My Newborn's Feet

Two weeks ago, my wife and I had baby number 10 born into our home. A child always brings with it excitement, a great amount of joy, less sleep and new stresses. Most babies are cute and fun to hold. Most bring a different feeling into a home. But they also bring a greater responsibility and some worries. One concern that often comes to a new mom is the question: “Are there 10 fingers and toes?” To alleviate this worry, I have created a list of the 5 things to check on a newborn’s feet.

1. Most Babies Are Flat Footed. Approximately 97% of newborn feet are visually flat. This is due to the fat pad in the arch area from birth. Over time, this fat resorbs and the muscles and tendons produce the development of an arch. A flat footed baby should not be a concern. Just enjoy those cute, fat feet.

2. Flexible Feet. A newborn foot is and should be very flexible as bones are only partially developed and muscle, tendons and ligaments are still developing. A foot that is poorly positioned on the leg (tilted out or tilted in), not flexible (tight against the front of the leg) or even contorted (clubfoot) is a warning sign and should be evaluated by a foot and ankle specialist. Remember, thought, that sine the feet are soft and flexible, shoes should be purchased with the same features for a newborn foot (or even better allow them to be barefoot).

3. Baby Shape. The newborn foot shape is characteristically triangular in shape, consisting of a narrow heel and wide forefoot. The foot should be easily held between the thumb and forefinger in a “V” shape. This evaluation allows for evaluation of a foot that is “C” shaped, as the toes and forefoot area tilt in or out, instead of remaining straight. Due to the flexible nature of the infant foot, any abnormalities in shape may be modified by stretching and splinting if caught early.

4. Reflexes. In an infant, the common reflex tested is the Babinski sign. This is elicited by running a blunt instrument or finger from the bottom outside of the heel in a curve towards the big toe. The adult response is curving of toes down and turning the foot outward. In an infant, the response is spreading of the toes and elevation of the great toe. No response would be the only concerning finding at this time.

5. 10 Toes. This is commonly the first thing evaluated on the feet. Abnormalities may include toes that are abnormally large compared to other toes, too many toes, too few toes, or even absence of toes. Webbing of the toes may also be seen at this time. Treatment for many of these conditions is possible but may not always be necessary. Evaluation should be done through a specialized foot and ankle physician.

The foot is a very complex arrangement of bones, tendons, ligaments and vascular/nervous tissues. It will carry the new infant throughout life and should be protected. A key to the development of each foot is the ability to develop unimpeded by constricting clothes or shoes, as the foot with move quite regularly as muscle and tendons mature. Enjoy your babies feet, as they are part of the cuteness that is your baby.

Dr Brandt R Gibson
Moutain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
www.UtahFootDoc.com

My Active Child Has Foot Pain

As childhood obesity skyrockets, video game consoles seek for ways to make their games “active” and obesity related diseases such as diabetes is at epidemic levels, athletics is a blessing to many children. Since children are less likely today (compared to 20 years ago) to run outside, ride bikes or play sports in the streets, more children are becoming active in sports from soccer and football to gymnastics and dance. This increased activity has improved the health of many children, but sometimes is accompanied by heel or ankle pain.

When a child between the age of 9-14 in girls or 9-16 in boys presents to my office complaining of either heel pain or ankle pain, the cause is usually the same. The entity is commonly known as Severs Disease or Calcaneal Apophysitis. This is a disease of growing bone and therefore only presents in children during their stages of active growth. Let me explain some.

Every growing bone as a region called the physis that is cartilaginous tissue instead of calcified bone. As the bone grows, this allows expansion and calcification at the edges to help produce this growth. When full growth potential has been met, the calcification replaces the physis and creates healthy bone. This physis, however can be affected by pressure or tension and can become painful.

In calcaneal apophysitis, the growth plate of the heel bone (or calcaneus) receives tension during sports from the Achilles tendon (the strongest tendon in the body). This pressure causes increased stress, swelling and associated pain to the posterior heel area close to where the Achilles tendon attaches. The pain is caused by stretching of the physis or apophysis of the heel from a tight Achilles tendon during running. This pain can be problematic and significantly interfere with activities, and over the years has even stopped many from playing the sports they love. Although it resolves without treatment when the bone stops growing, often severe pain will limit activities for years. This is no longer the case. There are treatment options that can alleviate the pain and maintain the active lifestyle required to help our children remain healthy.

