Pediatric Foot and Ankle Disorder, Treatment & Surgery
The treatment and surgery most appropriate for pediatric foot and ankle disorders depends on the age of your child, their 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 Disorder Diagnosis
Pediatric foot and ankle disorders differ from those in adults in that 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 they are complaining of any pain, it is important to seek medical attention immediately. In order 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 – The way in which a child walks has a lot to do with determining the type of disorder they suffer from, as well as the best treatment for the disorder. 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 – When evaluating the range of motion of the foot or ankle, the child will generally be seated and the doctor will go through 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 distinguish between bone cartilage and soft tissue, making it easier to diagnose some diseases in growing children.
Nonsurgical Treatment for Pediatric Foot and Ankle Disorders
The vast majority of 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 can also be used to correct the body as it grows, which allows children’s bodies to teach themselves as they develop naturally.
Surgery for Pediatric Foot and Ankle Disorders
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 their 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 go in surgically to 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 right direction.
- Soft Tissue and Bone Reconstruction – When the bones have grown in the wrong way, they, along with the surrounding soft tissue, may need to be reconstructed to a point where orthotics cannot help. In this case, a surgeon goes into the feet or ankles of the child and does this for them, helping their body to develop more normally.
Pediatric Foot and Ankle Disorders Research
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 significant 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, MD, 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 4-6 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.
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York performs Pediatric foot and ankle disorder surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.