16 January 2019
Consultant Podiatric Surgeon Mr Stuart Metcalfe has just started a regular clinic to deal with foot problems in children and young people. The clinic will be held at Spire Parkway Hospital in Solihull, near Birmingham West Midlands, on the second Tuesday of every month.
Here Mr Metcalfe discusses some of the most common foot complaints likely to be suffered by children.
“Hospitals, health visitors and GP’s are very good at screening for those serious congenital foot problems which present at birth, so most of the children I see are aged five years and upwards.
“What can be challenging is spotting the more subtle signs around a child’s gait (way of walking) and foot posture as the child’s foot develops into what will be its adult form.”
Conditions that are present on a more regular basis include:
- Flat Feet
This is an area of huge confusion for parents. Put simply, we would expect all infants to have a flat footed appearance with no arch because of the infants flexibility, bone structure and infant fat pad. But, by the time the child reaches five or six years of age the foot should have taken on its adult shape. By then we are not so much concerned with the actual arch height but rather how well the bones are aligned internally.
Where the bones collapse when the child stands upright we know this places abnormal stresses on the bones and soft tissues which in turn can cause secondary problems. Typical symptoms include leg /foot aches and pains, a poor stance or gait, clawed toes and muscle fatigue. Treatment may involve footwear modification, muscle strengthening, gait analysis and orthotic devices worn in the shoe to help support the foot. Fortunately, the need for surgery is very rare.
- Growth Plate Problems
A common condition seen in the 8-12 year age range is called Sever’s disease. This is a condition in which the growth plate at the back of the heel becomes acutely painful. Although usually self-limiting, children can often be helped with orthotics to reduce the tension from the Achilles tendon over the growth plate thus reducing pain. In rare cases immobilisation for a few weeks can be necessary. There are many similar problems which can occur in the feet which is why pain in a child’s foot requires detailed assessment.
- Walking Problems (In-toeing / Out-toeing)
I often see children who have excessive in-toe or out-toed gaits which can lead to recurrent trips falls and abnormal walking patterns. These are often transient problems related to the natural realignments of the bones in the lower limb and determining the precise cause can help ensure treatment is directed appropriately. For children with significant problems, treatment may involve stretching out contractures, muscle strengthening and gait plates.
- Ingrowing Toenails
I must see over two hundred such cases every year. It is a particularly common problem in children of ten years and upwards. Causes may include poor nail cutting, sweaty feet, nail picking and nail curvature. The problem typically begins with an area of redness to the nail fold of the big toe. Untreated it can quickly become more inflamed and infected. Antibiotics alone are not the answer as the infection is a result of the nail penetrating the nail fold which, in turn, acts like any other foreign-body and provides a portal of entry for infection.
Treatment needs to be directed at removing the offending nail section under local or general anaesthetic. Here at Spire Parkway we have a dedicated paediatric team to provide this service in a child-friendly environment.
Verrucas are caused by a specific type of virus, papilloma virus. Once inside the cells of the skin the virus multiplies, causing the growing layer of your skin to produce cells much more quickly than normal. The end result on the foot is the typical area of thickened skin which very often has black dots visible. These black dots are the blood vessels within the skin which grow up inside the verruca.
For most people - especially children - the body’s own immune system will eventually destroy the verruca so, as a general rule, we would not advise treatment unless the lesion is painful, has started to spread or has been present for more than six months.
Most treatments attempt to physically destroy the verruca while minimizing any damage to surrounding skin. They involve things like medicated plasters, strong acids to burn the verruca, freezing with liquid nitrogen or cauterizing (burning) the lesion.
A pioneering new microwave therapy for skin called Swift is a precise and easy way of treating verrucae. Swift uses microwave energy which is delivered through a special probe applied to the skin to treat the affected tissue. Unlike freezing treatments (cryosurgery), Swift is virtually pain free and requires no injections. Most patients experience no more than a “scratch-like” sensation which makes it an ideal treatment for children.
Q: How quickly could I have a consultation, and how much would it cost?
A: It depends on the availability of the consultant, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours. Initial consultation fees vary by consultant, but between £175-£250 is a reasonable guide.
Q: I don’t have health insurance, can I self-pay?