Our children are our greatest accomplishment. We love to watch them grow (not too fast!) and take interest in activities, music, sports and academics. Just as with adults, when kids feet hurt or have issues, it can affect their entire outlook. Our office sees pediatric patients for a number of reasons. So let’s discuss some of the more common issues that are seen in the feet in the pediatric population.
Starting with the skin and nails
Pediatric patients are seen commonly at our office for ingrown toenails, thick toenails, toenail injuries, warts and skin infections. Ingrown toenails are painful and can even become infected if not addressed promptly. In some cases, our kiddos at the office have inherited a nail that possesses an increased curvature on the borders and is simply more susceptible to irritation, pain or infection. In other cases, there are ways to avoid painful ingrown and infected toenails.
Wearing shoes that are too tight can cause pressure on the junction between the nail and the skin. If this pressure is not alleviated, the skin adjacent to the nail can swell and become painful. Furthermore, if the pressure is not resolved, the proximity between the nail and skin border gets closer and the nail can either puncture a small opening in the skin or create so much pressure that it forms a blister of sorts which can become infected. Our kids feet grow so quickly, it can be hard to keep up, but making sure to resize your kids for shoes every so often is critical to prevent crowding of the toes from side to side and also to make sure there is no undue pressure from the tip of the toenail towards the cuticle.
We have seen some pediatric patients in our office that develop an ‘ingrown nail’ of sorts but near the cuticle (behind the nail). This can be from either a shoe that is too small and tight, or a shoe that is loose in a way that causes the foot to slide within. When this happens, the toes can repeatedly hit the end of the shoe and cause irritation from that retrograde pressure on the nail. Ultimately when there is excess pressure in this way, the bacteria that is part of our normal flora can be forced under the cuticle and cause an infection.
Another reason that the corners of the nail can become ingrown and/or infected is from improper nail trimming. While this may come as a surprise, we recommend cutting the nails straight across and leaving a little of the white portion of the nail. This ensures the nails isn’t too short. By trimming straight across, you aren’t as likely to cut the nail incompletely, resulting in a small piece (spicule) of nail getting caught under the nail fold (skin to the side of the nail) and then subsequently growing into the skin underneath where you can access it. If the corners of the nails seem sharp, use a nail file. If there is nail curving in or you think you may have trimmed your little ones nails too short already, soaking the area and applying topical antibiotic ointment for a couple of days may help. If this home treatment doesn’t work or (worse yet) you notice your LO has redness, swelling, bleeding or other drainage, call right away. The longer that nail stays angry, the riskier it can be and the more likely it is that a procedure will need to be done.
In kids these can have the same cause as ingrown nails – shoes that don’t fit correctly – but the thickness happens over a slower period of time typically. Another predisposing factor to developing thick toenails is if your child has curvatures of their toes that put more pressure on the nail. A thick toenail by the general population is deemed as fungus. However, childrens’ immune systems are so much more effective than ours that fungal infections in the nails of kids are rare. The thickened nail in a child is more often due to stress or pressure to the nail that changes the way the keratin forms, making the nail look thick or discolored. In some other cases, kids can actually have a congenital dystrophic nail from an issue in utero.
The tough thing about nails is that they are STUBBORN. Nails themselves do not heal in the way our skin, bones, tendons and muscles do. Once an excessive amount of damage has occurred, the nail does not recover and return to its normal appearance.
That being said, an acutely injured nail, when addressed promptly, may require treatment and in some cases a new nail can grow in with little change noted. Injuries of the toenails in kids are caused by much the same reasons as those in adults. Dropping something heavy on the toe or stubbing the toe can cause bleeding under the nail or can even cause the nail to lift or loosen. If an acute injury has occurred in a toe, prompt evaluation is key to ensuring that long-term side effects are avoided when possible.
So how about warts?