Calcaneal apophysitis or Severs Disease was once a disease of boys playing soccer. With the increased competition levels in all sports including dance and gymnastics, we are encountering this problem in boys and girls when they are active. So if your child is in the age range of 9 – 16 and complains of heel pain, especially when running or being active in sports, think calcaneal apophysitis. Get treatment from a foot and ankle specialist and help alleviate the pain associated with the exercise our children enjoy. Don’t make them stop their sport because of foot pain, help them resolve the pain while they await calcification of the growth plate and complete resolution of their symptoms.

Dr Brandt R Gibson
Moutain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
www.UtahFootDoc.com

Protect Your Child From Ingrown Toenails

On a regular basis, I see ingrown nails in both adults and children. Although the treatment is quite common, they can become a big problem and often can interfere in even normal activities and normal shoes.

Parents can help prevent this common and painful foot problem in children by following a few simple tips, and with a careful understanding of the common causes.

Ingrown toenails are primarily caused by an inherited tendency for the nails to curve, but may be aggravated by tight shoes, tight socks and incorrect nail trimming (nails should be trimmed straight across as opposed to curved like fingernails). In fact many people without an inherited tendency for nails to curve, will never have ingrowing even with tight shoes, poor nail trimming and other causative actions.

In my experience, many kids hide their painful toenails from their parents, even though the condition can cause significant pain. Over time, the nail may become increasingly red, swollen and painful and may even break the skin and lead to dangerous infections. Over the last year ACFAS (American College of Foot & Ankle Surgeons) has made some recommendations for minimizing this problem. Together with these recommendations, I will provide 10 ways to limit and/or prevent ingrown toenails in your children:

1. Nails should be regularly trimmed straight to minimize trauma to the nail during athletics or simple walking. A cracked or broken nail can often lead to ingrowing of the nail.

2. Rarely do we teach our children how to trim toenails (or fingernails for that matter). ACFAS recommends that parents teach children how to trim their toenails properly. Trim toenails in a fairly straight line, and don't cut them too short. I commonly trim my toenails straight and then remove the corners so there are no sharp edges.

3. Check your children's feet regularly (at least once or twice a week) to ensure they are caring for their nails properly. Don't wait until they are limping or hurting to check their toenails for infection or ingrowth.

4. When fitting your children for shoes, ensure that the fit are measured for both width and length. Regularly we fit shoes based only on length, but shoe width is just as important as length. ACFAS reminds us to make sure that the widest part of the shoe matches the widest part of your child's foot. This may mean that you are unable to pass shoes down from child to child.

5. Ensure children are wearing the proper shoes for the proper activity. Don't wear flip flops or go barefoot for athletic activities as injury to the nail and even the toe can occur.

6. Treat nail injuries aggressively to allow proper healing and limit ingrowth as the nail regrows.

7. If a child develops a painful ingrown toenail, parents can reduce the inflammation by soaking the child's foot in warm water (not hot) with epson salts. While in the water, the parent may also gently massaging the side of the nail fold to help remove any infectious drainage.

8. Antibiotics may often not be necessary if the ingrown nail is treated properly. A majority of the inflammation occurring is due to the nail being treated by the body as a "sliver". Once the nail is removed from the area, the inflammation improves. Soaking as mentioned above will then usually remove any remaining infection.

9. As confirmed by ACFAS, the only proper way to treat a child's ingrown toenail is with a minor surgical procedure at a doctor's office. Parents should never try to dig the nail out or cut it off. These dangerous "bathroom surgeries" carry a high risk for infection.

10. Notice if you see your child limping, the child has a red swollen toe, you see blood or drainage on a sock or you see a child start to cry with a simple "bump" of the toe. With any of these occurrences, you should be thinking ingrown toenail and seek to alleviate the infection and the pain by having it treated correctly.

Until that time, follow the above steps to limit the presentation and recurrence of an ingrown nail. Like you, we want to keep your children active, using these techniques can make it happen. Ingrown toenails although not life threatening can definitely interfere with life.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com