Paediatrics – foot and ankle

Musculoskeletal (MSK) Therapy Services

There are several conditions that can affect the feet and ankle during childhood and adolescence, most commonly it is nothing to worry about but occasionally it can be the result of a condition that requires immediate Orthopaedic intervention.

If you are concerned about foot or ankle pain you should make an appointment with your GP in the first instance and they will be able to ensure you are appropriately screened.

If you would like a more in depth understanding of the anatomy of the spine, check out – AnatomyZone – Your Guide to Human Anatomy and search ‘ankle’ and ‘foot’.

Accordion

What is it?

Childhood foot and heel pain is a common condition in children that causes pain around the heel bone (calcaneus), inside of the foot (medial arch) or the ankle joint. It affects children going through a growth spurt and /or those who participate in lots of physical activity especially running or jumping. This condition has previously been known as Severs disease.

Children’s Foot and Heel Pain (CFHP)

Would an X-ray help?

An X-ray is not normally required to diagnose this condition and if an x-ray is taken it will often look normal.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation X-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the X-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an X-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about X-rays please see the NHS website below:

X-ray

What are the options at East Sussex Healthcare NHS Trust (ESHT)?

  1. Advice sheet – normally following referral for foot/ankle pain you will be sent an advice sheet, if appropriate, with the option to contact physiotherapy for an appointment if the exercises do not work.
  2. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  3. Advanced Practitioner – If your hip pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  4. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  5. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.

What is it?

Twisting an ankle is as common in children as it is in adults. Sometimes if you twist your ankle it can continue to be painful or can happen again. The following leaflet can help with both new and old injuries.

Ankle Sprain – Children

Would an x-ray help?

In the case of ankle sprain an X-ray is sometimes required to rule out a fracture.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation X-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the X-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an X-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

X-ray

What are the options at East Sussex Healthcare NHS Trust (ESHT)?

  1. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  2. Advanced Practitioner – If your knee pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  4. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.

What is it?

Tip toe walking is very common in toddlers and children under the age of 3, and usually resolves on its own. If it does not correct spontaneously, or begins suddenly, the child needs to be assessed by a health professional such as a Physiotherapist or Doctor, such as an Orthopaedic Surgeon. There are several reasons for a child to tiptoe walk including; growth spurts, childhood foot and heel pain, Autistic Spectrum Disorder and unknown causes.

Tip toe walking

Would an x-ray help?

In the case of tiptoe walking it would be rare that an x-ray would be required.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation x-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the x-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an x-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

X-ray – NHS UK

What are the options at East Sussex Healthcare NHS Trust (ESHT)?

  1. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation. Sometime serial casting may also be offered.

    Paediatric Serial Casting for Toe walking

  2. Advanced Practitioner – If your knee pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).

What is it?

Flat feet are common in children and adults. Recent research demonstrates that flat feet do not cause any problems in later life and do not increase your risk of Osteoarthritis. Flat feet can occur due to tight muscles, muscle weakness and occasionally due to abnormal bone growth.

Flat Feet in Children

Would an X-ray help?

In the case of flat feet a simple test of standing on tiptoes can indicate if an X-ray is required. In a muscular flat feet the arch of the foot will reappear with a tiptoe stand.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation X-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the X-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an X-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about X-rays please see the NHS website below:

X-ray

What are the options at East Sussex Healthcare NHS Trust (ESHT)?

  1. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation. Sometime serial casting may also be offered
  2. Advanced Practitioner – If your knee pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).