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Active Living
Full Listing with story descriptions
A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
Athletic Skin Infections
Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
Core Stability
Cross Country Skiing
Exercise and Disabilities
Exercise and Menstrual Irregularities
Exercise in the Cold
Exercise in the Heat
Exercise is Medicine
Exercise Options
Exercising in Pregnancy
Female Athletes
FITT Prescription
Footwear for Running
From Surviving to Thriving
Flexibility
Gadgets & Gizmos
Get Moving!
Get Motivated
Golf Exercises
Golf Injury Prevention
Head Injuries
Hockey Injuries
Home Gyms
Immunization
Jump Start Weight Loss
Knee Cap Pain
Knee Ligament Injuries
Live Actively
Low Back Pain
Osteoporosis & Exercise
Osteoarthritis
Osteoarthritis of the Knee
Plantar Fasciitis
Prehistoric Workout
Prevention of Sports Injury
Proprioception
Recreational Safety Equipment
Running
Safe Snow Shovelling
Shin Splints
Ski Conditioning
Shoes & Fit
Sore Elbow
Sore Shoulder
Spinal Cord Injuries
Staying Active
Staying Fit in the Cold
Sports Nutrition & Supplements
Strength Training
Swimming Injuries
Teen Sports Injuries
Walking
Water and Exercise
Weight Training
7 Wonders of Walking
Adolescent Health
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Acne
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Adolescent Growth & Development
Body Image
Body Piercing
Bullying
Chronic Diseases in Teens
Communications Skills
Concussion in Sport
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Dangers of Artificial Tanning
Depression
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Female Physical Exam
First Period
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Junior High
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Mononucleosis
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Teens & Exercise
A Woman's Physical
Your First Job
Youth Violence
Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
Birth Plans
Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
Care for the New Mother
Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
Diabetes in Pregnancy
Eating Well for Pregnancy
Evolving Ideas about Pregnancy and Birth
Exercise in Pregnancy
Flying During Pregnancy
Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
Induction of Labour
Infections During Pregnancy
Intrauterine Growth Restriction (IUGR)
In-Vitro Fertilization
Low Birth Weight Babies
Medication & Pregnancy
Miscarriage
Managing Your Own Labour
Monitoring Your Labour
Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
Preterm Labour
Planning a Pregnancy
Pregnancy Weight
Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
Childhood
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Asthma in Children
Attention Deficit Disorder
Babysitter
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Chickenpox
Childcare Options
Children's Headaches
Childhood Obesity
Choosing A Babysitter
Circumcision
Colds & Flu
Common Childhood Skin Infections
Croup
Developmental Milestones
Diaper Rash
Daytime Wetting
Introducing Solid Foods
Developmental Co-ordination Disorder
Diarrhea
Discipline
Earache
Eczema
Feeding Your Baby
Feeding Your Toddler
Fever
Head Lice
Hearing
How Children Grow
Hearing Loss
Hearing Issues in Newborns
Heart Murmers
Hip Clicks
Influenza
Iron
Is it an Emergency?
Children and Sports Injuries
Lazy Eye (Amblyopia)
Learning Disabilities
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Not Just Baby Fat
Orthodontics
Preparing for Lab Tests
Recognizing Learning Disabilities
Red Rashes
RSV-Childhood Respiratory Virus
Safe Summer Fun
School
Scoliosis
Sick Toddler
Sleep Struggles
Sniffles, Fevers, Rashes & Coughs
Sore Throats
Speech Problems
Strep Throat
Toddler Safety
Thumbsucking
Tooth Injuries
Tummyache
Urinary Tract Infections
Vaccinations
Vaccination and Autism
When to go to the Doctor
Whooping Cough
Worried Sick
Yeast Infections in Children
Chronic Pain
Full Listing with story descriptions
Introduction
Managing Your Pain
Movement Matters
Moving Forward
Nutrition
Opioids
Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
Cosmetic Dentistry
Mouth Guards
Dental Exam
Dental Care Devices
Dental Caries
Dental Care Offshore
Dental Implants
Dental X-Rays
Dentures and Healthy Jaw
Esthetic Dentistry
Fluoride
Fluoride Findings
First Dental Visit
Headaches
A Healthy Mouth
Healthy Mouth, Healthy Body
Jaw Joint and Muscle Problems
Keeping it Clean
Laser Use in Dentistry
Mouth Protection Equipment
Oral Cancer Screening
Oral Healthcare
Oral health and long term care
Oral Health Care Products
Orthodontics
Orthodontist First Visit
Painless Dentistry
Periodontal Disease
Removable Dentures
Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
Insulin Handling
Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Traveling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
Full Listing with story descriptions
ADHD in Children
Allergic Rhinitis
Allergies
Antibiotic Use
Arthritis
Aspirin Every Day?
Asthma
Back Pain
Back Pain Myths
Back Pain - Lower
Birth Control
Bladder Problems
Blood Transfusions
Breaast and Prostate Cancer Screening
Carpal Tunnel Syndrome
Check-Up
Colon Cancer Screening
Contact Lenses
Contraception
COPD
Cost of Doctor's Visit
Diabetes Management
Diarrhea
Diagnostic Tests
Do I Need a Bone Density Test?
Doctor Visit
Driving Vision
Dizziness
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Does My Sore Knee Require an MRI?
Do I Need an Annual Physical?
Eczema
Electronic Medical Records
Epilepsy
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Family Doctor
Fibromyalgia
Floaters and Flashes
Food Poisoning
5 Ways to Stay Healthy
Gallbladder
Get Active!
Glare
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Healthcare Teams
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Hepatitis C
Human Papilloma Virus
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How to Talk to Your Doctor
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Lazy Eye Blindness (Amblyopia)
Medical Digital Technology
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Opioid Myths
Primary Healthcare Reform
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Restore Your Core
Rosacea
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Stroke
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Vaccination Controversies (ask the doctor)
Win by Losing
Urinary Tract Infections
Vision Flickers
First Aid
Full Listing with story descriptions
Bites and Stings
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Cuts and Scrapes
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Fainting and Convulsions
First Aid Travel Kit
Hypothermia and Frostbite
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Poisoning - Household
Emergency Care Guidelines
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Growing Older
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Advance Care Plans
Age-Related Macular Degeneration
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Get Active!
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Have Health, Will Travel
Health Tips for Seniors
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Maintaining Quality of Life as You Age
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Travel Tips for Snowbirds
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Modern Living
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Abuse
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Barbecue Basics
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Bisphenol A
Canada's New Blood System
Caring for a Loved One Dying at Home
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Diabetes Epidemic
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Physiotherapy Visit
Planning for End of LIfe
Reproductive Freedom
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Schizophrenia
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Sexually Transmitted Diseases
Soy
Stigma of Mental Illness
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Stress in the Workplace
Stress Leave
Swim to Survive
Sunburn
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5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
Body Image
Breakfast is Important
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Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
Food Allergies
Food for Active Kids
Fast Food
Food Labels
Giving Up Gluten
Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
Fat Phobias
Fats & Cholesterol
Feeding Your Kids
Fibre
Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
Herbal Medicine and Nutrition
New Ingredients for Your Shopping Cart
Iron
Kid's Food
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Meal Planning with Planned Overs
Mercury Levels in Fish
Night Snacking
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Nutrition Questions Top 5
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Preventing Cancer Through Nutrition
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Power of Fruits & Veggies
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After a Heart Attack
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Changing Role of the Pharmacist
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15 Great Reasons to Breastfeed
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Family Health Magazine - CHILDHOOD

