In this episode, I’m joined by Dr. Michael Zapf, a podiatrist who’s been treating kids’ feet for nearly 40 years. We cover the most common foot concerns I hear from parents—how to tell what’s normal, when to worry, and what you can do to support healthy feet at home. In this episode you'll hear tips on ingrown toenails, shoes, feet hygiene, Severs disease, plantar warts, and more!
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
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Episode Transcript
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Unknown (00:00):
Hi everybody. Welcome back to your child is normal.
I'm your host and pediatrician,Dr Jessica Hochman, so in
today's episode, we're going todive into an incredibly
important and often overlookedpart of your child's health,
their feet. I'm joined bypodiatrist, Dr Michael Zapf.
He's a foot specialist with over40 years of experience. We're
going to talk about all of thefoot related concerns that
(00:20):
parents ask me about the most,like ingrown toenails, flat
feet, in towing, toe walking,plantar warts, and even what to
do about smelly, sweaty feet. DrZapp shares smart, practical
tips that will help you knowwhat you can manage at home and
when it's time to see aspecialist. And also, before we
get started, if you could takethe time to leave a five star
review about this podcast.
(00:42):
Wherever it is. You listen topodcasts, I would greatly
appreciate it. Good reviews helpother people find the show, and
honestly, they make my day. Nowon to the podcast. Dr Zapp,
thank you so much for coming onmy podcast. I'm so excited to
talk to you. I have so manyquestions, believe it or not,
related to the feat. Lookingforward to being here and
talking with you. Thank you forthis opportunity. So
(01:06):
So tell me about the work thatyou do, because I think feet are
so important. When your feet arebothering you, it is really
bothersome. It's really annoyingbecause you have to walk in the
day to day life. So I'm sure yousee a lot of people that when
they need to see you. They wantto see you and get in quickly.
So I'm curious, what are themost common issues that you take
care of? Well, Iwent, I did recently because of
(01:27):
this question, I did a littleresearch on my patients, and the
five most common things that Isee are ingrown nails, flat feet
with or without pain, seversdisease in our young athletes,
intoing and toe walking andplant our warts. So you want me
(01:49):
to talk about some of these?
I would love that. Actually,those are probably the questions
that I get most often, come tothink of it. So absolutely. So
where do you want to start?
Should we start should we startin
that order? I'm going to startwith ingrown nails I have, yeah,
yes, thatwould be great to hear some
guidance in terms of preventionand what to do once you have an
ingrown nail.
(02:10):
Right? Because we're, we're kindof a retail specialty. A lot of
people come to us before theysee their pediatrician, but a
lot of times we get patients onreferral from pediatricians or
internists with ingrown nails.
Kids, especially get them when Isee them, they have often been
on an antibiotic for a week ortwo, and the nails still
(02:30):
persist. And from a podiatristperspective, the problem really
isn't an infection, it's thisnail poking into the side of the
toe that doesn't belong there.
So from our perspective, thequickest way to get it past that
is to remove the offendingborder of the nail. For older
(02:51):
kids, put a little anesthesia inthere and snip the edge of the
nail. For the really littlekids, it's almost easier just to
spray it with a lot of coldFreezy spray and snip the edge.
But once the nail is out ofthere, these kids are better the
next day. In fact, they onlyhave to remove the nail that you
can't see, the part that's underthe skin. My catch phrase is,
(03:14):
the only thing you miss is thepain. You won't miss that edge
of the nail. You need a bandaid. You can go back to school.
You can play soccer the nextday. In fact, it's easier to
play soccer or ballet the nextday than it is to have the
ingrown nail andafterwards. Do you recommend
things like Epsom salt, soaks,hydrocortisone, any ointments
that you recommend to aid in thehealing process? Well, my
(03:39):
post op care is to when theybathe their shower, to clean the
nail. I often give them an earbulb syringe, or if they're in
the shower, they can have theshower water hit the nail and
clean out all the debris, allthe dried blood, the leaves and
twigs, whatever is build up inthere. And then you put a band
aid on with an antibioticsolution. Mupirocin is my
(04:01):
favorite. And then two moretimes during the day, they'll
put a new band aid on with newmupirocin, and in 10 days, it's
all healed.
