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Why You Should Skip the Flip-Flops This Summer

7 May
Flip-flops are just so easy – slip ’em on and run out the door. Seems like everybody starts wearing them as soon as outdoor temps climb above 50 degrees.


Unfortunately, flip-flops are just about the worst thing you can wear on your feet. In fact, there is a growing problem of heel pain among teens and young adults, which podiatrists are attributing to wearing this paper-thin footwear (no doubt intensified by the obesity epidemic).

Walking barefoot is better for your feet than walking in flip-flops. If your feet have any abnormal biomechanics, flip-flops can accentuate these problems, leading to plantar fasciitis and accelerating other foot problems.

Think about it: the bones in your feet are the base of your skeleton and your body weight is riding on them. If your feet aren’t supported correctly, the rest of your bones, joint, tendons, and muscles have to make up for it. The stress shifts elsewhere and that leads to foot pain, heel pain, leg pain, hip pain, bad knees, sore back, and any number of other ailments.

Naturally, wearing flip-flops in the sauna, locker room, or by the pool won’t cause any harm. But as everyday footwear, we suggest you make a smarter choice.

So how exactly do flip-flops affect your feet?

Toes: That little thong that slips between your toes actually makes the muscles in your feet work overtime. The perpetual gripping this requires of your feet can lead to a nasty case of tendinitis, hammertoes, and bunions. Additionally, bare skin rubbing against the plastic or leather thong can lead to nasty blisters.

Fractures: With no support under your feet, all of that pressure from your body weight can create stress fractures in the bones of your feet. If you spend a lot of time on your feet in flip-flops, this is very likely to occur.

Bottom of your feet: The flip-flop isn’t stationary on your foot like an athletic shoe is. Since the bottom of your foot is in a constant sliding motion against the material, it can create a burning feeling or blisters, especially on hot days.

Arch and heel pain: If your footwear doesn’t support your arch, you run an excellent chance of developing plantar fasciitis, the inflammation of the band of tissue which runs along the bottom of your foot, connecting your heel to your arch. Pain may be felt anywhere along the plantar fascia.

For summer footwear, we suggest that you always wear athletic shoes that fit properly or a solid, rugged pair of sandals with significant arch support and a heavy sole.

Thanks to Huffington Post for this excellent infographic on what happens to your feet when you wear flip-flops.

flip flops

What Is Sever’s Disease?

10 Oct

Sever’s disease, known as calcaneal apophysitis, is the most common cause of heel pain in children.  It’s a painful bone disorder created by inflammation of the growth plate in the heel, usually from muscle strain and repetitive stress. Sever’s Disease is very common in obese children and those who play lots of sports, and most commonly occurs during growth spurts in adolescence.  For girls, this is usually between 8 and 13 years of age, and for boys, between 10 and 15.

heel pain children

The heel is especially susceptible to injury in children. The foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. The growth plate is a soft area at the end of the heel bone where cartilage cells change into bone cells, and it eventually fuses with the heel bone.

During the early part of puberty, the heel bone sometimes grows faster than the leg muscles and the Achilles tendon, which attaches the calf to the heel bone. When this unequal growth occurs, the muscles and tendons become very tight, which makes the heel less flexible, placing a lot of stress on the growth plate. The Achilles tendon, when stretched too tightly, becomes swollen, tender, and painful where it attaches to the growth plate. This injury, a result of repetitive stress on the Achilles tendon, is Sever’s Disease.