Children's Leg Problems
Spotting and treating them

Parents and grandparents often notice that the legs and feet of the new baby in the family seem to be less than perfectly straight. Does the baby need special shoes or a brace? Will the child grow up looking funny or clumsy? Children’s legs are often not perfectly straight. Many variations are seen which are actually perfectly normal.

The shape of the leg is called its alignment, a trait usually inherited from a parent. Leg alignments in the normal adult population vary. There may be a slight tendency to toe-in or to toe the feet outwards. These alignments express the variations in people much the sameas variations in colour of hair. If your child has a tendency to toein, it will be most marked at birth when the in-toeing muscles are not well balanced by the out-toeing muscles. However, as your child grows and muscle balance improves with walking, the in-toeing alignment will
become less apparent. Other common alignment variations in children are bow legs, knock-knees and flat feet.

Toeing In

Toeing-in describes a method of walking where the toes or feet point inwards rather than straight ahead. The easiest way to explain toeing-in is to think of the leg as having three zones (Fig. 1). Zone 1 will be the foot, zone 2 will be the shin bone (between the ankle and the knee) and zone 3 the thigh (between the knee and the hip). One or more of these zones may be involved in causing toeing-in.

Zone 1: Foot (Metatarsus Varus)

Metatarsus VarusToeing-in which is due to a variation in the foot only is called metatarsus varus. The foot is bent inwards and curved like a banana. The space between the first and second toe tends to be increased (Fig. 2). This foot position is most obvious when the baby begins to stand.
If the curved part of the foot is flexible and corrects easily with light finger pressure, it is classified as mild and will generally correct itself. If the foot is curved enough to form a crease in the arch area and requires moderate or significant pressure to correct, more in-depth treatment by a doctor is recommended.

The moderate and severe cases will require the foot to be held in the corrected position by a
“straight last” shoe or leg casts. In severe cases, stretching casts will be applied to increase flexibility before the straight last shoe can be worn comfortably. The curved foot will gradually straighten as the child wears the straight last shoe. Surgical correction is rarely necessary.

Leg Alignment - normal rotation, Internal tibial rotationZone 2: Shin Bone (Internal Tibial Torsion)

Toeing-in may be due to the twisting inward of the shin bone, called internal tibial torsion. It can be recognized by laying the baby down with the knee bent, then turning the foot inwards and outwards (Fig. 3).

Normally the foot will turn the same distance in each direction. With internal tibial torsion, the foot can be rotated farther toward the inside and less toward the outside. When a child toes-in due to internal tibial torsion, it will become evident with walking. The feet turn inwards while the knees remain facing forward. The foot will be a normal shape.

A Parent’s Guide to Childrens Legs

If the internal tibial torsion is mild, it will correct itself after a year or two of walking (normally about age three years). If the torsion is moderate or severe, a doctor should be consulted.

Treatment may consist of exercises or a splint worn for about three months only at night, which helps rotate the lower leg outwards. If the outturning splint is applied before the child begins to walk, correction will occur but it will be difficult to hold because muscle imbalance is still present. When the child begins to walk however, muscle balance improves and use of the splint will be much more effective and lasting.

If the splint is used, it should be started when the child reaches walking age, continued for about 12 weeks and applied at night. During this time, increased out-turning flexibility is achieved and, hopefully, through muscle strengthening and improved muscle balance the position will be maintained. The out-toeing splints become less practical as the child gets older and are not used after age two to two-and-a-half. Balanced muscle development in the child’s lower limb usually requires up to two years of active walking. Do not be surprised if a younger child toes-in more when tired, as the muscle imbalance will be more pronounced at these times. Sometimes after reasonable correction of toeing-in has occurred, the condition will seem to recur. This may happen at times of rapid growth. Improvement will occur as the growth spurt slows down and muscle balance is re-established.

Zone 3: Thigh (Femoral Anteversion)

TV or "W" positionZone 3 toeing-in or femoral anteversion is the result of the entire leg turning inwards at the hip. The knee and the foot both point inwards. This type of toeing-in is more common in girls than boys. When it is present the child is able to sit in the “W” position or the TV position (Fig. 4). Femoral anteversion usually becomes most obvious after age six. Because the entire leg turns in, the child’s knee caps appear to have rotated inward instead of pointing straight ahead when standing or walking. When running, the style is awkward. The feet and lower legs swing out to the side, while the knees are together. This type of toeing-in worsens with rapid growth and improves as muscle strength and co-ordination catch up to the rapidly growing bone.

There are no simple treatments that are effective in correcting severe femoral anteversion. Happily it is usually mild to moderate. With maturity and increased activity, the child gains control over the lower legs and positions the feet pointing more forward.

