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.