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Posts for category: Pediatric

Pediatric Flatfeet and Sports


A flatfoot deformity is where the arch on the inside border of the foot is more flat than normal. Flatfoot deformities can occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these children have pain related to their flatfoot deformity throughout their lives. It is very important that if you have children with a flatfoot deformity that they are evaluated as soon as possible especially if your child is experiencing pain.

When the young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.

At the ages of two and three, the child’s foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. The reason that it is important to have the feet examined at this age is because the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.

Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity. Children with flatfoot deformity may have complaints in the foot such as arch, heel, or ankle pain which is generally associated with increased standing, walking, or running activities. However, since the excessive rolling inward of the arches of the foot also make the leg and knee more turned inwards.


Pediatric flatfoot deformity can be diagnosed at a very early age, but is unlikely to be properly diagnosed unless the doctor is a foot specialist, like a podiatrist, and is familiar with the intricacies of the structure and biomechanics of the foot. After speaking with the parent and child, the our foot specialists will examine the foot both while the child is not bearing weight but also while the child is standing, walking or running. Often, the family history is also taken since the foot should be examined closely if the child has a close relative who had a painful flatfoot deformity as a child or adult.

During the examination of the child, the podiatrist is looking for abnormal structure or function of the foot and lower extremity, which could lead to either problems during childhood or adulthood. X-rays may be taken of the foot if a significant pathology is noted or suspected. The more severe the flatfoot deformity and the more significant the complaints in the foot or lower extremity, then the more likely the podiatrist will recommend specific treatment for the flatfoot deformity.


If the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by the podiatrist. If, however, the child has a moderate to severe flatfoot deformity of has significant symptoms in the foot or lower extremity, then treatment is indicated.

Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by Custom foot orthotics. Custom foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child’s symptoms worse.

Very rarely is reconstructive flatfoot surgery recommended unless all other conservative treatment options have been exhausted. One minimally invasive surgery is called a SubtalarArthroereisis. It involves the placement of an implant in the space under the ankle joint (sinus tarsi) to prevent only the abnormal motion, but still allowing normal motion. This brief procedure only requires very little recovery time, and is completely reversible, if necessary.

Dr. Saffer was born with flatfeet and has been to foot specilalists his entire life. Dr. Saffer has been wearing custom foot orthotics since he was ten years old and was a competitive tennis and basketball player growing up. As an adult Dr. Saffer is able to participate in runnning and martial arts even with an excessive flattened arch.

For more information please refer to our website at

Back to School Foot Pain

After wearing flip-flops all summer, students head back to school with painful feet

As August approaches before you know it the ringing of school bells the moans and groans of students over tests, homework, relationships, and increasingly, their aching feet.

Around the Lowcountry flip-flops and sandals are the summer footwear of choice for many students. But while these sandals are inexpensive and stylish, they don't cushion or support the foot, leading to problems. After wearing flip-flops all summer, some students will head back to school this fall with foot pain and even injuries. The American College of Foot and Ankle Surgeons (ACFAS) reminds parents and students that foot pain isn't normal and can be reduced or eliminated.

People often don't realize that even into your mid-teens, there's new bone growing in your heel. Flip-flops don't cushion the heel, so repetitive stress from walking can inflame that heel bone growth area and cause pain and tenderness. Calcaneal Apophysitis or Severs Disease is a common foot condition that we see in children. This condition is an inflammaiton of the growth plate of the heel. We have noticed an increasing trend in this form of heel pain especially in young athletes playing year round sports.

Heel pain and arch pain rank among the most common complaints among students who wear flip-flops. Other flip-flop feet problems students can take back to school include inflammation of the Achilles tendon, painful pinched nerves, sprained ankles, broken or sprained toes, cuts and scrapes, plantar warts, Athlete's foot, and callus build-up on the heels and toes.

Foot and ankle surgeons can usually reduce or eliminate students' foot pain with simple treatment methods including stretching exercises, ice massage, anti-inflammatory medications, and custom or over-the-counter shoe inserts.

Back to school season will always be painful for some students, but it doesn't need to involve foot pain. For more information on foot and ankle health conditions please refer to our website at


Ingrown toenails occur when the toenail starts to curve into the skin along the side of the nail.  There a number of reasons that ingrown toenails can develop.  Just like you inherit genes for eyes and hair color you can also inherit that way your toenails grow. The way your toenail is shaped can cause you to be more prone to developing ingrown nails.  Playing sports and wearing a tighter toe box shoe can also cause ingrown nails from the constant pressing of the skin into the nail.  If you notice your child complaining of pain around their toenail, look for signs of an ingrown nail such as sweilling and  redness around the skin surrounding the nail.  Initially home treatment such as soaking in Epsom salts and applying antibiotic ointment can help to soften the skin surrounding the nail.  Using a band-aide can help to protect and alleviate pressure in shoes which could increase the severity of pain.  If the puffiness or redness in the skin persists, then you should call and make an appointment. Attempting to remove the ingrown nail at home bathroom surgery) is risky and could potentially cause an infection. 

Feel free to contact us at our West Ashley or Mt. Pleasant offices for same day/week appointments.

By drsaffer
September 07, 2010
Category: Pediatric

Check Children's Feet Before School Starts -
Back to school season is underway, and we would like to offer some advice to parents regarding their children's feet.
Take five minutes to inspect your children's feet for problems that could sideline your son or daughter from sports or other activities.Parents should look for the following warning signs:
1) Do your child shoes show uneven wear patterns on the sole of the shoe?
2) Does your child walk irregularly? Is one leg longer than the other or do their feet turn in or out excessively?
3) If your child is in pre-school do they walk on their toes?
4) Does your child often trip or stumble?
5) Does your child complain of tired legs, night pains and cramping?
Following this checklist can uncover common problems like ingrown toenails to more serious problems like flat feet. If your child's shoe is worn on the big toe side of their foot, it could be a sign of poor arch support or flat feet.
Parents can spot several potential foot problems by observing how their kids walk. If you find out one of your child's legs is longer than the other, heel lifts may be required to restore proper balance. Early intervention can prevent scoliosis, a curvature of spine, later in life.
Younger children can often walk on their toes because of tightness in their Achilles tendon. This can happen when toddlers spend too much time in walkers. A foot and ankle surgeon can recommend stretching exercises that can be fun for small children and help prevent lower back pain as they get older.
For older children beginning college, heel pain and shin splints can plague freshmen not used to walking long distances across campus to attend classes. We typically see students every fall complaining about pain from walking so much everyday. For most students, daily stretching and proper walking shoes can solve the problem. If there are foot deformities like hammertoes, surgery may be advised to make walking more comfortable.
If your chldren are complaining about tired legs, heel pain or leg or foot cramps at night, consider that a warning sign and see a doctor. Leg and foot pain can indicate flat feet or other disorders that are easier to treat the earlier they're diagnosed.
Children with flat feet are at risk for arthritis later in life if the problem is left untreated.

For more information on various foot conditions in children please visit our website at