Cymraeg
Your foot and ankle is made up of a lot of different bones, joints and soft tissues.
Foot and Ankle
Where is it felt?
Your child’s foot and ankle is made up of a lot of different bones, growth plates, joints and soft tissues.
There are 26 bones in the foot, 30 joints and more than 100 muscles, tendons and ligaments as well as nerves and blood vessels. In children there are also growth plates which are areas of cartilage at the end of long bones which harden into solid bone as your child grows. Foot and ankle pain can be felt in your child’s lower leg, around their ankle and into their foot and toes.
The foot can be separated into different areas where pain can be felt. These are:
Ankle
The largest joint (ankle) formed between the bones of the lower leg (tibia and fibula) and the talus bone. It is the joint between the foot and the leg. It is a hinge joint that allows upward and downward movement of the foot.
Forefoot
Comprised of the five metatarsal bones, the toes and soft tissues. The forefoot acts as a shock absorber and adapts to walking on uneven ground. It also plays an important role in pushing off when walking or running.
Midfoot
The mid-foot area goes from the base of the metatarsals up to the front of the ankle. The mid-foot not only manages the forces from the body weight above, but also the twisting forces caused as the foot adapts to moving over uneven ground.
Hindfoot
The hindfoot or rearfoot area is made up of the subtalar joint, calcaneus (heel bone) and soft tissues. The subtalar joint sits directly under the ankle and allows the foot to roll inwards (pronation) and outwards (supination) which helps us to walk on uneven surfaces and helps with shock absorption.
How could it affect me/my child?
The symptoms can be felt during simple day-to-day activities such as walking, standing, exercising or when moving their foot and ankle. This can affect your child’s ability to carry out daily activities at home, school or during sports and hobbies.
Children may complain of symptoms all of the time or just some of the time. This can be during specific activity or at rest.
Why does it happen?
Feet are complex and can sometimes cause aches and pains. Children’s feet are constantly growing and changing, and problems can affect children at any age. There are many different causes for foot and ankle pain.
Problems can be congenital, meaning children are born with a certain foot posture. They can occur during growth and development which can cause pain as the child’s body changes shape. Changes to activity levels and type of activity can also cause problems (for example when increasing exercise or activity).
Children may also complain of foot or ankle pain because of an injury (for example a trip or fall). Other problems may start for no obvious reason.
Common conditions causing foot pain in children
Severs disease
The condition causes inflammation or micro trauma at the growth plate in the heel bone. This can give pain and discomfort at the heel where the tendon of the calf muscles attaches to the bone.
The condition can be caused by the bones growing at a faster rate than the Achillis tendon and calf muscles at the back of the heel. This increases the tightness in these muscles and results in a pulling force at the heel bone (calcaneum). It may also be caused by overuse of the calf muscles (such as a lot of jumping or running) before the soft growth plate in the heel bone has fused at about age 14. Symptoms are often made worse as a child is going through a ‘growth spurt’.
If you think you or your child may have Severs disease you can try the following:
- Reduce activity for a short time
- Try gel heel inserts in shoes
If that does not help then seek a referral to physiotherapy for further advice.
Is foot pain serious?
Foot pain in children is rarely serious and often will resolve with rest, activity modification and time. If it is linked to growth the symptoms will often stop being a problem when the bone stops growing.
If your child has had a recent foot and ankle injury and they are unable to weight bear, they will need to be assessed in a minor injuries department. Go to your local minor injuries unit if:
- You or your child heard a snap, crack or pop noise at the time of the injury
- They are unable to stand or walk on it
- Their foot has changed shape
- They have significant movement loss in their foot or ankle
If the following symptoms are present at the same time as the pain or you feel they are linked to the pain, please seek a medical assessment:
- Pain in the joint
- swelling, fever
- stiffness
- rash
- tiredness
- loss of appetite
Normal Variants
There are a number of common foot and ankle positions seen in children that often don’t require a referral to physiotherapy.
These positions include:
- Toe walking
- Flat feet
- In-toeing
- Out-toeing
What can I do to help myself/my child?
Some of the most important things you can do to help your foot and ankle condition are related to your lifestyle choices and general health. We have provided some useful links to help guide you through.
These links and more are discussed more in Step Two and Step Three of the 3 step process. Following the 3-step process will help you make the most out of the information on this website.
Reducing Painful Activity
In order that you give your foot and ankle a chance to recover from an injury it is important to reduced activities that make your symptoms much worse such as running or walking and standing for long periods. However it is also important to keep the foot and ankle moving to avoid stiffness of your joints and a weakening of your muscles. Consider some of the self help information below to guide you through the recovery process.
Footwear
Choosing the correct shoe is one of the most important features to get right when you have foot & Ankle pain – They are like the foundations of a building – everything else you do that follows will rely on the correct shoe being used.
Acute Injury Management
In the days, weeks and months following an injury there are lots of things that you can do to help yourself. Following the advice set out in Acute Injury Management will guide you through the ‘what to do and when to do it’ so that you give the injured structure the best chance of recovering.
Calf Stretching
The two calf muscles at the back of your leg are connected to your heel via the Achilles tendon. Calf muscles are very active during every day activities – lifting us up, driving us forward and stabilising our ankles. They can become tight as a result of daily activity, normal aging and some medical conditions such as diabetes.
Tight calf muscles place increased pressure on the foot and ankle and it is important to stretch them regularly to help improve the range of motion and reduce pain.
Foot Muscle Strengthening
The small muscles in the foot can become overworked or weakened with certain conditions or injuries. It is important to keep them strong and healthy – you can do this by following the links.
Podiatry Foot Exercise
Versus Arthritis exercises for toes, feet and ankles.
Learn more about:
Useful Videos
What can be done to help me/my child?
An assessment of your problem and treatment may be necessary if the self-management advice in Step 3 does not help. Consider seeking further help.
If you continue to be concerned about the symptoms you are experiencing and are unsure what to do contact your GP practice or ring NHS Wales 111.
