Miss Caroline Edwards

Juvenile Hallux Valgus and Treatment, or Bunions in Kids

Juvenile Hallux Valgus and Treatment A bunion in a child is an uncommon entity. Usually occurring in girls with a family history of similar toes in mother or grandmother. Treatment is usually nonoperative as the outcome of surgery is unpredictable and recurrence rates are very high. What is it? Hallux interphalangeus: Relatively simple cause where one of the toe bones is triangular instead of square so the toe points in the wrong direction. True Hallux Valgus: This is where the joint on the end of the midfoot bone, metatarsal is on the side rather than the end, hence the toe points off to one side. Why Worry It can cause pain, trouble with footwear and obviously the cosmetic appearance issue. Other things we look for Hyperlaxity: A very mobile 1st ray on inside of the foot can cause this to progress faster. Flat foot/pes planus: this means orthotics may help the pain associated with the bunion. Simple medial heel wedge orthotics through to custom made shoe inserts can be considered. Neuromuscular conditions: rarely this is the cause, most patients know they have it before presenting to me. For example, Ehlos Danlos Syndrome or Cerebral Palsy. This would change how we treat it and increases recurrence rates. Tight calf muscles often are a driver for pain. A heel raise and stretching can help this. Accessory naviculae and coalition: These are unusual congenital abnormalities of the foot bones which would show on X-ray and examination. How we treat it 1. Do nothing. Many patients just want reassurance about what it is. If it is pain free and not changing, we can leave it alone. If it were to be a problem later, it is easily treated. 2. Orthotics: These can be to correct a flat foot, help with a tight calf muscle or to stretch the toe straight. 3. Waiting, sometimes surgery is needed but the patient isn’t ready due to age, exams, the worry about recurrence. 4. Surgery: There are many different operations and it depends on the alignment of the foot clinically, on X-ray and degree of hyperlaxity that helps us choose. Basically, we realign the metatarsal and toe bone and hold it with a tiny screw and staple until the bone has healed. It is all done through a long scar on the inside of the foot. Complications Unfortunately, foot surgery carries a high complication rate. The most important in children are: Recurrence: I counsel patients that if they have surgery done as a child, under 16 years then it will recur over their lifetime. This may result in the need for repeat surgery. The later surgery is left the lower this risk is. Pain: Obviously it hurts to start with, and good painkillers are needed. The first 2 weeks are the hardest and most pain has gone by 6-8 weeks. Many patients 1 in 5 have scar sensitivity which takes times to settle (weeks to months). A few will go onto get amplified pain syndrome. Please see separate link to find out about this. Avascular necrosis: this is where the blood supply to the joint is upset and the bone collapses. This is luckily very rare but if it occurs and is severe further surgery or joint fusion may be needed. Under correction: both over and under correction are possible but as overcorrection makes shoe wear impossible, we err on the side of caution. Other risks of general anaesthetic, wound infection, slow bone healing and thrombosis are luckily extremely rare in children.

Anti Inflammatory Supplements

Anti Inflammatory Supplements These all work like a mild form of ibuprofen and along with vitamin D can assist with generalised joint pains especially due to excess sport. I would suggest purchasing and trialling a pot and if you get no benefit try the next. Obviously, any side effects stop and try the next. Below are some Amazon links but Holland Barrett also do a good range. Turmeric Currently the most popular. Very yellow and the if the capsules split they will stain. They also turn your poo a bit yellow. Some people get some mild nausea and if you do just stop them. Combination with curcumin and black pepper is common. It is not clear of definite added benefits but no clear side effects. https://www.amazon.co.uk/Turmeric-Capsules-Strength-Black-Pepper/dp/B091FKLZ7P/ref=sr_1_21?crid=2VAJNTTLZ0AS6&keywords=tumeric+supplements&qid=1645130025&s=drugstore&sprefix=tumre%2Cdrugstore%2C155&sr=1-21 Green Lipped Mussel Extract Fish based supplement. Some people don’t like flavour although good capsules do hide it. https://www.amazon.co.uk/Green-Lipped-Mussel-500mg-Capsules/dp/B07QNCTVRP/ref=sr_1_2_sspa?crid=HP3AUWXIL8VY&keywords=green+lipped+mussel+capsules&qid=1645130325&s=drugstore&sprefix=gree%2Cdrugstore%2C191&sr=1-2-spons&psc=1&smid=A17MDI9IJZP3ZQ&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUExMjFCS05aODZXQ0UmZW5jcnlwdGVkSWQ9QTA1OTUzODEyMkpYWUk3RUZER0o4JmVuY3J5cHRlZEFkSWQ9QTA2NDQ5OTkyOUFBUlpUUU9XWFpTJndpZGdldE5hbWU9c3BfYXRmJmFjdGlvbj1jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQ== Omega 3 Another fish based although there are some plant based options now. https://www.amazon.co.uk/1000mg-Softgels-Supply-Balanced-Contaminant/dp/B01BFIHWDS/ref=sr_1_6?crid=1HV7L3YH6KRL5&keywords=omega+3&qid=1645130367&s=drugstore&sprefix=om%2Cdrugstore%2C105&sr=1-6

Insoles for flat feet

Insoles for flat feet Trialling off the shelf insoles is definitely worth a try as a fraction of the cost of custom made and fit most. Below are a list of ones to consider depending on your child’s foot size. Remember they all wear flat so keep an eye and usually need replacing annually. 1. Paediatrix, Kid’s feet in motion Size 3 up to adult Kid's Feet In Motion Neutral Orthotic Insoles - PAIR - Supplied to UK Hospitals for kids with flat feet, arch pain, foot pain, poor gait: Amazon.co.uk: Fashion 2. Pro 11 wellbeing ¾ insoles Adult size 3 up 3/4 Orthotic Insole Support Helps Weak and Fallen Arches Also Plantar Fasciitis, Blue,: Amazon.co.uk: Fashion 3. Footactive ¾ insoles Up to size 3 adult (trim to size) FootActive Kids 3/4 - 3/4-Length Children's Insole SK - 11/13 UK Child, Multicolour, 11/13 UK CHILD: Amazon.co.uk: Fashion