Foot and Ankle Deformities

Condition

Pediatric foot deformity is a term that includes a range of conditions that may affect the bones, tendons, and muscles of the foot. Among those most frequently treated at Hospital for Special Surgery (HSS) are cavus foot, tarsal coalition, clubfoot, accessory navicular, and juvenile bunion.

Treatment of foot deformities in children can vary significantly from that needed in adults. Fortunately, pediatric orthopedists who specialize in this field can bring to bear a range of non-operative and operative techniques specifically developed to address the distinctive needs of children, which include special attention to preserving the integrity of the growth plate, allowing continued growth and development of the foot.

Cavus foot is a condition in which the child has an excessively high arch. In many cases, the heel of the foot is turned inward; this is known as cavo-varus foot. The condition frequently affects both feet and is often progressive. Because the foot is not properly aligned, patients experience pain and develop calluses owing to uneven weight-bearing. Ankle sprains or even stress fractures may occur.

Tarsal coalition is an abnormal development of the connection between the bones in the midsection and back part of the foot. It is usually diagnosed in late childhood or early adolescence when the coalition begins to limit foot movement, causing pain and sometimes stiffness. Symptoms may be particularly noticeable when walking on an uneven surface, such as sand or gravel, an action that requires constant adjustment of the foot. Frequent ankle sprains may also signal the presence of a coalition.

Clubfoot describes a condition in which the foot—or sometimes both feet—are turned inward and are pointing down. Immediately apparent at birth, clubfoot is known to develop during intrauterine life, at between 9 and 14 weeks gestation. In fact, in many cases, the deformity is detected on routine ultrasound. “This can make an enormous difference for parents,” says Dr. Scher. “It’s much easier for parents to cope and plan when they know in advance what they have to do.”

Accessory navicular describes the presence of an extra bone growth center on the inside of the navicular and within the posterial tibial tendon that attaches to the navicular. The primary symptom from this additional bony prominence is pain and tenderness.

This congenital defect (present at birth) is thought to occur during development when the bone is calcifying. Because this accessory portion of the bone and the navicular never quite grow together, it is believed that, over time, the excessive motion between the two bones results in pain.

The initial treatment approach for accessory navicular is non-operative. An orthotic may be recommended or the patient may undergo a brief period of casting to rest the foot. For chronic pain, however, the orthopedic surgeon removes the extra bone, a relatively simple surgery with a brief rehabilitation period and a very good success rate.

Juvenile Bunion as with bunions in adults, in juvenile bunion, the joint at the base of the big toe (the metatarsophalangeal joint) moves out of alignment in such a way that the big toe angles inward to the second toe.

However, unlike adult bunion, which usually results from ill-fitting footwear or has a hereditary component, juvenile bunion occurs most often in children who are ligamentously lax or loose-jointed. The problem is more common in girls than in boys.

Surgical treatment for juvenile bunion is generally restricted until the end—or close to the end—of growth, both because of concern for damage to the growth plate and because the condition tends to recur. Non-operative treatment includes the use of wide shoes or sneakers and avoidance of narrow dress shoes and high heels. Usually this sufficiently alleviates symptoms to avoid or defer the need for surgery.

In younger patients who do not respond to non-operative treatment and who have pain that interferes with their daily activities, surgery to realign the bone and straighten the toe can be performed. A number of different approaches are used, depending on the type of bunion, the extent of the deformity, the age of the child, and how much growth remains.

Source: Hospital for Special Surgery

Staff

Charles White, DPM
Foot & Ankle Surgery / Podiatry

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