Ingrown Nails and Kids

One of the most common reasons we see children and teens at Prairie Path Foot and Ankle Clinic is ingrown or infected toenails. While this is a seemingly small problem it can add up to a lot of pain. Fact is children typically won't tell their parents about this because they are afraid that fixing it will hurt. Well, sometimes it does, but not fixing it can lead to much worse problems (even bone infections). Here are some tips:

1-Begin with prevention- only trim the nails straight across. A podiatrist (not mom or day or even a nail technician) should be the only person to trim into the corners of the nail. All too often, a spike of nail is left behind by the untrained eye and this almost always leads to an infection.

2-If the nail border is a little tender, apply antibiotic ointment (such as neosporin) and a band aid for a few days. You can also soak the toe in luke warm water (or a long bath for some younger children) once or twice daily. These will help ease the pain and ward off any early precursors to infection.

3-If you see any redness or drainage, you must be seen by a doctor quickly. At our office we will make our best effort to see you that day, if not definitely by the next day. When these infections are allowed to sit and multiply, they become much worse. While an oral antibiotic can be used to calm and infection, it won't get rid of it. A podiatrist will need to numb up the toe and clean out the nail border and the infection. Otherwise it will likely return within a week or two.

4- What to do if you have continued infections? Then likely the ingrown nail should be removed. This is done with a simple in office procedure that is 95% effective.

The key to remember is if you see any signs of infection, redness, drainage, swelling at the nail border, increasing pain, fever, chills; you should seek medical attention immediately for you or your child...because yes, adults get them too!

Is your child wearing the right size shoes?

So yesterday I was out shopping and saw a GREAT deal on Kamik boots for my boys. Of course these would be for next year, so I am buying ahead and hoping they will fit. But it got me to thinking.....How many parents are putting their kid's in the wrong size shoes? So I thought I would give some shoe fitting tips.

Of course the best thing to do is to have your child professionally fitted, but what if your like me? What if you bought the shoes last spring and are checking to see if they still fit this year? Here are the tips to ensure your kids are in well fitted shoes.

• Foot-care specialists roughly agree on the “thumbnail test”. While the child is standing in the shoes, use your thumbnail to push between the end of the longest toe (not necessarily the big toe) and the end of the shoe. If your thumb can't fit, the shoes are TOO SMALL! You can also use this for width (which is commonly overlooked) You should feel at least a 1/4-inch give in the shoe’s width when pushing your thumb down the outside of the shoe at the widest part of the foot.

• Check the heel of the shoe. The child’s heel should not slip when walking. If it is too loose, your child’s foot will slide forward, crowding the toe and possibly causing blisters.

• If the shoe style is low-cut, check that the ankle bones have a good fingers width away from the shoe. The bone on the outside is lower than the one on the inside of the ankle.

• Be sure that the lace rows fit together evenly. Rows that are too wide or too narrow on either the top or bottom may indicate poor fit.

• Check the foot for any signs of irritation, redness or blistering. You should check after wearing the first few hours and then again after a full day.

If you are having your child professionally fitted, I recommend:

• Be sure both feet are sized with a Brannock device (foot-measuring tool) while your child is standing, NOT sitting. One foot may be larger than the other and you must fit to the larger foot.

• Make sure the width is measured as well. Don't discount this, the width is equally as important as the length. It may mean you can't find shoes as readily but with so many retailers carrying wide and narrow it is much easier these days.

• Shop in the afternoon as feet are a little more swollen and be sure your child wears their "normal" everyday socks.

• Fight the urge to buy bigger shoes and trying to make them last. We all want to save money, but on your children's feet is not the place to do it.

Finally be sure to check your child's shoes each season. Any child under the age of 10 will often outgrow their shoes quickly. If it goes unrecognized it can lead to blisters, ingrown nails, black nails, and other problems that us MOMS don't want to deal with. So be preventative!

When your child's heel hurts

We often see kids at Prairie Path Foot and Ankle Clinic for heel pain. Moms and Dads usually become worried when their child complains of pain or doesn't want to play or participate in sports. Heel pain in children is NOT normal! This is not a normal part of growth.

So just what is it?

The most common cause of heel pain in kids is disturbance of the growth plate to the heel bone (calcaneus) where the Achilles Tendon attaches to the foot. This is know as Sever's Disease or Calcaneal Apophysitis...which is just a fancy way of saying the heel growth plate is inflamed.

Who gets it?

