Bones, Joints & Muscles

Foot & Ankle Conditions

Ankle Sprains

Ankle sprains are common occurrences for children.

Most sprains are ‘Grade 1’ and so are symptom free after a couple of hours.

Grade 2 sprains will persist for longer, up to 6-weeks. The ligaments will have partially torn so the ankle will be painful and swollen, walking will be difficult.

The most severe kind of sprain is a Grade 3, where an ankle ligament tears completely, causing more pain, bruising and swelling. It is unlikely that someone with a grade 3 sprain would be able to bear any weight on their foot.

Physiotherapy for ankle sprains may include:

• K-taping to reduce pain
• Advice on reducing pain and swelling for home
• Restoration of range of movement and strength around ankle and foot
• Assessment of hips and knees and provision of strengthening and mobilising exercises
• Activities to improve joint proprioception (sensation)
• Balance and gait re-education activities
• Advice and activities to prevent further injury
• Restoration of function, including sport specific activities

Flat Feet

The medical name for feet that are ‘flat’ or have ‘fallen arches’ is Pes Planus. This condition, where the whole of their feet are in contact with the floor in standing rather than the inside arch being raised, is thought to affect 25-30% of the population. Most children under five or six years old have naturally flat feet. Babies and toddlers also have a ‘fat pad’ under their arch, which gives the appearance of a very flat foot.

Treatment should not be necessary for flat feet if:

• An arch can be seen when your child stands on tip-toes
• There is no tightness in the ankle or foot
• There is no pain in hip, knee, ankle or foot
• There are no problems with coordination or development

Physiotherapy may be helpful if a child has:

• Tight structures in their foot or ankle
• Difficulty rising onto tip toes
• Frequent incidents of tripping or falling
• Pain in hips, knees or feet
• Difficulty keeping up with their peer group in PE and Games

Your Physiotherapist can:

• Provide, monitor and progress exercises and activities to
• Stretch muscles
• Strengthen muscles
• Improve sensory feedback (proprioception) from the foot and ankle
• Advise on footwear
• Advise on insoles / request referral to podiatry or orthotics for insoles
• Use Kinesio-taping to help the foot posture / relax or stimulate muscles

If you have any doubts or concerns regarding your child’s foot and ankle posture or walking pattern, contact KidsPhysio for an assessment appointment.

Sever's Disease

Sever's disease (Calcaneal apophysitis) is a childhood condition, where the growth plate (the main growing part) of the heel becomes inflamed, causing pain in one or both heels.

What are the characteristics of Sever's disease? A child will have some or all of the following signs:

• Typically it is seen in 8 - 10 year old girls, and in 10 - 12 year old boys.
• Heel pain, which may increase during running and jumping activities.
• Swelling or a lump at the back of the heel.
• Walking with a limp or on tip toes.
• Tight tendons at the back of the calf, causing reduced ankle movements.

How is Sever's Disease treated?

Depending on the outcome of your child’s assessment, your Physiotherapist can provide treatment and help you implement home programmes:

• Strategies to reduce pain and inflammation including Kinesio-taping. See case study.
• Stretching exercises for the muscles and tendons at the back of the leg.
• Stretches and strengthening exercises for the muscles around the knee and hip.
• Advice regarding reduction or cessation of activities that cause pain.
• Encourage non- or partial- weight bearing activities such as swimming or cycling.
• Use of gel heel pads to reduce tension at the heel.
• Use of orthotics (insoles or heelcups). Your physiotherapist may be able to supply these or refer you to a podiatrist.
• Onward referral if required for casting, medication, orthotics.

Are there any problems linked with Sever's Disease?

No long-term problems have been linked with Sever's disease. In occasional cases, children will be restricted in their activity until 16 years of age, when the growth plate fuses.

Can Sever's Disease be prevented?

Sever's disease, as with any injury, may be prevented by maintaining good muscle strength and ranges of movement. Your physiotherapist will be able to advise on specific exercises that will help your child.

Positional Talipes

Positional talipes used to be known as club foot. A baby’s foot rests in an abnormal position. Positional Talipes will usually correct fully and not affect walking in due course.

There are two types of Positional Talipes:

• Positional Talipes Equinovarus (PTEV) in which the foot is held pointing inwards towards the other foot.
• Positional Talipes Calcaneovalgus (PTCV) in which the foot is held turned outwards and upwards.

Physiotherapy

Depending on the outcome of your child’s full assessment, your physiotherapist may:

• Gently stretch on your baby’s foot.
• Encourage active foot and ankle movements.
• Advise on stretches for you to carry out at home.
• Tape your baby’s foot using baby-friendly k-tape.
• Monitor your baby’s development .
• Monitor your baby’s feet until the Positional Talipes has corrected.
• Refer your baby for other treatments such as splinting /orthotics .
• Refer your baby for an Orthopaedic Consultant’s opinion.