Warts are the skin presentation of a virus called the human papilloma virus (HPV). Not every person that has HPV has warts on the skin. Those who do usually seek treatment to get rid of them and try to keep those pesky things from moving from one kid to the next. When it comes to warts, there isn’t any particular way to prevent them. However, treating as soon as you notice them results in a better outcome. The fewer and smaller the warts are, the easier they are to get rid of. Treatments over the counter can be effective for some. However, we see patients at our office who are sure they have a wart and when they come to the office for an evaluation, it may be something completely different.
Infections in the skin for kids is usually related to athlete’s foot. This is a fungal infection of the skin. Some kids/people are more prone to developing this because of increased moisture in the shoes. This could be for instance if your child’s feet have started to perspire more. It could also be if they keep going back to the same sneakers they wore in the rain a week ago that never dried out. If your child has itching/burning/redness/blistering/peeling skin on their feet or between their toes, topical treatment is most effective when initiated early. If the condition is left untreated, small breaks in the skin can cause a secondary bacterial infection which increases pain, redness and swelling in the foot.
Moving on, another common subset of conditions in children is what we define as ‘musculoskeletal.’ These types of conditions are related to the tendons, ligaments, bones and joints. In the pediatric population, some conditions are very commonly seen pertaining to the feet and ankles.
Heel pain in children
around age 9-13 is most commonly a condition called Sever’s Disease, or calcaneal apophysitis. This condition is an inflammation of the growth plate at the back of the heel. So why would that be common in this age group? The range of 9 to 13 years is the timeframe when most children’s calcaneal (heel) growth plate, starts to ossify or form into bone. In springtime, we see a lot of child athletes playing soccer or running who experience this condition. The ground is harder from all the cold months prior and activities sometimes aren’t initiated gradually enough to allow the body to get used to that new demand. The growth plate becomes injured and results in pain that increases the longer the child is active.
Preventing heel pain in kids can be tough, as we don’t always have a say in how quickly they restart activities. The best you can do for your child is ensure that they have new and well-fitting shoes. Shoes that provide more support to the arch and more shock absorption in the heel will help decrease the energy the bones and growth plates have to absorb. They will also decrease the strain on the growth plate. In addition, having a stretching routine for your child can help ease the tension on the achilles tendon (which attaches right near this area) so that you can avoid as much undue stress on the growth plate as possible. Icing after sports practice and after school can also reduce inflammation that can become painful.
In some unfortunate cases, injuries can occur more acutely to the growth plates in kids feet. A fracture of a growth plate is an injury to take seriously, as this can lead to premature closure of the growth plate. An ankle sprain or fall that results in difficulty walking, swelling or bruising should be evaluated right away. The better protected your child is after an injury, the sooner they will recover and be able to safely return to their sport or activity. When it comes to injuries, some are truly just accidents. Of course, if you are anything like I am as a parent, you would love to avoid injuries if you can. So is there anything you can do? Of course!
When your child is participating in an activity that is of higher level of impact, or they will be on uneven surfaces, having the best supportive shoes will decrease their chances of a misstep or rolling their ankle. When it comes to recreation, the same is true. If it’s more the nail and skin issues you want to avoid, we can talk about that too. Now, I realize with my kids that I can’t MAKE them do anything. I can nag. It doesn’t always work. To be honest there are sometimes when you feel like they just have to learn on their own. But if you are effective at nagging, a couple of other considerations are:
- Make sure they don’t ride bikes in crocs or flipflops. This is a pet peeve of mine (can you tell by my specificity?). Not only is there no stability with these floppy squishy shoes, but their skin is exposed. So now if they go down, not only will they hurt something internal, but they could end up with scrapes, scratches or lacerations.
- With regards to ingrown nails, you may want to cut your kids’ nails for them for a while. Also, a common story I hear is that “I haven’t seen his feet in years!” Try to be a bit of a spy. Take a look at their feet and if something doesn’t look quite right, go back to nagging or make an appointment for them.
Our kids are amazing and they do amazing things. Let’s keep them on their feet and healthy so they can enjoy all that life has to offer. If you have questions or concerns, please make an appointment. We’d be happy to meet and treat your child!