The chiropractor is frequently questioned by parents who have noticed something "different" about a child's foot. Does the child need chiropractic treatment, referral to a podiatrist or an orthopedic surgeon? Should sports be limited or encouraged? What shoes are best?
The following is a summary of common pediatric foot conditions with recommendations. As will be seen, the vast majority can be managed by chiropractors, since specialized bracing and surgery are seldom necessary.
In-toeing is the most common pediatric foot problem seen in doctors' offices.1 The parent reports an abnormal appearance of the foot, an awkward gait or a "clumsiness" with the tendency to trip or fall. A structural and biomechanical examination of the lower extremities, including watching the child walk, will allow for differential diagnosis and appropriate treatment recommendations. In-toeing is caused by three conditions, whose timing and treatment considerations vary.
Metatarsus Adductus
Also known as a "hooked foot," metatarsus adductus is a contracture of the medial soft tissues of the foot. This condition has been found to be present in six percent of school children.2 On examination, the in-toeing can be passively stretched to normal, since there is no body abnormality associated. Over 90 percent of infants with this condition will resolve by the age of 18 months.3 When more than mild adduction persists beyond one year of age, a consultation with a pediatric podiatrist or orthopedic surgeon for consideration of casting is appropriate.
Recommendations
This is a very common condition in which the tibia has not completed its external rotation to normal adult position (therefore, a lack of torsion). On standing examination, the knees face forward while the ankles and feet face inward. The natural history is a gradual normalization with growth and use of the lower leg muscles. Most cases resolve by two years of age, but rotation values continue to increase an average of 1.5 degrees a year, up to age six.4 By age seven the vast majority of children have achieved normal adult position.5 There is a familial tendency among those who fail to reach normal values. When tibial torsion persists, compensatory pronation commonly develops.6
Recommendations
This is an inward rotation of the entire lower leg. Also a common condition, it is recognized by the medial facing of the knee, as well as the ankle and foot.5 With walking, more than 90 percent will resolve by eight years of age. Any persistency is thought to be due to ligamentous laxity of the hip joint capsule.3 Examination will find excessive passive internal hip rotation; and lumbar hyperlordosis, genu recurvatum, and hyperpronation are frequently associated.
Recommendations
Recommendations
Proper footwear is important for the developing foot. Whenever safety and comfort allow, going barefoot stimulates proprioceptors and encourages muscular coordination and strength. Children's shoes should have flexible soles to allow for proper foot joint movement (thick rubber soles may hamper and confine). Proper shoe sizing and fit is critical, since the developing bones are soft and malleable. Tight, constricting shoes will interfere with normal growth and may result in deformity. Frequent evaluation of size (use the Soda Straw Test) and fit (palpate child's foot for pressure points while standing with shoes on) is an important concept for parents.
Orthotics
As described above, the majority of pediatric foot problems will resolve with exercise and proper footwear. Orthotics are seldom needed in the early years of growth. If a supple flatfoot or excessive pronation associated with in-toeing is seen to persist beyond ages seven or eight or is responding poorly to home care interventions, custom-made flexible orthotics are appropriate. The additional corrective support they provide will encourage normal development while preventing further deformity and reducing abnormal kinetic chain stresses on the pelvis and spine during formative years.
Conclusion
Parents need reassurance and appropriate recommendations when they bring in a child with a "foot problem." Most common childhood foot conditions will resolve during normal growth and development, needing only home-care recommendations. As always, the developing spine should be evaluated and appropriate chiropractic care is recommended. Specific exercises may hasten the maturation and coordination of the support muscles. In some cases, orthotics may be needed to provide additional corrective stimulus.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
