Pediatric Care

Foot problems are common in children due to their high levels of physical activity, but it is easy for the signs and symptoms of underlying foot issues to go unnoticed because of children's resiliency.

Common symptoms to look out for:

  • Ankles turning in more than usual
  • Foot arch flattening
  • Warts and Ingrown toenails


Pediatric Flatfoot - partial or total collapse of the arch. Flatfoot can be apparent at birth or it may not show up until later years. Most children with flatfoot have no symptoms, but some have one or more of the following:

  • Awkwardness or changes in walking
  • Difficulty with shoes
  • Outward tilting of the heel
  • Pain, tenderness in the foot, leg and knee

Nonsurgical Treatments of Flatfoot

If a child has no symptoms, treatment is often not required. Instead, the condition will be observed and reevaluated periodically by the foot and ankle surgeon.

Custom orthotic devices may be considered for some cases of asymptomatic flatfoot.

When the child has symptoms, treatment is required. The foot and ankle surgeon may select one or more of the following nonsurgical approaches:

  • Activity modifications: The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing.
  • Orthotic devices: The foot and ankle surgeon can provide custom orthotic devices that fit inside the shoe to support the structure of the foot and improve function.
  • Physical therapy: Stretching exercises, supervised by the foot and ankle surgeon or a physical therapist, provide relief in some cases of flatfoot.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
  • Shoe modifications:The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with flatfoot.
  • Toe walking, in-toeing and flat or high arches.

While these conditions and their treatments are different, they share some common signs that show parents there is a problem that needs addressing by a foot and ankle surgeon:

  • Ankles that are weak or easily give out
  • Development of thick calluses in one area of the foot
  • Pain, swelling and redness that does not subside
  • Problems with the way your child walks (gait)
  • Shins or thighbones that appear to turn inward

A variety of treatment options for these conditions is available that parents can evaluate in partnership with their healthcare team. Whether a less invasive approach, such as shoe modifications, orthotic devices and physical therapy, or more intensive interventions, such as bracing, steroid injections or surgery, a foot and ankle surgeon can advise parents on which treatment offers the best long-term prognosis for their children.

Field Sports Injuries:

Spring and summer bring longer days and, for many children, lots of outdoor activity.

The American College of Foot and Ankle Surgeons (ACFAS) reminds parents and coaches that increased participation in outdoor sports can also increase the number of foot and ankle injuries, particularly for children who play field sports.

Ankle sprains alone account for 10 percent of all injuries seen in emergency departments. ACFAS calls for parents and coaches to educate themselves on the signs of foot and ankle injuries and to seek treatment early.

Childhood Obesity Linked to Foot Pain

Physician members of the American College of Foot and Ankle Surgeons have noticed a link between foot pain and childhood obesity.
A vicious cycle occurs with overweight children. They should exercise and lose weight, but because of their weight, their feet hurt and they cannot exercise. An estimated 16 percent of U.S. children ages six to 19 are overweight, and doctors are starting to see more overweight and obese children with foot and ankle pain.

Being overweight can cause many problems in the feet. For example, the pressure of extra weight causes a flattening of the foot, resulting in strain on the plantar fascia (the band of tissue which runs from the heel to the base of the toes), a primary cause of heel pain. Foot and ankle surgeons may treat overweight children with custom orthotic devices (shoe inserts), physical therapy and other conservative measures to reduce and eliminate pain. Parents should also watch their child's lifestyle and diet.

Congenital Pediatric Foot Deformities

Dr. Fernandez will diagnose and treat all types of pediatric congenital foot deformities in children, from newborns to teens and young adults. They will work hard to find the right way to correct your child's congenital foot deformity, so they can develop normally and reach their full potential.

What are congenital foot deformities? Congenital (means the child was born with the condition) foot deformities can affect feet, toes and/or ankles. Many congenital foot deformities are common, like clubfoot; 1 in 1,000 children are born each year with a clubfoot. Other common congenital foot deformities include vertical talus, tarsal coalition, polydactyly, macrodactyly and cleft foot. Some congenital foot deformities have a genetic background, which means someone in your direct family history had the gene that caused the condition, and it was passed to your child.

Treating congenital foot deformities:

  • Casting
  • Custom orthoptics
  • Manipulation and splinting
  • Surgery

Foot Health Facts for Children
Pain in a child's foot or ankle is never normal. There is no such thing as "growing pains." Any pain that lasts more than a few days, or that is severe enough to limit the child's walking, should be evaluated by a foot and ankle surgeon.

Foot problems commonly experienced by children:

  • Pediatric Flatfoot: Most children with flat feet have no symptoms. However, sometimes they may have trouble participating in physical activities or sports or may appear to walk or run awkwardly. Some complain of pain or cramping in their feet, legs or knees. Any pain or difficulty with a child's feet should be evaluated.
  • Calcaneal Apophysitis (Sever's Disease): Calcaneal apophysitis is a painful inflammation of the heel's growth plate. It typically affects children between the ages of eight and 14 years old because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.
  • Ingrown Toenails: Tight shoes or socks or incorrect nail trimming are the most common cause of ingrown toenails in children, although sometimes the tendency for nails to curve inward is inherited. When the nail breaks the skin, serious infections can result. Parents should never try to dig the nail out at home; treatment by a doctor is advised.
  • Plantar Wart (Verruca Plantaris): Warts can develop anywhere on the foot, but they typically appear on the bottom (plantar side) of the foot. Plantar warts, which are caused by the human papilloma virus, the same virus that causes warts on other parts of the body, commonly occur in children and adolescents. These warts grow deep into the skin and can make walking or standing painful.