It is critical as a health professional to maintain your professional accreditation by doing CPDs (Continuous Professional Development) training. I attended the Society of Chiropodists and Podiatrists Annual Symposium in Liverpool recently, and learnt a number of things; some, just a refresher of information and known techniques. As well, a great part of meeting up with colleagues, is discussing patient caseloads and feeding off of each other’s energies.

I attended diabetes, vascular, and podopaediatrics sessions, from which discussions, (sometimes a debate) may have occurred, which in itself was informative.

What is Podopaediatrics?

It is a specialist area of podiatry that specifically focuses on the developing lower limb in children.  Through it, assessments, appropriate treatment, screening, advice, and where necessary, referrals are done in order to improve quality of life. By assessing and treating lower limb musculoskeletal abnormalities in children, the ultimate aim is preventative interventions, for potentially debilitating and costly pathologies in later life.

Given it is a specialist area, I can’t claim to know it all; however, it is an area in which I have a keen interest. From since I’ve known myself, I get excited when seeing babies and toddlers. So, listening to some dynamics, and getting details surrounding development, was great.

Foot and Lower Limb Development

In the early stages of life, the feet and lower limbs undergo many changes during certain phases of developmental milestones. Observation of the child during walking can highlight any abnormalities present. Some developmental milestones suggest that at 6-7 months, the baby will sit unassisted. By 12 months, the child may briefly walk. This style of walking will usually be characterised by wide position of the limbs for stability, and the arms being held high for balance. Heel to toe walking is usually achieved by 3 years of age. It should be established that these stages of developmental milestones will vary considerably, depending on the type of birth (breech, premature etc.), and from child to child. It is important to recognise when an abnormality is present.

• Is your child walking differently to other children?
• Does your child refuse to walk?
• Are there any complaints of tiredness, aches or pains during walking, or at night?

The following are some of the more common foot problems that occur:

Flat Foot

Flat foot is a condition of the foot often associated with gross in-rolling of the foot. Flat feet can occur for a number of reasons: poor development of the bones in the foot, inheritance, and rotational problems in the limbs are just a few. Standing behind your child, can you see the 5th, 4th, 3rd or 2nd toes? If so, it is important to have your child assessed by a podiatrist.

In-toeing

This is where the child walks with one or both of their feet pointing inwards. The abnormality is often associated with the development of the lower limbs after birth. Research suggests that 30% of children will in-toe at the age of four. In-toeing can cause the child to trip during walking.

Knock knees

Describes the pointing of the knees inwards, to face each other. During walking, the knees can also rub together. Knock knees can be associated with flat feet, or other rotational problems in the lower limb.

Bow legs

This abnormality is characterised by the knees facing outward, and when standing, there is usually a large gap present between the knees and the lower legs. If left alone, these abnormalities of the feet and lower limbs, may cause problems in the hips and knees in later life.

Metatarsus Adductus

A deformity where the outside border of the foot takes a ‘C’ shaped position. This condition can be associated with the position of the feet in the womb, or poor growth of the foot.

Other Abnormalities

• Toe walking
• Curly toes
• Toes that sit under/over other toes
• Limping
• Hip and knee pain
• Heel pain
• Fatigue when standing for long periods
• Plantar warts (Fish eyes)
• Ingrown toenails

Further Indications to be Aware of

These include a family history of foot or lower limb problems; hip abnormalities at birth; breech or premature births; taking medication during pregnancy; late walking; lumps and bumps present on the feet or limbs; sleeping and sitting positions. It is important to have your child assessed by a specialist podiatrist to investigate any abnormalities that may be present. Many problems can be successfully treated when the child is young. The assessments carried out by the podiatrist are painless, and with little inconvenience.

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