As a parent, every bit of your child’s wellbeing is important. Everyone wants their children to grow up healthy and strong so, the more they can be helped along the way, the better.

In order to make sure that your child has correct bony development, knowing when something is not normal is important.

 

INFANT HEAD SHAPE

Many children have slightly unusual head shapes following birth. This is perfectly normal and tends to resolve quickly. Up until 12-15 months old, the cranial sutures remain mobile and head shape can alter significantly.

This diagram shows the positioning of the sutures underneath the skin. Due to the squeezing of the head during delivery, the cranial bones will move to make birthing as easy as possible. This will swiftly resolve in the weeks after birth.

 

 

 

 

 

CRANIAL SYNOSTOSIS

If the abnormal head shape does not resolve then investigation should be pursued as there is a medical condition which can cause this to happen called Cranial Synostosis. This happens when there is premature fusion of one or more of the sutures. The brain growth causes the skull to expand assymmetricaly as the fused suture will not expand to accommodate it. There will be elements of facial and cranial asymmetry in most cases.

Incidences of Cranial Synostosis are low. 1 child in 115,000 suffer from the condition. Treatment will generally require a multi disciplinary team approach and surgery may be involved.

 

CRANIAL BANDING

Much more commonly, children with abnormal head shapes have a condition called positional plagiocephaly/brachycephaly. This condition is usually only a cosmetic problem and can be treated through a combination of positioning, advice and occasionally, orthotic intervention in the form of a cranial band.

Cranial bands are more correctly known as cranial remoulding orthosis. They are worn intensively for a number of months during which time there should be significant improvements in head shape.

A typical cranial remoulding orthosis is on the left.

 

For more information regarding cranial remoulding, click here.

 

INFANT AND CHILD FOOT POSITION

The infant and child foot position is always a topic of great discussion. What is normal? What is the best treatment? Is treatment required or will it self resolve? Unfortunately, there are no black and white answers, and the most important thing is to educate yourself and decide on the right course of action for you and your child.

The first important fact is that it is normal for an infant to have flat feet (meaning that there is no arch). Over the next 2-3 years, the arch begins to form and by the age of 6 or 7, the foot should have normal anatomy and a normal shaped arch.

However, this does not always happen and it is important to know at what stage intervention should take place, if at all. It is also important that the cause of the foot position is determined.

Sometimes, the flat foot position is causing certain problems which can be picked up by parents or the health visitor:

• Pain in the knees or hips
• Fatigue in the legs
• Clumsiness or unsteadiness when walking
• Not started walking until older than 18 months
• Foot position looks unnatural

Most often these are developmental issues which can be easily treated using orthotic corrective insoles or supportive footwear. What age treatment should begin and what treatment is appropriate is difficult to determine without some kind of assessment.

The assessment should also flag up any more serious anomalies.

Many people ask if the problem will resolve itself and what the treatment goals are if intervention takes place. Unfortunately, it is impossible to predict if things will resolve themselves. Only an opinion, based upon examination, can be given. In all cases, if intervention takes place, it will not be detrimental. It may only stop the progression of a potential problem or, as in many cases, give active correction.

If a child’s foot position is similar to the picture shown above, there is a greater risk of developing problems later in life. Problems such as:

• Pain in the knees or hips
• Fatigue in the legs
• Clumsiness or unsteadiness when walking
• Not started walking until older than 18 months
• Foot position looks unnatural

 

Most often these are developmental issues which can be easily treated using orthotic corrective insoles or supportive footwear. What age treatment should begin and what treatment is appropriate is difficult to determine without some kind of assessment. The assessment should also flag up any more serious anomalies.

Many people ask if the problem will resolve itself and what the treatment goals are if intervention takes place. Unfortunately, it is impossible to predict if things will resolve themselves. Only an opinion, based upon examination, can be given. In all cases, if intervention takes place, it will not be detrimental. It may only stop the progression of a potential problem or, as in many cases, give active correction.

If a child’s foot position is similar to the picture shown, there is a greater risk of developing problems later in life. Problems such as:

• Bunions (Hallux valgus)
• Tib post tendonitis
• Plantar fascitiis
• Osteoarthritis in the knees
• Back pain

 

 

It is important to realise that anyone can develop these problems, not just children who have had flat feet. However, by correcting this foot position by using orthotic devices such as corrective insoles, the risk is reduced. This may be of greater significance if the child has a particularly high activity level or if he or she competes in high level sport.

For more information, contact us.

HEEL PAIN

Heel pain appearing in the adolescent boy or girl is not uncommon. The pain usually arises due to one of two problems:

• Plantar fasciitis - click here for more infomation
  
  
• Severs Disease - Severs disease sounds very frightening but it is actually relatively harmless. In the immature foot, the heel bone (calcaneus) is not fully formed and has a growth plate on the back, rather like an eggshell.

Strain or damage to this eggshell layer (apophysis) can cause the pain described by sufferers in the bottom/back of the heel whenever running or walking. As the child ages, the growth plate fuses and the damage to the apophysis no longer causes any problems.

In the meantime, it is important to treat the symptoms using orthotics. Treatment includes:

• Soft silicone heel pad. The heel pad removes tension from the Achilles tendon and gives some pressure relief



• Reduce activity levels to a level which is manageable



• Ice the area and rest after hard excercise

Before any treatment is pursued, professional advice should be sought to negate any other potential problems. If you would like further information, contact us.

 

KNEE ALIGNMENT

Many parents worry about the alignment of the knees, in particular, the “knock knee” position, as shown in the accompanying picture. The correct name for this condition is genu valgum.

As with flat foot position, genu valgum is a perfectly normal position and will change in magnitude throughout growth. In cases where the genu valgum persists, there will be a greater risk of postural alignment problems and the causes should be investigated. Sometimes, it is a genetic alignment problem. It can also be due to a metabolic disorder or occasionally due to poor foot position in the overweight child which can be corrected with orthotic insoles.

Once again, it is difficult to predict the chances of resolution and assessment by a professional will give a more definitive treatment plan.

If you would like further information, contact us.

 

PIGEON TOE WALKING

A more correct term for this type of walking is known as “In Toeing”. The picture shown is a mild case of in toeing gait in a child. The common misconception is that the foot is causing the problem. In some cases, foot position does have an effect and can be treated with specially made footwear. More commonly, the rotation of the foot will be starting at the hip in which case corrective insoles can help. Note in the picture the internally rotated angle which the knee is adopting.

Intoeing can be evident from an early age. This will gradually disappear over time in most children. However, in some children, the problem will persist and it is usually a positional problem. The biggest culprit is, “W Sitting”.

In this position, the hips are forced into an internally rotated position. Prolonged use of this position will change the hip alignment. The internally rotated hip position leads to internal rotation of the knees and the feet i.e. intoeing.

Intoeing is usually only a cosmetic problem and has little effect on function other than more frequent tripping. However, it is not advisable to let it happen. The best preventative measure is to sit your infant on their bottom as opposed to their knees, even if they are more stable on their knees. If your child is going to kneel, make sure they do not sit down on their knees but instead stand up on their knees, otherwise known as high kneeling.

If you would like further information on this condition, please contact us.

 

There are many more conditions that affect children and can be improved by with orthotic treatment. For more information on orthotics for children or to discuss a specific complaint, please contact us.