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Foot Problems in Persons with Down Syndrome

I just got back from Minnesota; I went to do the Train-the-Trainer programme with Special Olympics International. Many thanks to local Podiatrist – Ms. Celia St. Hill; the Chairperson of Special Olympics Trinidad and Tobago – Ms. Candilla Berment-Harper; and Board Member responsible for Healthy Athletes programme – Dr. Yvonne Batson. Through them the opportunity to volunteer for the position of Clinical Director – Fit Feet was made possible. It is a responsibility I plan to take quite seriously, to train fellow health professionals and other volunteers in the process involved in screening Special Olympians. I invite persons with an interest in helping persons with intellectual disabilities to contact me so we can partner as I develop a Fit Feet screening programme for future events. I must thank Dr. Marc Colaluce – Podiatrist, Orlando, Florida, who was my trainer, and a great motivator, along with the other participants I trained with in Fit Feet. Much gratitude as well, to Special Olympics International for making it all happen.

After experiencing the National Games in Minnesota on March 25, I swear I would never be the same person. It was so heart warming seeing persons with varied intellectual disabilities strive to do their best in their sport discipline. The effort put into their sports showed that it was all about team and not self. Even in disciplines like swimming and powerlifting where it was an individual effort, you could see the love, commitment and encouragement displayed by others towards fellow competitors. Passion for sport is definitely not dead! National Games in Trinidad was held on April 1, and yet again it was an amazing experience meeting the participants, and doing screening with the Health Promotion team.  My appreciation to Dr. Karen Pierre, Clinical Director – Health Promotion, for the opportunity to assist with her screening, and furthering my knowledge of what it is all about.

Today I focus on one of the groups that fall within the grouping, persons with Down Syndrome. It seems to be a large grouping amongst Olympians, but the question is…are the foot care needs of these persons sufficiently addressed? It was noted in our training that many persons with intellectual disabilities are often neglected with respect to health care. I’ll explore some characteristics unique to this grouping of persons. As I gather more experience from seeing this group, I’ll provide more information.

A Brief Review of Down Syndrome

 Down Syndrome is set of mental and physical symptoms that result from having an extra copy of chromosome 21. Many of these characteristics are well understood and are able to be managed. The related foot conditions are also generally well understood, although management and treatment of these often painful and debilitating symptoms are often overlooked or ignored. It should be noted that although persons with Down Syndrome share some of the same characteristics, each person is different.

Medical researchers have identified more than 50 characteristics which may be found in people with Down Syndrome. Most people will have only a few of these. The most common defining foot and gait features of Down Syndrome patients include:

  • Smaller and/or shorter limbs, fingers, hands, toes and feet
  • Low muscle tone and loose ligaments
  • Broad feet with a deep plantar crease
  • Flat ‘pronated’ feet

    Flat Fleet
  • Increased space between first and second toes
  • Narrow heels
  • Genu valgum (knock knee)
  • Decreased ankle range of motion
  • Abducted and wider base of gait / support
  • Excessive external hip rotation (feet pointed outwards)
  • Inadequate heel contact during gait (tendency to walk on toes)
  • Poor foot clearance during swing phase (tendency to scuff the foot and trip)
  • Poor balance
  • Brachymetatarsia (a shortened metatarsal, typically fourth toe)
  • Anhydrotic (dry) or sometimes fissured (cracked) skinAthlete’s foot
  • Varied nail pathologies

The combination of loose ligaments and low muscle tone contribute to orthopaedic problems in such persons. Often these characteristics become evident when children learn to walk, as specific physiological differences may be compounded by gravity. This is largely where Podiatrists and other health professionals can play a role in aiding Down Syndrome lower-limb development and coordination.

The most common foot and leg conditions include:

Bunions
Claw Toes
  1. Hallux Abducto-Valgus (bunions)
  2. Plantar Fasciitis (pain in the arch)
  3. Anterior knee pain related to flat ‘pronated’ feet
  4. Clawing of the toes
  5. Calluses and corns and    associated ingrown toenails
  6. Shoe irritation (generally from footwear with insufficient width)

The importance of comprehensive podiatric evaluation in patients with Down Syndrome for early diagnosis and treatment of problems, is crucial. Through these evaluations other health professionals would be incorporated for the required needs.

Treatment

Treatment is directed towards the cause, and is generally painless.

Soft Orthotics
  • Foot Orthotics – If flat feet are implicated in the development of symptoms, this can be addressed with soft, rubberised, highly contoured foot orthotics to assist in maintaining good foot and ankle alignment. Hard plastic orthotics should be avoided, due to pressure they apply to the arch in isolation, whereas soft full length orthotics can support the foot from heel to toe. In some instances an ankle orthosis may be required.
  • General Footcare – Hard skin and thickened toenails can be treated painlessly with skilful removal by a podiatrist. This may need to be performed periodically to maintain comfort, although alignment of the feet with orthotics generally assists in this area too.
  • Wide and Supportive Footwear – It can often be a challenge to find footwear that both fits well and provides adequate support, whilst still being socially acceptable. Custom made footwear is expensive and rarely available here.
  • Surgery – Orthopaedic surgery is an option for severe bunions deformities, rigid ankle equinus and other symptoms relating to flexible flat feet. Surgery is often the last option following exhaustion of all other conservative measures. Specific advice on the appropriateness of surgery can be discussed with your podiatrist.

                                            Your feet mirror your general health . . . cherish them!

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