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If Your Kid's Shoe Doesn't Fit, See a Doctor

Every parent comes face to face with childhood injuries. Sometimes it's hard to know the seriousness of the injury. Does your child need to see a doctor?

The foot is one of the parts of the body that is especially challenging. A broken bone in the foot of an infant or toddler is rare since most of the bones are still more like cartilage (similar to the gristle in meat or chicken). But in the older child, a broken bone or fracture in the foot is possible. By the time a child turns 10 years old, the bones of the foot have hardened as expected.

As with most injuries in children, foot fractures occur more often in boys than in girls. Car accidents, jumping or falling from heights, and lawnmower accidents are the most often reported causes of broken feet. Accidents occur with all kinds of lawnmowers, but most occur when young children are hit by riding mowers.

Examining the foot can be challenging if the child is frightened and unable to cooperate or if there is swelling and pain. Doctors have tests and new technology to help identify the problem. Finding a foot fracture early is important because without treatment other problems can occur.

For example, some of the bones of the foot do not have much of a blood supply. A fracture can stop the blood from reaching the bone. When this happens, the bone can die, a condition called osteonecrosis ("osteo" refers to bone; "necrosis" is death). Another problem is when a large amount of swelling puts pressure on the nerves, muscles, and blood vessels. This can lead to a condition called compartment syndrome, which needs immediate medical attention.

A visit to the doctor is advised anytime a child reports toe, ankle, or heel pain with swelling, tenderness to touch, and difficulty moving the toes or ankle. This is especially true if the child can't fit the foot into a shoe, tie the shoe, put any weight on the foot, or walk without limping. A toddler will be able to crawl without difficulty but will limp with walking. Early identification of a broken bone and early treatment of muscle or ligament injuries can prevent further problems.

References: Robert M. Kay, MD, and Chris W. Tang, MD. Pediatric Foot Fractures: Evaluation and Treatment. In Journal of the American Academy of Orthopaedic Surgeons. September/October 2001. Vol. 9. No. 5. Pp. 308-319.

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