September 2007

Summer's end means extra care for kids' feet

by Terry A. Rondberg, DC

A new report from the American College of Foot and Ankle Surgeons (ACFAS) serves as an important reminder that this month ‑‑ with the end of summer and return to school ‑‑ is a critical time to help young patients address foot and gait problems that could cause or aggravate vertebral subluxations.

According to the report, the major culprits are the flip‑flop sandals that so many kids wear during the summer. Although they may be cool ‑‑ in more ways than one ‑‑ these inexpensive flat shoes do not cushion or support the foot, leading to problems. "After wearing flip‑flops all summer, some students will head back to school this fall with foot pain and even injuries."

The ACFAS put out the report to remind parents and students that foot pain isn't normal and can be reduced or eliminated.

"People may not realize that even into your mid‑teens, there's new bone growing in your heel," explained Michael Cosenza, DPM, FACFAS, a foot and ankle surgeon in Ukiah, Calif. "Flip‑flops don't cushion the heel, so repetitive stress from walking can inflame that heel bone growth area and cause pain and tenderness."

Heel pain and arch pain rank among the most common complaints among students who wear flip‑flops. Other flip‑flop feet problems students can take back to school include inflammation of the Achilles tendon, painful pinched nerves, sprained ankles, broken or sprained toes, cuts and scrapes, plantar warts, Athlete's foot, and callus build‑up on the heels and toes.

Foot and ankle surgeons can usually reduce or eliminate students' foot pain with simple treatment methods including stretching exercises, ice massage, anti‑inflammatory medications, and custom or over‑the‑counter shoe inserts.

Naturally, the ACFAS didn't mention anything about subluxations or chiropractors, but more and more parents are turning to DCs to help address any structural problem that could cause subluxations and, therefore, a general negative impact on their children's health. In response, more and more DCs are becoming aware of the direct link between foot and gait problems, improper posture, and subluxations. They are obtaining the training and tools needed to provide posture‑correcting orthotics to all their patients, including youths.

The importance of such care isn't limited to school‑aged children. In fact, the problem of subluxation in very young, pre‑school children is exacerbated by the prevalence of poor posture. Unless the doctor of chiropractic addresses both problems at once ‑‑ subluxation and posture ‑‑ the child could be destined for a lifetime of serious health issues.

Children's feet undergo important transformations during the first six years of life. They progress from primarily soft cartilage (for the first 18 months) to rapidly developing bone structure that can support the body. As the child advances from crawling to walking, the bowed legs and "toed‑in" feet of infancy straighten, and the arch begins to form.

While many of the postural problems associated with childhood foot development resolve themselves by the time the child is five or six, the incidence of continued abnormalities is higher than might be supposed. In fact, a survey of 52 five‑year‑old children showed that 92.3% had knocked knees, and 77.9% had hyperpronation.

A research study published in the Journal of the American Podiatric Medical Association noted that many young children who suffer from aching legs are clinically assessed as having a pronated foot posture: "This foot posture is thought to be deleterious and is often treated with in‑shoe devices such as triplane wedges or orthoses. Intervention aiming to reduce the amount of foot pronation in both stance and gait has been reported by parents and children to reduce, and in many cases eliminate, the episodes of aching legs..." To test that theory, the researchers used a single‑case experimental design in conjunction with age‑appropriate pain scores for the children and independent parental ratings. At the conclusion of the study, they concluded that "The in‑shoe intervention proved efficacious for children with a pronated foot posture and aching legs."[1]

Of course, as is the case in many subluxation‑related issues, foot imbalance is often asymptomatic ‑‑ at least at first. Among a group of children with identified pedal instability, 84% were pain‑free.[2] Still, the child could be developing problems that will manifest later in life. When symptoms are present, they may not be directly related to the feet. Imbalance may cause pain or other symptoms in the back, knees, or other remote location, explained Mark N. Charrette.[3]

The doctor of chiropractic is in the ideal position to be able to detect these abnormalities, since they are very often among the primary causes for subluxation or the inability to maintain an adjustment. By paying attention to every young patient's posture, the DC can not only correct existing problems, but go a long way toward preventing or decreasing future subluxations.

Being able to detect the problem, however, is only one part of the equation. It's just as critical that the DC be equipped with the proper tools to address the problem. Telling parents that the child may need orthotics could lead to them to purchase store‑bought "over the counter" shoe inserts. This is not recommended, since proper fit is of crucial importance. At that stage in their development, children's feet are too susceptible to damage to risk buying orthotics that are not specifically fitted to the individual foot. Orthotics made especially for children are essential.

When looking for a reliable orthotics company to work with, it's also important to find one that works extensively with chiropractors and understands the unique role of chiropractic in the health care system. Footlevelers, for instance, has become the most popular orthotics manufacturer among chiropractors because its entire manufacturing and marketing program is designed to fit within and support the chiropractic practice. The company's understanding of the link between subluxations and foot and postural abnormalities makes it possible for even the most principled DC to incorporate orthotics into his or her practice.

References

1. "Relationship Between Growing Pains and Foot Posture in Children Single‑Case Experimental Designs in Clinical Practice," J Am Podiatr Med Assoc 93(2): 111‑117, 2003.

2. "Study of the Incidence of Pedal Pathology in Children." Notari MA, Mittler BE: J Am Podiatr Med Assoc 1988;78(10):518‑521.

3. "Keep an eye on children's feet," Charrette M: The Chiropractic Journal, Jan. 2004.

(Dr. Terry Rondberg is president of the World Chiropractic Alliance and publisher of The Chiropractic Journal and the Journal of Vertebral Subluxation Research. A popular speaker at chiropractic conferences and seminars, Dr. Rondberg is also a frequent guest on TV and radio shows. He has written numerous articles on chiropractic for the profession and the public, as well as several best‑selling books, including "Chiropractic First," "Under the Influence of Modern Medicine," and, with Timothy J. Feuling, the "CBS Malpractice Prevention Program," and "Chiropractic: Compassion and Expectation.")