Foot and Ankle Pain in Teenagers and Older Children
Do you remember when you were a teenager: the questions, the doubts, the fear you experienced? With all the things our children must learn and accept in our complex society today, the least of their concerns should be problems with physical development, especially ongoing foot pain.Among the more painful foot conditions which may develop during the teen years is a Tarsal Coalition, an abnormal connection between two bones at the rear of the foot, generally causing pain and an awkward gait.
Tarsal Coalitions and Other Causes of Adolescent Foot Pain
Generally, a Tarsal Coalition will develop in the womb, yet will not become problematic until the child ages, usually from the ages of 9-16, as the bone starts to ossify and the child becomes more active and places more stress on the bones. In some, the condition will not manifest until even later in life.
Tarsal coalitions hurt because they stop the normal motion between the bones at one of two areas:
- Between the heel bone (calcaneus) and the ankle bone (talus)
- Between the heel bone and bones of the midfoot (navicular and cuboid)
- Between the ankle bone and the bones of the midfoot
Tarsal Coalition Symptoms
- Mild to severe pain when walking or standing
- Regularly tired or fatigued legs
- Muscle spasms in the affected leg, causing the foot to turn outward when walking
- Walking with a limp
- Stiffness in the foot and ankle
As always, it is the goal of our doctors, to treat your children conservatively, without surgery. In fact, we will use every treatment protocol possible to end your child’s teenage foot pain without surgery, and we have been very successful in doing so.
Tarsal Coalitions are Often Missed
This is a diagnosis that is often missed. We often see kids who have seen several doctors and not had a proper diagnosis. We regularly see patients who have tarsal coalitions diagnosed with the following conditions:
- Ankle sprain
- Growing pains
If you have received one of these diagnoses and your child is not improving, please make an appointment to see us or another foot and ankle specialist who regularly treats children and adolescents.
It should also be noted that tarsal coalitions can be missed because the pain from a coalition may occur following an ankle or foot sprain. These type of injuries can break the abnormal connection (the coalition) between the bones. Your child may be treated appropriately for the initial injury but you may then find that he or she simply does not heal as expected.
If your child has had a foot sprain or ankle sprain that is not healing as expected, call us for an appointment if you are in the Seattle area. If not, ask that that they be evaluated for a tarsal coalition.
Diagnosis of Tarsal Coalition
There are several parts to a getting an accurate diagnosis of foot and ankle pain due to tarsal coalition.
History: We are often suspicious of tarsal coalition based on the patient’s history. A history of fairly rapid onset of achy pain affecting the foot or ankle in a child aged 9 – 16, particularly in the absence of an acute injury, would make us suspicious of tarsal coalition. We are also suspicious of a coalition if a child has suffered a foot or ankle sprain and is not healing as expected.
Examination: There are several findings on examination that are common with coalitions. These include:
- Decreased joint range of motion
- Differences in joint motion between the right and left foot
- Localized pain on the joint
- Swelling around the joint
X-rays: There are several findings that can be seen on x-ray that are commonly seen when a tarsal coalition is present. These findings are not always present but when they are they are very diagnostic of a coalition.
Sometimes we can see the coalition itself and sometimes there are bone changes caused by the coalition that can be seen on x-ray.
CT Scans and MRIs: CT Scans or MRI are often the definitive tests for diagnosing a tarsal coalition.
Treatment of Tarsal Coalitions
Conservative Treatment of Tarsal Coalition
- Orthotic devices. Custom orthotic devices can be most beneficial in distributing your child’s weight away from the affected joint, limiting motion at the joint and relieving pain. If you are not able to get a custom orthotic try an over-the-counter device. The FootChair Adjustable Arch Orthotic has the best arch height we have found on an over-the-counter arch support to transfer pressure off your joints as it is the only OTC orthotic to have an adjustable arch.
- Immobilization. Sometimes the foot must be immobilized to give the affected area time to rest. The foot may be placed in a cast or cast boot, and crutches are recommended to avoid placing weight on the affected foot.
- Injection of an anesthetic agent. Injection of an anesthetic into the affected leg may be used to relax muscle spasms, and is often performed prior to immobilization of the affected foot.
If conservative treatment does not eliminate the pain from tarsal coalition, then there are surgical options. Often the coalition itself is removed to allow more normal motion between the bones. There are a number of different options depending on which joints are involved and the extent of the coalition.
If Your Child Has Foot or Ankle Pain
If your teenager or older child is complaining of any of the symptoms above, or is you have noticed any of these symptoms, make an appointment to see Dr. Hale or Dr. Huppin as soon as possible in our Seattle office, for accurate diagnosis, treatment, and relief of his or her teenage foot pain.