A normal shape of the feet is crucial for an upright gait and ensures optimal load distribution. During childhood, therefore, two different arches of the foot develop that serve as shock absorbers: One is the longitudinal arch, which extends from the heel to the metatarsophalangeal joints of the toes, and the other is the transverse arch in the forefoot.
However, misalignments of the feet occur time and again, which can have effects on the entire musculoskeletal system, including the knee joint, the hip joint and the spine. These can be congenital or acquired deformities. The most important foot deformities in childhood and adolescence are described below.
Clubfoot
Clubfoot is a deformity of the foot in which various foot deformities are present simultaneously. As the most common congenital foot deformity, it affects two out of 1000 newborns.
Signs of clubfoot include:
- Pointed toe: Due to a shortening of the calf muscles, more precisely the Achilles tendon, a permanent bending of the foot occurs. Due to the elevation of the heel, the affected person walks only on the forefoot.
- Inward rotation: The foot is turned inward, i.e. the inner edge of the foot points upward.
- Sickle foot: The toes point inward, resulting in a sickle shape of the foot.
- High arch: The longitudinal arch of the foot is significantly reinforced, so that the sole of the foot is not in contact with the ground when walking.
With regard to diagnostics, it can be stated that clubfoot can already be diagnosed by ultrasound examinations during pregnancy. After birth, the clubfoot is noticeable due to its characteristic shape during the newborn examination.
The following therapies are possible:
- Clubfoot treatment according to Ponseti
- Rare operation
The treatment of clubfoot is indispensable, otherwise, in addition to pain, problems with walking and premature joint wear may occur.
The treatment according to Ponseti is a worldwide established gentle method for the treatment of clubfoot. This is the so-called "gold standard" of clubfoot treatment. In several stages, plaster casts are used to correct the individual components of the clubfoot and to bring the foot into the correct position. In the majority of cases, a small operation to lengthen the Achilles tendon follows after about 5-6 weeks of therapy. Through this, the last remaining component of the clubfoot, the pointed foot, is treated. After completion of the plaster treatment, a splint must be worn, the wearing time of which is gradually reduced. Treatment usually lasts until the patient is four years old. About 90 percent of all clubfeet are successfully treated with this method.
Our pediatric orthopedist Priv.-Doz. Dr. Pestka will be happy to advise you in a detailed consultation and clarify any concerns and open questions with you.
Buckling flat foot (Pes planovalgus)
The bent flat foot consists of a combination of two foot malpositions that favor each other.
Signs of buckling flatfoot include:
- Buckling foot: A buckling of the heel to the inside is found. A conspicuously strong wear of the inner edge of the shoe is typical.
- Drop foot: The longitudinal arch of the foot is clearly flattened so that the sole of the foot rests on the ground.
This foot malposition is part of the normal developmental process of the child's foot, as both the longitudinal and transverse arches of the foot, as well as the surrounding musculature, have yet to form sufficiently.
A bent flatfoot can be diagnosed by means of a thorough clinical examination of the feet as well as foot pressure measurement (podometry). The distinction between a normal and a pathological bent flat foot is crucial. To do this, the foot can be assessed in the toe-off position, as the deformity usually corrects itself in this position and a longitudinal arch becomes visible.
The following therapies are possible:
- Wait and see and regular checks
- Shoe insoles, physiotherapy
In the vast majority of cases, it is not necessary to treat the bending flatfoot in childhood, as it is a normal finding that disappears on its own during elementary school age. In the case of pathological deformities that persist beyond elementary school age and/or show a tendency to worsen, the use of insoles or the performance of physiotherapy may be considered. Rarely, surgery must be performed.
If you are unsure whether your child has a normal flatfoot, you are welcome to make an appointment with our pediatric orthopedist Priv.-Doz. Dr. Pestka to make an appointment.
Sickle foot
Sickle foot is a common, usually congenital foot deformity whose cause is unclear.
Signs of sickle foot include:
- Inward rotation of the toes
The toes point inward so that the foot has a crescent shape when viewed from above. Often both feet are affected. Pain and movement restrictions usually do not occur.
Our pediatric orthopedist Priv.-Doz. Dr. Pestka makes the diagnosis with the help of a thorough physical examination. The sickle shape of the foot is decisive. Transverse creases on the sole of the foot are another typical sign. To assess the severity of the deformity, it should be checked to what extent it is possible to achieve a normal position. This can be checked, for example, by stroking the outer edge of the foot. If the deformity is corrected, the foot is said to have a flexible sickle foot, which does not require therapy.
If, on the other hand, it is not possible to bring the foot into a normal position by manual manipulation, therapy is required.
The following therapies are possible:
- Regular controls
- Stretching exercises by the parents
- Gypsum plant
- Rare operation
The therapy differs depending on the severity and the age of the child.
In mild cases, regular checks and stretching exercises by the parents are sufficient. If there is no satisfactory improvement, a cast is used. Surgery is only considered in very severe cases.
Pointed foot
Pointed foot refers to a fixed flexion of the foot with an elevation of the heel. This foot malposition can occur in the context of neurological diseases,
Signs of a pointed foot may include:
- High heel
- Tiptoe walk
- Gait Insecurity
With regard to diagnostics, a detailed examination should be carried out in which the feet are assessed while standing and walking. It is noticeable that when walking, only the forefoot of the affected person is in contact with the ground (toe-off gait). Rolling of the foot is not possible. This results in an unsteady gait pattern.
The following therapies are possible:
- Plaster, orthoses
- Physiotherapy
- OP
If, on the other hand, the pointed foot occurs independently, a cast and the implementation of physiotherapy can be helpful. Only rarely does surgery take place.
Hacklefoot
Hooked toe describes a common foot deformity in infancy in which the foot is bent upward toward the shin. In many cases, the toes touch the shin.
Signs of hacking foot may include:
- Extending the foot upwards
- Outward rotation of the sole of the foot
In addition to hyperextension of the foot, outward rotation of the sole of the foot occurs.
The following therapies are possible:
- Wait and see
- Splint, plaster
- Physiotherapy
In the case of newborns, a wait-and-see attitude is usually adopted, as the malposition often corrects itself. If this is not the case, the use of splints or a cast can be considered in addition to physiotherapy.
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