Common Disorders
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Did you know the foot has 28 bones, 37 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that most Americans will experience a foot problem that will require the care of a specialist at one point or another in their lifetime.

Weakness in the leg muscles, contracture with limitations in the movement in the joints of the legs or feet should be evaluated by your physician immediately.

When a child complains of soreness in the legs it is frequently said that they are having "growing pains". In fact the act of growing is not a painful condition. "Growing pains" indicate that something abnormal is occurring. The muscles in the lower leg control the function of the foot. When the feet are not functioning properly it causes the muscles in the legs to fatigue. This fatigue results in soreness or cramping in the muscles of the legs. This may manifest itself early in development of the child. A newly walking child may prefer to be carried or held instead of exploring their new world. Youngsters may protest walking in the mall or at amusement parks, tiring easily during a fun adventure.

Treatment

Treatment consists of using custom molded inserts for the shoes called orthotics to correct the underlying abnormal foot function. This in turn reduces the stress experienced in the leg muscles and will ease or eliminate the soreness. The results can be quite dramatic with a rapid improvement in the child's symptoms. As with all medical treatments results may vary and orthotics may failure to resolve the problem.

A flatfoot deformity is where the arch on the inside border of the foot is more flat than normal. Flatfoot deformities can occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these children have pain related to their flatfoot deformity throughout their lives. It is very important that children with flatfoot deformity be evaluated by a podiatrist to determine if they need treatment to prevent future pain or deformity in their feet.

When the young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.

At the ages of two and three, the child's foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. The reason that it is important to have the feet examined at this age is because the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.

Knee pain in children may be caused by a variety of conditions. Some of these conditions may be rare but can be quite serious in nature. Knee pain in children should be evaluated by your doctor.

Osgood-Schlatter's Disease

A common cause of knee pain in a growing child is injury to a growth plate in the front of the knee. This may be accompanied by swelling in the area. This condition is called Osgood-Schlatter's disease. It occurs most commonly in children between the ages of 10 -14. It is often associated with playing sports and aggressive bicycle riding. It is felt that the condition is primarily caused by an abnormal pull of the tendon that attaches into the painful area from the kneecap. This tendon is called the patellar tendon.

Freiberg's Disease

The spontaneous development of pain in children generally indicates some form of injury to the growth plate of a growing bone. This can occur without a specific memorable event. When pain occurs in the ball of a child's foot the most likely cause is injury to the growth plate of one of the long bones behind the toes called metatarsals. The most common bone involved is the metatarsal behind the second toe. When numbering the toes the big toe is the first toe.

This condition is called Freiberg's disease. This disorder is most frequently seen in the adolescent between the ages of 13 - 15 years of age. It is three times as likely to occur in females as compared to males. The pain is a result of a loss of blood flow to the growth plate in the bone.

Diagnosis

The diagnosis of Friebergs disease is made by x-ray evaluation. X-rays will reveal a flattening of the head of the metatarsal bone. Early changes may be very subtle or not apparent. On physical exam there may be swelling in the area that is tender to touch. A useful tool for diagnosing growth plate injuries and stress fracture is to strike a tuning fork and placing the vibrating tuning fork on the area of the suspected site of injury. Pain with vibration may indicate bone or growth plate injury.

The spontaneous development of pain in children generally indicates some form of injury to the growth plate of a growing bone. This can occur without a specific memorable event. When pain occurs in the ball of a child's foot the most likely cause is injury to the growth plate of one of the long bones behind the toes called metatarsals. The most common bone involved is the metatarsal behind the second toe. When numbering the toes the big toe is the first toe.

This condition is called Freiberg's disease. This disorder is most frequently seen in the adolescent between the ages of 13 - 15 years of age. It is three times as likely to occur in females as compared to males. The pain is a result of a loss of blood flow to the growth plate in the bone.

Diagnosis

The diagnosis of Friebergs disease is made by x-ray evaluation. X-rays will reveal a flattening of the head of the metatarsal bone. Early changes may be very subtle or not apparent. On physical exam there may be swelling in the area that is tender to touch. A useful tool for diagnosing growth plate injuries and stress fracture is to strike a tuning fork and placing the vibrating tuning fork on the area of the suspected site of injury. Pain with vibration may indicate bone or growth plate injury.

Sever's Disease

The spontaneous development of pain in children generally indicates some form of injury to the growth plate of a growing bone. This can occur without a specific memorable event. When pain occurs in the heel of a child the most likely cause is due to injury of the growth plate in the heel bone. This is called Sever's disease. A condition that may mimic Sever's disease is Achilles tendonitis. Achilles tendonitis is inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Seiver's disease by pulling excessively on the growth plate of the heel bone. This condition is most common between the ages of 8 - 15 years of age and boys tend to be affected more than girls. It is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats seem to aggravate the condition. It is believed that the condition is due to an underlying mechanical problem with the way the foot functions.

Children can have pain in their feet and legs and never complain about it. Common areas of pain in the growing child are the balls of the feetthe heels and the knees. Aching in the legs (Restless legs) is also common and frequently called growing pains. What should be remembered is that growing does not normally hurt. Pain is a sign that something abnormal happening and should be regarded as a warning sign.

In the infant, pre walker and early walker signs that something abnormal is occurring include excessively bowed legscurved feetin-toeing or out-toeing, excessive tripping or stumbling or excessive toe walking. Any newly walking child who prefers to be carried or held instead of exploring their new world maybe communicating discomfort with standing or walking. Hip and back pain in children is not common and should be evaluated by your doctor early.

Tarsal Tunnel Syndrome is due to compression of a nerve called the Posterior Tibial Nerve.The nerve passes into the foot from around the inside of the ankle just below the ankle bone. Just beyond this point, the nerve enters the foot by passing between a muscle and a bone in the foot. This area is called the Tarsal Tunnel. The Posterior Tibial Nerve is the largest nerve that enters the foot. At the level of the ankle, the nerve branches out like the branches of a tree as it goes out toward the toes. This nerve supplies most of the sensation to the bottom of the foot and the muscles in the bottom of the foot. When pressure is placed on this nerve, a burning or numbness will be experienced on the bottom of the foot. The area of the bottom of the foot that is affected can be variable. Most commonly, it affects the outside portion of the bottom of the foot. It can also affect the toes, mimicking a neuroma. The most common cause of Tarsal Tunnel Syndrome is a flat foot or a foot in which the arch flattens excessively while walking. Over time, this causes the nerve to stretch or become compressed in the area of the tarsal tunnel. The condition is slowly progressive and occurs more commonly after 30 to 40 years of age. Other causes of Tarsal Tunnel Syndrome are the formation of soft tissue masses such as ganglionsfibromas, or lipomas that may occur in the Tarsal Tunnel and cause compression of the nerve. Also, small varicose veins may form around the nerve that can also cause compression of the nerve.