In the context of podiatry care, foot mobilisation refers to gentle, hands-on, very small passive movements of the joints in your feet. Foot mobilisations are used to improve joint motion and reduce pain.

Foot mobilisations are sometimes incorporated into a treatment plan for people with foot pain where restricted joint movement (or stiffness) are contributing to the problem. Combined with a specific stretching and strengthening programme, foot mobilisations can help with problems ranging from heel pain to bunions and more.

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Camille joined the My FootDr team in 2019 and has been helping people stay active and happy on their feet for over a decade. After graduating with honours from Queensland University of Technology, she has practiced in clinics in Brisbane’s southside and the Redlands.

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While bunions are often seen in adult feet, they can present in children at an early age too. Bunions describe a prominent bony bulge on the inside of the foot by the big toe. In this condition, the big toe has changed alignment to start moving towards the second toe, pushing the joint at the ball of the foot (called the metatarsophalangeal joint) outwards, making it more prominent. 

As bunions tend to progressively worsen over time, a bunion in childhood can be a large cause of concern for parents. If you’ve noticed a bunion starting to form on your child’s feet, bring them in for an assessment with our experienced podiatry team.

 

Why does my child have a bunion?

In kids, there are two primary causes of bunions:

 

1. Wearing ill-fitting shoes

When kids wear tight, narrow or poorly fitting footwear, the pressure from the shoes can push on the big toe, pushing it in towards the lesser toes. This can happen quickly without you noticing with kids growing so fast – a recent study showed that 65% of kids may be wearing the wrong-sized shoes.

As kids can wear shoes for full days, day after day, the cumulative effect can lead to changes in the alignment of the joints. 

 

2. Hereditary predisposition

Genetics is the most common cause of bunions in kids – genetics can dictate foot posture and gait characteristics. We often see this with flat feet that roll onto the side of the big toe during walking. This repeated pressure can cause the big toe joint to become less stable, progressively altering its position.

Unfortunately, while there’s nothing that can be done to change genetics, we can help modify the way load is distributed to relieve pressure on the big toe.

 

The Symptoms

The bony prominence of the big toe joint at the ball of the foot is the distinguishing feature of a bunion. For some, the bunion will remain painless and asymptomatic. Others may experience joint pain, redness, swelling, and pain when bending the toe (including during walking). As footwear can become difficult to fit and rub against the joint, corns, calluses and blisters may develop.

Over time, the big toe may start buttressing against, over-riding or under-riding the second and third toes. If your child is raising concerns about pain in the big toe joint, this should be taken seriously, as the symptoms of bunions tend to worsen over time.

 

Treatment

The good news is that unlike adult bunions that are often rigid and inflexible, bunions in children tend to still be mobile and flexible – making treatment significantly easier.

 

Footwear

Treating bunions must start with addressing the cause. If the cause is tight, ill-fitting footwear, then switching to shoes with a wide toe box (the area of the shoe surrounding the toes) is essential to help prevent the bunion from worsening. Ensure the width is sufficient to not continue to push on, or rub against the side of the bunion.

 

Orthotics

If the cause is a hereditary foot type and gait characteristics, then we want to control the aspect that is contributing to the bunion, which for many is the repeated rolling on the inside border of the foot, through the big toe. This can be done using custom orthotics and good footwear. By supporting the arch and the level of pronation (rolling inwards), we can redistribute the pressure more evenly through the foot, reducing or preventing the excess pressure through the big toe.

Next, we want to encourage the big toe and joint to straighten. This can be done using physical therapy, splinting, joint mobilisation and other techniques. Your podiatrist will discuss the best options for your child at their assessment.

While many juvenile bunions can be treated conservatively, others may require surgery. If this is the case, we will refer you to an orthopaedic surgeon.

 

Juvenile idiopathic arthritis (JIA) is the most common arthritis that occurs in kids, affecting approximately one in 500 children [1]. Technically, JIA is an umbrella term for any arthritis affecting those aged below 16 years. The cause is typically unknown, hence the term idiopathic. While JIA can affect any joint in the body, the joints in the feet and knees are often affected.

 

What Causes JIA

JIA is an autoimmune condition, where the body’s own immune system attacks its healthy cells in the joints. The reason this occurs is currently poorly understood, though is thought to possibly be triggered by a viral or bacterial infection where the immune system fails to stop its response once the infection has been cleared. It is not contagious. 

 

The Symptoms

As with any inflammatory arthritis, symptoms may include: 

• Swelling, redness and warmth at the joints
• Stiff or restricted joint movement
• Pain when walking or moving the joints
• Fatigue or exhaustion
• Fevers and chills
• Skin rashes

These symptoms tend to come on all together in flares and can vary in severity. The flares are often spontaneous and can affect one or more joints, on one or both sides of the body.

