Pediatric foot and ankle disorder treatment
The treatment and surgery most appropriate for foot and ankle disorders in children depends on the age of your child, past and current health, the severity of the disorder and prior experience with other treatments and medications. Pediatric foot and ankle disorders are in most cases not severe, but do require treatment.
Pediatric foot and ankle disorders differ from those in adults, since a child’s body is still growing. In addition, there are more social pressures to deal with that can affect the child mentally. If you are concerned about the way your child walks, or if your child complains of any pain, it is important to seek medical attention immediately. To diagnose a foot or ankle condition, the doctor will ask you questions about your child’s medical history and perform a physical exam. Once the doctor has more information, one or more of these tests may be performed:
- Gait evaluation – How a child walks has a lot to do with determining the type of disorder and the best treatment. To evaluate this, the doctor will monitor the child’s foot progression angle to determine how the foot is hitting the ground and being propelled forward by the ankle.
- Lateral view – To look for some disorders such as clubfoot, viewing the foot laterally can help. This can include turning the foot out to a 90-degree angle and walking on tiptoes.
- Range of motion – While being evaluated for the range of motion of the foot or ankle, the child generally will be seated and the doctor will perform a variety of tests to see how far the foot can move.
- Magnetic resonance imaging (MRI) – In some cases, a doctor may order an MRI to be performed. This gives doctors an overview of the tissue of the foot and can help distinguish between bone cartilage and soft tissue, making it easier to diagnose some diseases in growing children.
Most pediatric foot and ankle disorders do not have to be treated using surgical methods. For some, minor changes, such as the type of shoes worn by patients, can have a significant effect on correcting a disorder. Casting, braces or splints also can be used to correct the body as it grows, which allows children’s bodies to teach themselves as they develop naturally.
In some cases, surgery is required to correct pediatric foot and ankle disorders. The goal of surgery is to help the child maintain the optimal range of motion and function in the lower extremities. These surgeries can consist of the following techniques:
- Tenotomy – In some cases, when the child’s condition is caught too late or is too severe, a doctor will have to surgically adjust the tendons and ligaments to reshape them and redirect them to grow in the right way. This is done by lengthening the tendons and ligaments and placing them in the correct direction.
- Soft tissue and bone reconstruction – When the bones have grown in the wrong way, to the point where orthotics cannot help, they, along with the surrounding soft tissue, may need to be reconstructed. In this case, a surgeon operates on the feet or ankles of the child to help the bones develop normally.
The multidisciplinary team of foot and ankle experts at Northwell Health Orthopaedic Institute performs pediatric foot and ankle disorder surgery as well as a broad range of non-surgical and surgical treatments for conditions that affect the bones.
The primary research surrounding pediatric foot and ankle disorders has to do with the management of these conditions. This is particularly true in the case of clubfoot and similar disorders, as these require the most extensive treatment.
In the past, these disorders were treated using surgical methods that required deep incisions and cuts to multiple ligaments and tendons. The severity of the surgery, however, left many people with stiff extremities that oftentimes worsened with age. While the method of ligament and tendon reconstruction is still used, and is necessary to treatment, less invasive surgical approaches are being researched and put into practice to reduce the number of complications and the recovery time.
Dr. Ignacio Ponseti, a Spanish orthopaedic physician, discovered a surgical approach to correcting these disorders that leaves minimal stiffness and scarring. The surgery entails a number of specific manipulations over the course of four to six weeks. Once these have been completed, surgery is performed. Because of the initial manipulations, fewer cuts are needed to reshape the tendons, making the surgery less invasive overall. After the surgery has been performed, the child wears a cast for three weeks. After this, the child wears a brace for three months. This approach is being used successfully by some hospitals around the country; however, there is still much research to be done on this and similar methods to determine their benefits.
As research on treatments is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.