If  a child is active, doing a lot of running, jumping, and playing on hard surfaces, they can put a lot of stress on those too-short muscles and Achilles tendon, resulting in heel pain. Other factors which can contribute are:

Severs-Disease heel pain children

  • Long periods of standing which put constant pressure on the heel
  • Pronated foot (a foot that rolls inward when walking). Pronation tightens and twists the Achilles tendon and pulls on the growth plate
  • Flat feet or a high arch. This again cause the Achilles to be overstretched
  • Short leg syndrome, in which one leg is shorter than the other. This causes the foot on the short leg to bend downward, putting stress on the Achilles
  • Obesity  – weight puts pressure on the growth plate

Symptoms of Sever’s Disease

  • Pain or tenderness in one or both heels. Pain is usually felt at the back of the heel, but may also be felt along the sides and bottom of the heel, all the way to the arch.
  • Swelling and redness in the heel
  • Feet are stiff upon waking
  • Difficulty walking or running
  • Child may walk on tiptoes or with a limp to avoid putting pressure on the heel
  • Pain may increase with activity

To relieve symptoms

  • Rest to relieve pain
  • Curtail athletic activities
  • Wear athletic shoes that fit properly and provide cushioning
  • Ice and elevate the sore foot to reduce swelling
  • Stretching exercises for the heel and hamstring
  • No high heeled shoes
  • Over the counter pain medicine (check with your doctor first)
  • If symptoms are caused by obesity, a weight management plan

Sever’s Disease fortunately is a temporary condition. With proper care and treatment, symptoms will usually go away within 2-8 weeks, and it will have no long term consequences. If the condition recurs due to the child having a pronated foot, or a flat or high arch, your podiatrist may recommend custom orthotics to position the foot correctly inside the shoe and reduce stress on the heel.

The risk of recurrence of Sever’s Disease diminishes with age, and as a rule won’t occur after the age of 15. By that time, foot growth is complete and the growth plate has fused to the rest of the heel bone.

Buying Athletic Shoes For Kids: Avoid Hand-Me-Downs

22 Aug

athletic shoes kidsIt’s true that every parent with young children wants to save a buck wherever possible. You might be tempted to hand down your 12 year old’s outgrown shoes to your 10 year old, but you might want to think twice before doing that, especially when it comes to athletic shoes.

Sneakers, cleats, and any shoes made for athletic training need to fit every foot correctly. Considering the heavy beating a foot takes when they’re in these shoes, this is not an area to skimp. Your child will be running, jumping, and kicking, and their feet require padding and comfort to not only perform as well as possible, but to protect their feet from injury. Athletic shoes that are too tight will create blisters, corns, calluses, redness, sores, or ingrown toenails. Those that are too loose will allow the foot to slide, putting undue stress on the toes.

Hand-me-downs also may provide less support for the arch and heel than what’s needed. “Shoes lose their shock absorption over time, and wear and tear around the edges of the sole usually indicates it’s worn out and should be replaced.”, notes Dr Teichman at PA Foot and Ankle Associates. “If a child keeps wearing worn-out or non-supportive dress or athletic shoes, it elevates the risk for developing heel pain, Achilles tendonitis and even ankle sprains and stress fractures.”

When you’re buying new shoes for your child, make sure they’re not too tight, and resist the urge to buy a pair that are slightly large, believing that your child will “grow into them”. And with the innovations in shoe design and construction, modern materials don’t need to “break-in”, like they did years ago.

How to know if the shoe is right for your child:

  • Make sure there’s a finger’s width distance in the shoe box between the longest toe and the front of the shoe
  • No redness should appear on the child’s feet after taking the shoes off. Redness is a sign of the shoe rubbing or pinching
  • The shoe should not bend in the middle of the sole, it should bend at the ball of the foot
  • The toe box should flex easily
  • The back of the shoe should meet your child’s foot, but not be tight
  • Shoes should be made of quality materials which will cushion the foot
  • The toe box should be roomy enough that your child can wiggle their toes

Your child’s shoes not only protect their feet from injury this year, but also protect them from developing foot problems which may follow them into adulthood. Take the time and choose wisely.