It is common in children between the ages of 10-14 but I have seen cases as early as 8. It all depends on when the growth plate starts to calcify. It affects boys slightly more than girls. The most common kids I see are young athletes and seems to have a higher incidence in those who play sports where spikes are worn (baseball, soccer, football).

What are the Symptoms?

Pain is usually felt at the back and side of the heel bone. Sometimes there may be pain at the bottom of the heel or up the Achilles tendon. The pain is usually relieved with rest and aggravated with activity and sports. Squeezing the sides of the heel bone is often painful. It can even lead to limping.

How to treat it?

If your child has calcaneal apophysitis, the following is suggested:

1- Cut back on sporting activities - don't stop, just slow down for awhile until symptoms improve (if the condition has been present for a while, a total break from sport may be needed later)

2- Avoid going barefoot -wear good supportive shoes at all times, even in the house.

3- A heel lift or arch support is very important, some children even need custom made orthotics if the problem becomes persistent.

4-Decrease the inflammation - We typically use ice for 10 minutes 3-4 times per day. In some cases we also need to place the child on a short course of anti-inflammatory medication.

5-Stretching the calf muscles and sometime Physical therapy are used once the inflammation has decreased.

6- In rare cases, we need to immobilize the child in a cast boot or actual cast and crutches if the case is very severe and does not respond to other treatments.

The best advice I can give any parent with concern is to see a podiatrist who regularly treats children. It is always better to seek care early as this is the quickest way to resolve your child's pain.

Check your kids boots!

Last night I cracked up when I read a friend's , Dr. Michelle Colon, post on Facebook. She is also a podiatrist and she said her Daughters Ugg boots had a hole in them. So she posted...I gave her an early Christmas present, and be sure to check your kids boots.

I laughed OUT LOUD! Then I checked my kids boots. You won't believe what I found:

1-Check the insole- One boot was missing the insole! My son had been walking on this hard sole of the boot with no cushion and no arch support. When I asked him about it (he is seven) he said "Oh I think it came out at some time." Really?

2-Check the sole - My younger son wore his boots a lot last year and while they are still OK, they are pretty worn. I think he can hold out a few weeks, but good thing I checked them..now I have a verifiable excuse to hit the after Christmas sales!

3-Check for holes - Nope my kids didn't have any but if your children do, get out immediately and purchase new ones. In a climate like ours in Chicago, you can get frostbite with just 15-20 minutes of exposure...sometimes less!

4-Check the fit - I had both my boys put them on. My older son is really nearing the point of needing a bigger size. I checked this just by having them stand in the shoes (with the thick socks they would be wearing to play in the snow) and used my thumb to see where their toes hit. If you can't fit your thumb between the end of the longest toe (often this is the 2nd toe, NOT the big toe) and the shoe then it's time to upsize.

5-Check the lining- If the lining of the boot gets too thin...it likely isn't keeping those piggies warm any more. Again, another reason to hit the sales.

If you have any other questions about kid's shoes or boots, be sure to post them here!

Should my child run?

This is a question I get frequently. The answer is a definite maybe! My 8 year old son just ran his first 5k, our local Dan Gibbons Turkey Trot in Elmhurst. He ran it faster than my first- 30:32! When I excitedly told him we had hit the 2 mile mark, the look on his face was priceless. He thought we were almost done...but he pressed on to an impressive, strong finish!

Seriously though running is great for physical fitness and mental wellness. While each individual situation is different, for the most part running is just fine for children but there are certain things to take into consideration:

1-Shoes, shoes, shoes...oh and did I say shoes. They need running shoes just like us adults. I am not talking stride rite gym shoes here. You should go to the running specialty store and purchase the same quality shoes as you do for yourself. They are going to set you back about $50 or $60, but will save you more than that in the long run. Oh and don't forget to track them just like you would for yourself. 300-400 miles or 6 months max. Don't worry, they will likely grow out of them before that anyway!

2- Mileage should be really low for anyone under 12. I think a few 1-2.5 mile runs are the most a child should do. When they get up into middle school you can increase days as well as miles and into high school...well those cross country teams run some serious mileage.

3-Start Slow! We want to give their bodies time to get used to the pounding of running. Start them off with a trip around the block, then 2. Ease up to a mile and celebrate with a local kids 1 mile race (lots of bigger races are incorporating them). Then slowly increase until they are ready to take on their first 5k.

4-Run with them --running is a great family sport and can be good bonding as our children get older. It's also a lot safer too!

