbalance of the muscle chains, which are the cause of poor posture. For example, a Hallux Valgus or 'Bunion', causes a first radius alignment problem.

This area is essential to distribute the weight of the body and to propel the foot during the march. Must have good alignment and mobility. Eventually, the plantar arch weakens and the fascia becomes inflamed, causing pain, changing support, and triggering a postural problem.

  • A flat foot, due to a fall of the plantar arch, can cause stretching of the ligaments on the inner side of the knee and pain around the patella. It could also cause a knee valgus, which can affect the cartilage and even the menisci, misaligning the hips and can cause dorsal-lumbar discomfort, scoliosis ...
  • A cavus foot has a more pronounced plantar arch and greater support from the outer edge of the foot. Sometimes it only supports forefoot and hindfoot. This increases the tone of the intrinsic muscles of the plantar arch and the extensors of the fingers, which can force the knee outwards causing an external rotation of the femur that compresses the hip. The lumbar muscles will have to adapt to the position of the pelvis and in turn the dorsal and cervical ones.
  • A stiff foot will not absorb well the forces during walking that will have to be absorbed by other structures. Regarding the deformations of the feet in childhood, we should make a distinction between malposition and deformation.
  • How are the feet of newborns

The newborn may have one or both crooked feet. They are usually inwards and downwards (in inversion). These positions of the feet are due to the postures that the babies maintained inside the uterus. As they grow, the space in the uterus decreases and the feet adopt a preferential position, making it difficult for them to place them in the opposite direction. A part of the musculature will shrink, while its antagonists will stretch.

Malpositions will last for a while, but they are easily reducible on their own or with physical therapy. The deformations can be reducible or non-reducible. The latter are usually related to neurological problems such as congenital clubfoot, where surgery and continued physiotherapy treatment with orthotic aids are sometimes necessary.

It should be remembered that children up to two or three years have flat feet. The plantar arch does not develop until you are walking for a while, so flat feet below this age should never be treated. If it persists at five years, it may be because children have excessive ligament laxity or low muscle tone.

And the great question of the parents arrives and before which many doubts arise. When should we consult these professionals? Here are a series of symptoms that can be worrisome.

- Pain in feet, calf, back of thigh, knees.

- If the shoes wear very quickly, they do not do so symmetrically, or even if they are symmetrical they deform the footwear a bit.

- If they walk in a strange way.

- If they get cramps frequently.

- If they suffer a lot of falls or are clumsy.

- If they adopt bad postures.

- If they get very tired when walking.

- If they have orthodontics

- If they have scoliosis.

- If they suffer from headaches.

- If they complain of back or neck pain.

The treatment will consist of finding out where the problem is that generates the patient's symptoms, since many times it is distance. A bad footprint can produce a bad bite and an ocular hypoconvergence, causing poor foot support due to descending muscle chains.

Once the problem has been identified, stretches of the shortened muscles, manipulations, mobilizations and exercises will be carried out to activate the weak muscles.

Sometimes the physiotherapist will refer the child to another professional: podiatrist, dentist, ophthalmologist or pediatrician to be able to perform a correct and complete treatment.

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