Symptoms
The presence of the pigeon-toed foot does not usually cause any symptoms in affected children. If there are no other malpositions, the children usually feel no pain. In a few cases, the heel bone (Os calcaneus) can become trapped in the course of a pronounced plantar arch.
This causes severe pain in the area of the outer ankle (lateral malleolus). In children, the bent foot rarely leads to the development of arthrosis. If this is the case, it leads to severe movement disorders in the course of the disease.
Risks and consequences
If the malpositioning does not recede within the first decade of life in children with fallen arches, treatment should be initiated as soon as possible. The longer the feet are incorrectly loaded, the more the adjacent joints are affected. Especially in the area of the ankle and knee joints there are strong signs of wear and tear in the long run.
In many cases, the affected children quickly fall ill with arthrosis. In children with undiagnosed (and therefore untreated) flat feet, regular sports activities can lead to knee problems early on. The effects of the malposition are usually not limited to the affected foot.
In most cases, the pigeon-toed foot in children affects the entire body’s statistics. Affected children develop X- or O-positions in the course of the disease. In addition, the incorrect weight distribution can also affect the entire spine. As a result, a complete deformation of the lumbar spine can occur.Affected children then develop severe back pain that can radiate into the buttocks.
Diagnosis
The diagnosis “buckling foot” can be made in most children by simply looking at the foot and the leg axis. On closer examination, a children’s “twisted foot” can be recognized by the shoe. Parents should look for signs of wear and tear on their child’s shoes if there is any suspicion of a clubfoot.
Classically, the shoes wear out very much after a few days at the edges. The specialist will first perform a simple clinical examination in the course of the analysis of fallen arches. Viewing the barefoot child from behind allows an assessment of the foot axis.
In healthy children, the angle between the axis of the lower leg and the heel is approximately five degrees. In the presence of a hindfoot, this angle is greatly increased. In addition, the bent foot in children is conspicuous by a reduced varus position (joint axis is bent outwards) of the heel when standing on the toe.
This phenomenon is due to an insufficiency of the posterior tibial muscle. In addition, pronounced calluses on the outer edge of the sole of the foot indicate the presence of a pigeon-toed foot. Imaging procedures such as X-rays are generally not helpful in the diagnosis of the hindfoot in children, since malpositioning cannot usually be visualized in this way.
By making a so-called podogram (footprint), the treating physician can depict the foot silhouette of the child. In this way, especially the inner arch of the foot can be depicted and assessed. In the case of children with a pigeon-toed foot, the podogram shows a clear flattening of the inner arch of the foot.
The treatment of the pigeon-toed foot in children depends on the extent of the malposition. As a rule, the treatment is not started until the age of eight to ten years, because a clubfoot often regresses spontaneously by this time. In general, all possible non-surgical measures should be exhausted before a surgical correction is considered.
In the case of a slightly developed flat foot, simple gymnastic exercises usually help to correct the axis of the foot. Especially for children (but also for adults with fallen arches) walking barefoot on natural surfaces is recommended. Furthermore, the choice of a shoe with a firmer sole can have a positive influence on the stability of the affected foot.
If no additional malpositioning in the form of a fallen arches is diagnosed in children with fallen arches, special heel inserts help to correct the fallen arches. However, since the majority of children with a pigeon-toed foot are also diagnosed with the formation of a flat foot, so-called custom insoles must often be prescribed. After evaluation of the exact incorrect load pattern, these insoles are manufactured in such a way that the affected foot is supported mainly on the inside.
In this way, the distribution of body weight can be balanced and possible late complications can be prevented. In the case of overweight (obese) children with buckling feet, weight reduction should be a priority in addition to the non-surgical treatment measures. Only if a child’s fallen arches do not recede despite years of physiotherapy and/or complaints (such as pain or problems with walking) should surgery be considered.
In everyday clinical practice, two procedures are used for the surgical correction of the pigeon-toed foot in children. The so-called “soft-tissue surgery” is intended to improve the traction of the muscles and thus raise the arch of the foot. The “bony operation” is mainly used for children with a pronounced pigeon foot.
