Updated: Aug 13, 2018

Summer-time is here and so are the injuries. Clinics, urgent care centers, and emergency departments become busy with sports, and other pediatric-related, injuries as kids remain activity during summer break. Below are 4 common lower extremity complaints and problems children will face this summer, along with their treatment options and ways of prevention.



Flat foot deformity (sometimes referred to as “fallen arches”) is a complex condition that can differ in presentation, symptoms, and ways in which it is treated. It is often inherited and progresses over time, which can cause further lower extremity problems, including arch pain, bunion deformities, shin splints, along with knee and back problems. Even though a child’s feet can develop arches over time, by the time the child hits about 8-10 years of age, the arch has typically formed so beyond that point there is likely no chance of further development.

Treatment Options:

Treatment depends on the severity of the deformity and the presence, or absence, of pain. In children, this often means making sure they are wearing proper athletic shoes and adding an orthotic that will help realign the lower extremity, thus making it biomechanically efficient. Activities do not need be limited, as long as the child is not in pain.


Parents often ask whether or not they should have brought their child in sooner to prevent them from developing flat feet. The answer is not necessarily. If children are asymptomatic, it is not always necessary to treat the flat feet. There are several adults who have lived with flat feet their entire lives and do not have pain. Furthermore, the treatment options could have been the same: proper shoe gear and inserts.



Ingrown toenails can occur for a variety of reasons, including ill-fitted shoe gear and improper trimming of toenails. If there is additional increased redness, swelling, and purulent drainage, there is an infection associated to the ingrowth of the nail. This is called a paronychia.

Treatment Options:

If there is no associated infection, you may be able to soak the toe in warm water with Epson salt. If there is no improvement to the toe, or if it worsens, it is important to consult your doctor as the child may need to be put on antibiotics or even have the ingrowth section(s) of the nail removed.


  • Shoes that fit properly both in length and width

  • Cut the toenails straight across instead of with rounded corners



Plantar warts (aka verrucas) are skin lesions that develop along the toes or bottoms of the feet. They are caused by the human papilloma virus (HPV) and often look like a callus. Depending on the size and location, they can be painful.

Treatment Options:

Some warts may resolve on their own over time without treatment. If the wart becomes tender and at-home, or over-the-counter, remedies do not work, additional treatment options are available by visiting your healthcare professional. These treatments may include prescription topical medications, cryotherapy, canthrone, laser, and surgical excision. You and your doctor can discuss the details of the above treatment options, but several of them may require multiple treatments spaced weeks apart from one another.


  • Avoid touching the wart. Warts are often called “kissing lesions”, meaning that a wart on one side of the toe can spread to the adjacent toe just from rubbing against it. Therefore, you should prevent things from coming in contact with the wart.

  • Avoid walking barefoot and sharing personal items with other.



Sever’s disease is a condition that occurs at the heel growth plate region. It is more common in young boys, around the ages of 8-11 years. The pain is present with activities, as the soft tissue structures (Achilles tendon & plantar fascia) pull along the heel bone, irritating the growth plate and causing inflammation and pain around the heel.

Treatment Options:

Unfortunately, the child’s symptoms often last until the growth plate closes during their teenage years. Until that time, treatment is directed at pain relief.

  • Rest, modification of activities, & Immobilization – The pain is often associated with activities, so depending on how severe the pain is will determine how much the child’s activities need to be modified.

  • Orthotics to supports the foot


DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare provider, should you have questions related to your, or your child's, health.


1. Calcaneal Apophysitis (Sever's Disease). Retrieved from http://www.acfas.org/Content.aspx?id=1483.

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