Heel Pain in Children: Warning Signs For Parents

7 Jun

There’s simply no substitute for organized game play in a child’s physical, emotional and mental development. Even non-organized physical activity is important, like climbing trees, going for a swim on a hot Saturday, or riding a bicycle to a friend’s house.

child heel pain soccerBut kids are notorious for not complaining about their injuries, for any number of reasons. And injuries at such a young age can literally change the development of every muscle in their body, as the uninjured parts compensate for the injured parts. As a parent, you need a sharp eye to watch for changes in behavior or body language, even though we all know how hard that is.

Signs of possible unspoken injury to a child’s feet or ankles may include changes in their gait, occasional limping, favoring one foot over another, walking on their toes, problems running, or unusual fatigue.

The most common sports injury in children is heel pain. Many times this can be simple plantar fasciitis from overuse, usually controlled with pain medicine, rest, icing and if necessary, physical therapy and custom orthotics to be worn in their shoes. But it may also be a sign of Sever’s disease, an inflammation of the heel’s growth plate due to muscle strain and repetitive stress. This is especially common in highly active children and those carrying extra pounds.

Bear in mind that the symptoms of heel pain in adults are considerably different than heel pain in children. In adults, heel pain is usually worst in the morning upon rising, and subsides as the tissue warms up with light activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.

If your child complains about heel pain, don’t take it lightly. Make an appointment with our office immediately for a thorough diagnosis, because early intervention is key to a continued healthy development.

Why you need to buy children’s shoes that fit properly

6 Jul

Do you have hammertoes? Bunions? Ingrown toenails? These may not be a recent development. In fact, the root of these problems  may have started in childhood with shoes that didn’t fit properly.

kids feet proper fitting shoes

It won’t be a surprise to any parent that kids burn through shoes – sometimes it’s hard to believe how fast they grow. It’s easy to tell when your kids have outgrown shirts, pants, socks, gloves, etc. But what might escape your attention is their footwear. If your child isn’t complaining about their shoes being too tight or hurting, we tend to forget that their feet are growing at least as fast as the rest of their bodies.

When should I buy my child’s first pair of shoes?

A child’s feet grow rapidly during the first year, reaching almost half their adult foot size. As they develop, their feet are soft and pliable and abnormal pressure can easily cause the foot to deform.

During the first year, don’t force their feet into baby shoes when it’s not necessary. Children don’t actually need shoes until they begin walking, between 12-15 months. Until then, socks or booties are enough to protect their feet and keep them warm. When your child begins standing and walking, shoes provide protection from injury.

Little girls actually have it the worst where this is concerned. Buying a shoe for her based on style instead of a pair which are actually supportive for her growing feet may cause her problems in adulthood.  The most important quality to look for in shoes is durable construction that will protect her feet and keep them comfortable. Remember that her shoes should conform to the shape of her feet – not the other way around. Soreness, blisters, callouses, and permanent disfigurements can be caused by repeatedly stuffing your child’s feet into shoes that don’t fit her well.

Recommendations for buying children’s shoes
  • Have your child’s feet measured every 3 months – check for signs of too-tight shoes like redness, callouses or blisters.
  • Generally speaking, if a shoe fits correctly, there is a thumb width between the end of the shoe and the end of the longest toe.
  • The sole of the shoe should be relatively straight, just like the foot.
  • The heel should sit firmly in the back of the shoe so that the foot doesn’t slide inside of it.
  • The shoe should bend where the foot bends – at the ball of the foot, not the arch.
  • Best shoe materials are leather or canvas, as they’re more durable and can breathe. No plastics.
  • The toe boxes should be rounded, not pointed, to allow the toes room to move.
  • Modern shoes do not need to be “broken in”. They should fit well and be comfortable the first time your child tries them on.

A sneaker is usually the ideal shoe for a child of any age. The toe box should provide enough space for growth, and should be wide enough to allow their toes to wiggle. High-top shoes are recommended for younger children who may have trouble keeping their shoes on, but contrary to what you may have heard, high-tops offer no advantage in foot or ankle support over low-cut shoes.

Remember that the primary purpose of shoes is to prevent injury and support the foot as it grows.

