This patient guide describes five conditions of the ankle and foot that only occur in children and adolescents. They are due to a birth defect, trauma or overwork during growth.
Köhler’s disease
Köhler’s disease is an extremely rare condition of the bone (navicular bone) on the inner side of the metatarsal (the set of bones in the midfoot). It occurs between 3 and 7 years old. Due to a disturbance in the blood supply, the bone ‘dies’ (it necroses) and stops growing. Trauma or abnormal posture of the foot can also be the cause of the problem.
Symptoms include pain, swelling on the back of the foot and on the inside of the foot and limp. Pressing on the bone causes pain.
The doctor will confirm the diagnosis based on an x-ray. The condition resolves on its own, but wearing a cast for a relatively short period of time can be helpful in relieving the condition. pain.
Sever’s disease
Sever’s disease is characterized by pain at the point where the Achilles tendon attaches to the calcaneus (the largest bone in the heel) in children aged 7 to 11. The likely cause is inflammation of the soft tissues around the tendon, following excessive traction. The condition often occurs in both heels.
The main symptom is pain that worsens after physical exertion. Sometimes swelling and redness also appear. Pressing on the sides of the calcaneus causes pain.
In the presence of characteristic symptoms and signs, an x-ray is unnecessary. The pain goes away spontaneously in adolescence. A heel lift of max. 2 cm helps reduce tendon traction. In mild cases, the child should avoid jumping and running for 6 weeks.
Freiberg’s disease
Freiberg’s disease is a condition that causes necrosis of the head of one of the five bones of the metatarsal (therefore, at the tip of the foot). It occurs in children and young adults.
Symptoms include: pain, swelling in the head of the bone and limited mobility of the corresponding toe joint.
The doctor makes the diagnosis based on an x-ray. Treatment consists of wearing shoes with thick soles or orthopedic insoles; plastering may be necessary. Surgical treatment is only indicated after non-surgical treatment for 1 to 2 years.
A supernumerary navicular bone
A supernumerary navicular bone is a piece of bone in a tendon at the height of the metatarsal. It is often detected by chance, as a small swelling that can move freely or is attached to the bone inside the foot. It can cause discomfort in people with flat feet and pressure in the boot, especially in skates and ski boots.
Symptoms start in pre-adolescence and usually go away once the skeleton is fully developed. They are rarely present in adulthood.
Treatment involves temporarily reducing physical activity and wearing well-fitting shoes or boots. In case of pains acute and severe, the doctor recommends placing a cast below the knee for 4 to 6 weeks. Surgery, which removes the bone fragment, is only necessary in exceptional circumstances.
The flat foot (pes planovalgus)
Flatfoot refers to a sagging of the arch of the foot (planus) and the heel turned outward (valgus). In the case of a flexible flat foot, the arch returns to its arched shape and the heel position is corrected when the child is holding the arms or standing on their toes. In the event of a fixed flat foot, the posture remains unchanged.
In young children, flat feet are so common that the problem is considered a normal age-related abnormality. For every 100 children aged 3 to 6, 44 have flat feet. The arch sags and touches the ground, while the heel is turned slightly outward. The weight is therefore more on the forefoot and especially on the big toe. In principle, a flexible flat foot during childhood is painless and corrects itself spontaneously through muscle forces during growth. Insoles or special shoes do not have the slightest influence on natural development. The problem is usually mild and does not require treatment.
No causal relationship has been established between the shape of the foot and other muscle or bone conditions, such as growing pains in childhood or knee, hip or back adulthood. The shape of the feet does not affect the sports possibilities of children and adolescents.
In some children, flat feet will not correct themselves on their own. The underlying causes may be muscle weakness or an overly stretched calf muscle. It may be helpful to have calf muscle stretching sessions under the supervision of a physiotherapist. Sometimes a temporary cast is required. The effectiveness of orthopedic insoles has not been proven.
In contrast, a painful or stiff flat foot on one side only is not normal. Joint inflammation, the repercussions of trauma or a tumor can be the cause. It is advisable to consult a specialist (pediatric orthopedist or rheumatologist) if the child or adolescent has a rigid flat foot which is accompanied by pain while moving, or if a child aged 7 or over has a serious aesthetic or functional disability. If necessary, surgery can be done at the age of 7-10 years. Corrective intervention becomes more complex at a later age.
Want to know more?
- The feet: the most common disorders – to be born and to grow
- Choosing the right shoes and sandals for children – Naître et grandir
- Navicular bone – Health Passport
- Metatarsus – Health Passport
- Achilles tendon – Calcaneum – National Institute of Arthritis and Musculoskeleta