5-Sign them up for a running club. Many schools and park districts have running clubs. These are specifically designed for children and can ease them into the sport nicely. Plus they will very quickly learn about the community aspect of running.

The most important thing is to remember that if they get injured to bring them in to the doctor right away. Delay in treatment can make healing them all that much more difficult.

Finding shoes that fit...and your kids will wear!

As a mother myself, I know you always want the best for our children. Of course we do! Unfortunately as we get busy with the day to day details of life, some of the most important health issues get pushed by the wayside.

Trying to get your child to eat a balanced diet, get off the video games and exercise, finish their homework, read 30 minutes a night...who has time to think about it all?!

So its no surprise that most children come into my office wearing shoes that are too small? Yes...even my kids will be heard sometimes saying...mom my shoes hurt!

It's so common, because we are used to our own adult feet, which are no longer growing. We wear our shoes until they die, and often well past their prime. We buy shoes out of desire, but not necessity. Kids are MUCH different.

The feet of children are rapidly growing and developing and need room to do so. But don’t give them too much room. The old days of buying shoes with “room to grow” were just our parents trying to stretch the usage of the shoes. Don’t do that! Kids need shoes that fit them properly, just like you do.

So lets go through the stages of baby and toddler-hood!

Keep shoes off of your infant! Babies who are not yet walking should be barefoot or wearing socks or soft booties…nothing more. Yes they are cute, but you are doing them a diservice. Babies need to explore their feet for proper development and feel what it is like to stand and balance barefoot. They need that natural feedback, so let them have it.

What about those first few steps? Now they should start in a shoe that is flexible. You should be able to bend the shoe easily with your hands...gone are the days of the white boots! Toddlers’ feet also do not need any arch support, so don’t look for shoes that have it.

Onto ages 3 and 4 - the childs foot is rapidly changing... you may notice some in-toeing, out-toeing, toe walking, or excessive stumbling. Children this age don’t have the ability to compensate for biomechanical forces and issues like adults do. Their pediatrician may tell you that the child will grow out of it. Even so, what most commonly happens is that kids just develop the ability to compensate for those biomechanical forces and the mechanics lead to problems down the road. Identifying issues early and putting a child into a custom foot support, called an orthotic, when needed will allow the kid to develop around a more mechanically correct position. Because of this, the correction that an orthotic device provides to a child may become permanent. Not all kids need orthotics, but if you are at all concerned you should have them examined by a podiatrist who treats children.

School age- Now kids start wearing shoes that look more like your adult shoes. Many athletic shoe companies will make sizes for children. You should also buy a shoe according to the activity, just like you do for adults. For instance a running shoe for kids who enjoy running (not playing, I’m talking about running). The rule of thumb is to have about a half-inch between the longest toe and the end of the shoe.

Your child’s feet are crucial to their happiness. If you see your kid sitting out during a game, not wanting to play, getting tired when you are at the museum, wanting to ride or be carried...it's usually a sign that their feet are causing them pain. First check to see if the shoes are too small..if they have a blister, something in their shoe or another obvious problem. If nothing seems to show on the surface...stop in and a podiatrist who can usually set your mind at ease and get your child off on the right path.

Oh what are those things? What kids hide in their shoes!

This is a common quote heard at my office. Usually happens when Mom or Dad brings in a child...who recently decided to show them some interesting happenings hidden by their shoes and socks! We will start today with warts....

....otherwise known as verruca plantaris. Warts have nothing to do with hygiene. They are simply a virus that is contracted (usually at the gym, pool, locker room, or during sports). It loves the feet because they are a nice warm, often sweaty place. Warts are typically treated at home first with an over the counter medication. These will work if the wart is less than 2-3mm in size. If the wart is much bigger in size, there are many of them, or they aren't going away in 2 weeks of at home treatment...call our office. 630-834-Foot

The reason I say this is warts are very easily treated by us...typically 4-6 weekly in office treatments if they are caught when they are small. Never fear...if they are larger or they have been along for longer than you wish to admit, they will still go away, but it will take a little longer.

We use a series of in office acid treatments, that are non-painful. Note...this is not a freezing treatment...I have found those to be highly ineffective against warts on the feet. The acid treatment is especially great for kids...because it DOES NOT HURT. As a mom myself, I know getting a child to go back to an office over and over for painful treatments is IMPOSSIBLE!

Stay tuned for next weeks installment of What are those things?...Infected ingrown toenails