When you check your child’s feet, if you notice anything out of the ordinary, make an appointment with PA Foot and Ankle Associates for a thorough examination and diagnosis of your child’s foot problem. Foot problems treated in adolescence may prevent more serious problems in adulthood.

My child has flat feet – what should I do?

12 Jun

If your child has flat feet, there may be no need for worry – it could be normal for their age.

my child has flat feet

Many parents become concerned when they notice that their child has flat feet. Depending on the age of your child, it may be nothing to worry about or it may indicate fallen arches, which Podiatrists call pes planus.

When a child is born, their feet are definitely flat – well, more like chubby. That’s because the foot needs to be very flexible while the baby is in the womb. Until a child is about three years old, her foot is made mostly of cartilage and you’ll notice very little change in it’s appearance until her feet are bearing weight – standing, walking, running.

Between the ages of two and three, your child’s foot will start to show it’s true shape as her baby fat and cartilage diminish and the bones become more prominent. Ligaments and tendons start to strengthen at this time as well. Yet, the foot may still look flat. In fact, 90% of two year olds exhibit flat feet, but by the time they’re ten, only 10-15% have flat feet.

When does the arch of the foot form?

The arch of the foot begins to develop between the ages of two and four, as your child walks more and more. Your child is growing, changing posture, and building their muscles, and as they do, the tarsal bones develop in the foot and the connective tissues that bridge the midfoot.  Thus, the arch forms… or doesn’t.

If your child is halfway through their second year and their arch is still not developing, then it’s time to visit East Penn Foot and Ankle Associates for a complete diagnosis of your child’s foot.

A study published in 2009 found that overweight children have a higher incidence of flat feet than children of normal weight. The cause and effect is unclear and it remains to be seen if overweight kids will grow into adulthood with pes planus.

When do I need to worry about my child’s flat feet?

If your child’s feet are still very flat by the time she is eight years old, she will likely complain of aching, fatigue in her legs or arches, and difficulty keeping up with other kids during athletic activities. She may also complain of pain or fatigue in the lower back, hips, knees, or legs due to the compromised mechanics caused by the flatfoot deformity. This is when you should call a podiatrist for a thorough examination of your child’s foot and a course of treatment.

normal foot flat foot compared

Treatment for flat feet

If your child has a mild flatfoot deformity and no symptoms, your podiatrist may simply recommended a yearly check-up to monitor the development of their feet. If your child has a moderate to severe flatfoot deformity and does have significant symptoms in the foot or lower extremity, treatment may include:

  • Supportive shoes
  • In-shoe inserts such as arch padding
  • Functional foot orthotics which limit the abnormal flat arch and stabilize the heel
  • Calf muscle stretching exercises – tight calf muscles may worsen flatfoot deformity and make symptoms worse
  • Surgery in the most extreme cases

The biggest question a physician must answer when examining your child’s feet: Will this child’s flat feet remain stiff and inflexible into adulthood?  Some flat feet remain that way but create no symptoms. Others remain stiff and inflexible, with the loss of inward and outward movement (inversion and eversion). In this case, they can be responsible for quite a bit of discomfort. A podiatrist is expert at spotting inconsistencies in the structure of the foot and is in the best position to ascertain how serious your child’s problem is… or will be.

How can my child avoid getting flat feet?

Here’s some food for thought: Researchers in India found that flat feet were far more prevalent among people who wore footwear before the age of six. Kids who went barefoot for most of their first six years – the formative years for feet – had better developed arches and exhibited flat feet far less often. No other factors had comparable impacts. It may seem counterintuitive to parents, but letting young children run barefoot as often as possible may be the best way to insure that their feet develop properly.

My child has heel pain!

3 May

child heel pain, pediatric heel pain

When children resume athletic activities after a winter or summer break, it’s not unusual to hear them complain about pain in their heels. This is usually due to an increase in physical activity as soccer leagues,  little leagues, and spring sports begin and children generally spend more time outdoors.