The child is asked not to sit in the “W” position and is encouraged to participate in parallel type sports such as skiing and skating. As well, gymnastics and ballet help strengthen those muscles of the lower leg that keep it turned correctly and help to improve walking. Sports that involve prolonged running are very difficult for these children and may cause aching in the knee or foot. A knee brace may be helpful to ease ligament strain at the knee.

In rare instances, where femoral anteversion is severe and does not improve, surgical correction after age 10 to 12 is sometimes necessary.

The Flat Foot

The flat foot is a common cause of parental concern. Will the child have a disability in later life
because of this? Will the child have sore feet? When assessing the flat foot, it should be remembered that a child’s arch does not appear until about age three. Before that age, although the arch is present, it is not visible due to a fat pad in the arch area. This makes the foot appear flat. There are two types of flat foot. The most common type is the flexible flat foot (which is often inherited). The other type of flat foot is the rigid flat foot.

Flexible Flat Foot

Diagram: Normal foot / Pronating footThe diagnosis of flexible flat foot is made by asking the child to stand on tip-toes. In this position the arch of the foot appears. When the child stands with the foot flat on the floor and is viewed from behind, the heel appears tilted and the ankle may slant inwards (Fig. 5). This foot position is called pronation and is very common among children. It can cause aching in the foot after prolonged activity and results in an abnormal shoe wear pattern. The child’s shoes show excessive wear on the inside edges of the soles. The flexible flat foot or pronating foot can be divided into mild, moderate and severe. If the pronation is mild, it will correct spontaneously in early adolescence. In the moderate to severe types of flexible flat foot, sometimes treatment is necessary. It is important to begin with simple methods of management.

Running shoe design has come a long way in the past 20 years, and anti-pronation runners, such as a cross trainer or jogger are available in many styles. The runner is designed with a very strong heel cup and a very strong sole that cannot be twisted. extends from the heel cup area of the foot into the arch area. In moderate to severe forms of pronation, the child may experience aching in the arch area and have significant wear on the inside of the shoe. Sometimes arch supports or orthotics are indicated for these children.

Pronation usually gets better as the child gets older. If however, there is a family tendency towards pronation, it may persist and require lifelong support to help ease aching feet. Surgery is reserved for the severe, persistent flat foot with significant aching.

Rigid Flat Foot

The rigid flat foot comes in two varieties. The most common form is an inherited absence of the arch, pes planus. The foot is otherwise completely normal with a straight heel and ankle. With tip-toe walking, the arch does not appear. The foot functions normally, but may not be as well suited to prolonged running. An arch support placed in the shoe is painful and not well tolerated. No treatment is necessary.

The second variety of rigid flat foot is generally painful and involves either chronic inflammation of the joints of the foot or abnormalities of the bones of the foot. The foot appears like a severely pronated foot as discussed in the previous section, but does not correct with tip-toe walking. It is painful and aches after activities. This type of foot alignment requires evaluation by a family doctor and perhaps a specialist.

Bowed leg and knocked knees

Diagram: Bowed legBowed leg is defined as an alignment of the legs where there is a space between the knees when the ankles are together (Fig. 6). This is a normal alignment of the legs from the time a child begins walking until about age two years, after which the bowed legs gradually straighten without treatment.

The bow is usually present equally on both sides and gets better on both sides at the same time. In cases where a child has one bowed leg or where the bowed legs cause pain, a limp or are rapidly becoming worse, it is important to consult a doctor.

Knocked-knee is defined as an alignment of the lower legs where there is a space between the ankles when the knees are touching. This leg alignment is common between ages two and seven. The feet may show some degree of pronation (see previous section). There is gradual improvement in the condition by age seven, with a normal leg alignment occurring by the teenage years.

With moderate to severe cases of knocked knees or bowed legs, improvement may not be evident with growth. In some cases where severe malalignment persists, bracing or surgical treatment may be required to correct the leg alignment.

The appearance of the leg in the newborn child is very different from what one expects to see in adulthood. Although parents may be concerned by what they see, in most cases the legs and feet are normal and will develop as they should. When the changes in appearance are very noticeable or do not seem to fit with the age of the child as discussed in this article, you should ask your doctor about the problem. If treatment is suggested it is usually exercises, special footwear or braces and rarely requires casts or surgery.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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