Children with Down syndrome can experience a wide range of orthopaedic problems due to their loose ligaments and hypotonia. These problems include scoliosis (side-to-side curvature of the spine), joint dislocation, hop and knee cap instability, weak ankles and problems with the feet including flat foot and metatarsus primus varus. Today we are going to have a look at the feet issues.

Nik Nikolopoulos, Director of Podiatry at the Port Philip Specialist School in Port Melbourne points out that problems with feet “come to the fore when children start walking, as certain physiological differences are compounded by gravity. For example, if a joint is unstable and you add gravity to that, it just gives the joint greater license to go where it wants to go and do what it wants to do, which affects the muscles and the rest of the body.”

Flat foot is seen in the vast majority of people with Ds. In mild cases, the heel is in a neutral position. In severe cases, the heel rotates so that the person is walking on the inside of the heel. Flat feet result in heavy calluses of the feet, pointing of the front part of the feet away from each other (the opposite of being ‘pigeon-toed’), and even the creation of bone spurs in the feet. Many cases respond to special shoes or orthotics, but severe cases may need surgical correction.

Metatarsus primus varus is also commonly seen in people with Down syndrome, and is the condition in which the front part of the foot behind the big toe bends inward.  (In the picture, it’s the foot on the right that has the problem.) This creates an obvious deformity of the foot, making the task of finding shoes that fit more difficult.  If the condition exists long enough, a painful irritation called a bunion appears at the spot where the foot bends in the most. Again mild or early cases of the varus may be treated with orthotics or special shoes, but severe cases may require surgical correction.

There are two prominent types of orthotic shoes that are widely used for children with disabilities, Piedro boots and Ricosta Shoes.

Piedro boots are designed for children who require an extra arch or ankle support to fit into. They look similar to a normal boot but open closer to the toes so they are easier to put on children particularly if their toes curl. Piedros can help to maintain a good foot position for standing and walking and can be tried before other orthotic devices, such as Ankle Foot Orthosis (AFO’s) are used. They are available in several widths and sizes. An Orthotist should measure your child’s foot, and then size the boot accordingly. Then, depending on the correction needed, will identify which boot, trainer or sandal may be used in a variety of styles and colours. Piedro’s also have removable insoles in case they need to be replaced by custom made ones designed and manufactured specifically for an individual child’s foot.

Riscosta is a leading German brand of children’s shoes. They are not specifically aimed at children with orthotic problems but because of their lightweight soles and the fact that they are made from high quality leather, which is breathable, comfortable and durable they are ideal for feet that need an extra bit of care. They come in 3 different width sizes, slim, medium and wide. Riscosta’s are available in many good shoe shops, and great pride is taken to accurately measure the child’s feet. Half of the sole consists of air, this is what makes these shoes so lightweight, which makes it easier for children to walk, and to run faster. They are very flexible shock absorbing shoes, which also provide very good insulation.

So to sum up, good foot care is really very important because problems that affect a child’s gait or posture for any length of time can tend to affect the rest of their bodies, especially the back. Deformities that are caused by poor choice of footwear can cause a lot of suffering in later life. It is a good idea to let toddlers go barefoot until they really need outdoor shoes, if they need something warm to wear indoors, let them wear loose-fitting socks with grip soles. Lightweight shoes are great to start off with, and remember to make sure their socks are not too tight either for their growing feet. Sometimes tight socks could deform little feet as much as tight shoes. It is a good idea to have your child’s feet measured regularly, about every 3 months or so and if possible by a trained shop assistant. It’s never ideal to pass down shoes to younger children, and particularly so when there are special feet involved that need extra care. There should be about an empty finger’s width or so at the tips to give the feet room to grow. But make sure too that the shoes are not too loose, this is no good either as children then just tend to screw up their toes to keep the shoes on.

References:

http://www.podiatryvic.com.au/FHW/pdf/Little%20feet%20get%20special%20care.pdf

http://www.ds-health.com/ortho.htm

http://www.specialkidsintheuk.org/Medical/Orthotics.php

http://www.ricosta.com

http://www.drlockie.com/article_disease_view.fcm?articleid=13458&subsite=3