 

Treating JIA

Managing foot and leg problems in JIA is complex and involves the combination of medical and non-medical therapies. Children must be tested and diagnosed by your GP, who will also take care of your medical management. They will stay under the care of a multidisciplinary team that will monitor and work to promote your child’s long-term health and well-being. 

Despite recent improvements in the medical management of JIA, foot impairments and disability persist in over 60% of children. As such, podiatrists are important members of the management team.

Podiatry care focuses on maintaining your comfort and mobility during and in-between your flares. By helping to alleviate some of your pain and helping you feel more comfortable and confident walking, you can further maintain your independence and ability to perform everyday tasks. Furthermore, reducing some of the stress on specific joints can help reduce the rate of joint damage. We may use footwear, orthotics, splints and physical therapy to help achieve this. 

It is estimated that 50% of children will continue to have disease symptoms into adulthood, while others will resolve.

 

 

 

Curly toes, otherwise known as clinodactyly, describes when some of the toes curl inwards when a child is standing. Curly toes often affects the third, fourth and fifth toes, and the shape is usually present from birth, becoming more noticeable as your child begins walking.

 

What causes curly toes?

We all have tendons that run beneath our foot and attach to our toes, supporting the healthy function of the foot. Curly toes develop because the tendons that run beneath the toes pull on the toes so that they curl downwards and may rotate inwards. This condition appears to run in families, as it often presents in several generations.

If you notice your child’s toes start to curl with prominent bumps at the joints, they may have hammertoes or claw toes. These usually occur from changes to the joints in the toes and may occur as a result of pressure from tight footwear.

 

What are the symptoms?

Often, curly toes will not cause any painful symptoms, just the visible curling of the toes. Sometimes, curly toes may cause discomfort and changes to the skin or nails, like corns, callus, blisters, thickening or distortion to the shape and appearance of the nail. The changes may make it difficult to wear some types of footwear.

 

How are curly toes treated?

If your child is not experiencing any symptoms, treatment is typically not indicated. You can help by choosing shoes for your child that have a wide toe-box, so that nothing is pushing against the ends of the toes. Up to the age of five, toes may also change shape significantly. Studies have shown that 25% of curly toes may resolve on their own [1]

If your child is experiencing pain or other symptoms, bring them in to see us. We’ll perform an assessment to understand the best ways to relieve the painful symptoms and implement strategies to reduce the likelihood of them from coming back. We always look at non-surgical treatment options first, like stretching and toe-props.

In very rare cases, we may refer you to an orthopaedic surgeon for an assessment. 

 

1 – Sweetham R. Congenital curly toes: An investigation into the value of treatment. Lancet 1958; 2(7043): 398-400.

Osgood-Schlatter’s apophysitis is a common cause of knee pain in children and adolescents. It is often referred to as growing pains in the knees. The condition was originally described back in the 1890’s, and is a term used to describe a painful traction apophysitis of the tibial tuberosity (the bony bit at the top of the shin bone).

 

What causes Osgood-Schlatter’s apophysitis?

There is still some controversy around the cause of Osgood-Schlatter’s apophysitis. It is thought to be primarily caused by repetitive contractions of the strong quadriceps muscle (the group of muscles at the front of the thigh bone) irritating the growth plate at the top of the tibia. The condition tends to occur in highly active children and adolescents who participate in regular sport and most often starts during a growth spurt.

 

What are the symptoms of Osgood-Schlatter’s apophysitis?

Symptoms are usually felt at the front of the knee and can include pain, swelling and tenderness below the kneecap at the top of the shin bone. The symptoms are aggravated by physical activity, especially when running, bending the knee, squatting, kicking and kneeling. Recent studies suggest Osgood-Schlatters affects boys and girls equally. 

What can be done to treat the symptoms?

Treating Osgood-Schlatter’s apophysitis starts with addressing modifiable risk factors such as training programs, practice routines and any surrounding soft tissue changes such as muscle tightness. Treatment will be directed at alleviating painful symptoms and helping you and your child implement self-management strategies at home.

While every treatment plan is individualised depending on the specific presentation, the results of a comprehensive lower limb assessment, and your child’s symptoms, we may use:

• Isometric strengthening and stretching of the surrounding muscles
• Footwear assessment, to ensure their shoes are keeping the feet in good alignment and not contributing to the onset of symptoms
• Technique revision and education to go over warm-up and cool-down exercises, as well as other tips, to help modify contributing factors
• Custom orthotics to help correct any alignment problems in the feet or legs that may be contributing to the knee pain