Pediatric Conditions of the Foot and Ankle
In general kids are resilient and tend not to have foot pain. When kids do have foot pain that lasts more than a few weeks it is good to have them examined by their pediatrician, and potentially a specialist. Believe it or not, kids can suffer from many of the ailments that adults do. Bunion deformities, hammertoes, painful flatfeet, tarsal coalitions, ankle sprains, heel pain, and Achilles tendinits. There are also multiple congenital anomalies that can be seen in children that may need to be addressed if it causes dysfunction and pain.
Doctor Adams is a Fellowship Trained Foot and Ankle Surgeon who completed specialty training in pediatric surgery. He works closely with pediatricians to get children pain free, and back to their busy activities.
If you have a pediatric foot or ankle issue and have questions or concerns, please feel free to call Doctor Adams at (317) 477-6683 or schedule a consultation online.
Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his surgical residency where was Chief resident. He stayed in Indianapolis and completed a Fellowship focusing in Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.
Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.
He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.
Dr. Adams has special interests in the following areas:
Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.
A tarsal coalition is simply the abnormal connection of 2 or more bones in the foot/ankle. This connection can be made of bone, cartilage, or fibrous tissue. It is often diagnosed during a clinical visit/evaluation of the patient, and can be confirmed with X-rays, CT scans and MRIs.
There are plenty of asymptomatic tarsal coalitions that people have everyday that never need treatment. In those instances ignorance is bliss. In other cases where a patient (often a child) has pain, and often a flat foot, a tarsal coalition should be ruled out. Treating a flat foot that is caused by a tarsal coalition is very different from treating a pediatric flat foot that is without this condition.
Fortunately there are good conservative and surgical treatment options for symptomatic tarsal coalitions.
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Pediatric Flatfeet (Juvenile Pes Planus)
Flat feet can bother both children and adults alike. The severity of the condition often dictates when the condition manifests. In instances where a flat foot is painful during childhood it is because the condition is more severe.
The condition is best diagnosed through a thorough physical exam, and x-rays. Diagnosing the deformity is actually more accurate with a xray, rather than an MRI as x-rays are taken while the patient is bearing weight – which provides a more accurate depiction of the bony architecture of the foot. While this is true – sometimes a MRI is still ordered to rule out a tarsal coalition.
Our first treatment option for symptomatic flat feet (pes planus) in children is always to utilize orthotics (shoe insert). This can help support the arch and take pressure of ligaments and tendons that are responsible for supporting the foot. This insert does not necessarily need to be an expensive custom device.
Children often complain of pain first by suggesting their “feet hurt”, or they are “tired of walking”. Occasionally, this is simply due to a long day of activities and can be associated with growing pains. When the complaint becomes recurrent this is when we recommend evaluation by a specialist.
When conservative care fails to allow resolution of symptoms to an acceptable level surgical intervention is appropriate.
The surgical options for pediatric flat feet are similar and also dissimilar to the procedures utilized to correct adult flat feet. Both the Evans and Cotton osteotomies are procedures routinely utilized due to their utility, and predictability. In more mild cases soft tissue procedures, and an arthroeresis procedure may be appropriate. These decisions are carefully made with the patient, surgeon and parent.Request Consultation
Toe walking past the age of 2 is generally considered by specialists as abnormal. When children are learning to walk it’s normal for the heel to not contact the ground, and for the gait to be unsteady. However, past the age of 2 this type of gait becomes problematic, and long term can cause other lower extremity developmental issues.
The first line of treatment is often to use a pediatric physical therapist to evaluate and treat the condition. This oftentimes for mild to moderate cases works very well, and can remedy the condition. This will often be paired with braces or splints.
In more severe cases surgical lengthening of the achilles tendon needs to be performed. This typically is not recommended before the age of 4-5. Thankfully in most instances can be performed through a minimally invasive approach that does not even require skin sutures. Kids heal fast and they tend to recover from this long term with reportedly few ill effects.
After surgery walking cast(s) are typically applied, and after 4-6 weeks removed. Physical therapy is then recommended to regain strength, and maintain correction.
In all cases of toe walking it is important to rule out neurological causes. If there is any consideration that neurologic disease may be lending to the issue, we will refer to a neurologist for further evaluation.