Podiatrists refer to heel pain in children as Calcaneal Apophysitis, or Sever’s Disease.

What is Calcaneal Apophysitis?

Between the ages of eight and fourteen, a child’s bones grow faster than their tendons. This causes the tendon at the back of the heel to pull on the growth plate of the heel (a growth plate is an area of growing tissue within the bone that determines the future length and shape of the bone). This action creates a great deal of tension between the two and the result is irritation, pain, and sometimes a more serious condition. During this time, the bone in the heel is still immature and is more prone to injury.

child foot pain, pediatric foot pain

If your child complains about heel pain, it’s important that you don’t let them “play with pain”, as it could cause much more damage to the heel and tendons. Your child’s heel pain usually will not improve with activity. In fact, walking around typically makes the pain worse.

How to relieve your child’s heel pain
  • To get your child’s heel pain under control, make sure they rest, elevate and ice their heel, and begin taking Advil or Aleve to reduce the inflammation which is causing the pain. Make an appointment with PA Foot And Ankle Associates right away for a thorough exam and diagnosis. Our treatment may include:
  • Cushioning the heel
  • Physical therapy
  • Non Steroidal Anti Inflammatory drugs
  • Custom made orthotic devices
  • immobilization
  • surgery (for cases where the tendon may need to be corrected)

A complaint of heel pain from your child is an indication that they have a condition that needs attention. Dr Teichman at PA Foot And Ankle Associates is expert at treating sports injuries in children.

Pediatric Heel Pain

1 Mar pediatric heel pain

A complaint of heel pain from your child is a warning sign that deserves attention.  Heel pain in children is often caused by injury to the growth plate commonly referred to as Calcaneal Apophysitis orSever’s Disease.  A growth plate is an area of growing tissue within the bone that determines the future length and shape of the bone.  Growth plate injuries of the heel are usually caused by overuse. However, pediatric heel pain may be the sign of many other problems, and can occur in infants through teenagers.

pediatric heel pain

Your child’s symptoms may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on the toes
  • Difficulty participating in normal activities or sports

How does Pediatric Heel Pain differ from adult heel pain?

During young ages (8 to 14 years old), bones are growing faster than tendons.  At this time the heel cord is relatively short compared to the leg bone, causing the tendon to pull on the growth plate of the heel. When this is the case, a great deal of tension is put on the heel bone causing irritation and pain.  The heel bone is still immature at this time and is therefore more prone to injury.

Pediatric heel pain usually does not improve with activity. In fact, walking typically makes the pain worse in children, whereas adult heel pain improves with activity.

Causes of Pediatric Heel Pain

  • Calcaneal Apophysitis: Heel pain in children caused by injury to the growth plate in the heel bone
  • Tendo-Achilles Bursitis: Inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. May be a symptom of certain diseases such as juvenile rheumatoid arthritis
  • Overuse Syndrome: A collective term for a range of conditions, including injury, characterised by discomfort or persistent pain in muscles, tendons and other soft tissues.
  • Fractures: Heel pain caused by a break in the bone such as Stress Fractures

To diagnose the underlying cause of your child’s heel pain, East Penn Foot and Ankle Associates will first obtain a thorough medical history and ask questions about recent activities. A thorough exam of the child’s foot and leg, followed by X-rays are often used to evaluate the condition. In some cases the physician will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.

Treatment of pediatric heel pain

  • Reduce activity
  • Cushion the heel
  • Medications – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Advil (Ibuprofen) or Aleve (Naproxen Sodium)
  • Physical Therapy – Rehabilitation program with Robbins Rehabilitaion
  • Custom Foot Orthotic Devices
  • Immobilization
  • Surgery – There are some instances when surgery may be required to lengthen the tendon or correct other problems

A complaint of heel pain from your child should not be ignored. Make an appointment with East Penn Foot And Ankle Associates to have your child’s complaints evaluated as soon as possible.

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