Amazing, amazing. And what aboutin terms of prevention? Is there
anything that anyone can do toprevent ingrown toenails? I'm
sure pressure of shoes andathletic activities contribute
(04:22):
to the formation of them. Makesure the shoes have they haven't
outgrown their shoes. We'regoing to talk about shoes later,
but for as little as $10 you canbuy a shoe measuring guide from
Amazon, and maybe every threemonths, you should check and
make sure that the foot hasn'toutgrown the size of the shoe,
(04:43):
because your whole toe can growright into the side of the shoe,
pushing the skin into the nail,causing an ingrown nail.
And what about the way youactually cut the toenail? Does
that matter as well? Most of theingrown
nails I see are down below any.
Piece that you can cut on yourown. And it's just that it's
almost as if the nail is toowide for the toe. Certainly cut
(05:05):
the nail straight across, but II actually just sort of round
the edge a little bit. If youcut it straight straight across,
then there's this little gougypiece that, you know, catches on
your saw, catches on yoursheets. You got around it just a
little bit. I'm not a straightacross purist.
(05:26):
That's good to know. That's goodto know. More realistic. Now,
the next that you mentioned flatfeet, tell me about flat feet,
because that is something that Iget a lot of questions from
parents about. When shouldparents worry? Is this something
that naturally just occurs? Isthere ever a problem having flat
feet?
Absolutely, there's sometimes aproblem with flat feet.
There's a easy way to tellwhether the feet are flat. Have
(05:51):
the child stand on the groundand see if you can put the
eraser end of a pencil under thearch. So if the paint, if the
pencil cannot go under the arch.
It's probably a flat foot.
Another way is to look at theheel, the foot from behind, and
you should see one little toe,and if you see two toes, or
(06:12):
three toes, probably that's aflat foot. Flat feet are
unstable. Flat feet are hard towalk on. It's almost as if
you're walking on ice a littlebit. It's never good to have a
flat foot, but if your foot isnot too flat and you don't have
complaints of pain, it canprobably let that go. But if it
(06:33):
looks flat at all, you should atleast wear a good stable shoe,
not a sandal, not a jelly andsomething that when you squeeze
the heel of the shoe, it shouldbe give you some resistance,
nice and stiff, not, not like askateboarding shoe. I'm sorry,
these young kids loveskateboarding shoes, the
vans, you mean, and the I knowmy kids love those too, right?
(06:54):
Unfortunately,skateboarding shoes with no
support, I would say half of thekids have feet that can handle
those the other half, it'sprobably going to well, at least
not for sports. Maybe they canwear them casually, but when the
feet are too flat, you'll seethe kneecaps point towards each
other, and when you put the feetin a corrected position, the
(07:17):
kneecaps point more straightahead. When you see the kneecaps
pointing together from the feet,from the feet being flat, that
leads to poor poor leg and hipalignment. It leads to poor
jumping ability, poor endurance.
These are the kids that whenthey're three years old, will
(07:38):
want to be in a scroller atDisneyland after the first 30
minutes when all of their sameage friends are running around
being really active, kids withflat feet that have problems
don't complain of pain. Theyjust not as active. And so I
always say, yes, we need poetsand piano players too, but we
(07:59):
should not have the feet makethat decision. It should be the
child's inclination to not beactive. No,
that's a great advice. It's truethat if a child isn't naturally
active, you have to think what'sgoing on here, because that's
definitely not the natural stateof children.
If your child isn't as active asits friends, if they complain of
(08:19):
running, they don't want to runin school, and you see the
kneecaps pointing towards eachother. You can't put the pencil
under the arch. You can see thattoo many toes, they will really
do well with an orthotic. Beforetheir age of nine or 10, we
usually use a kid ethotic, alittle pre made device that
slips in the shoe. You can getthose online. You can most every
(08:43):
podiatrist sells them. A lot ofpediatricians sell them, and
it's kind of like a trainingdevice. So when they get to be
nine or 10 and have a real heelto toe gate and you need to
correct it with a real orthotic,they're already used to
something in their shoe, andit's easier to get them
accustomed to it.
Do you have any particularbrands that you recommend to
(09:04):
families, or do you stay awayfrom recommending brands? Well,
for young children, stride,right? We box always very stable
shoes. But if you go to the shoestore and you want the shoe that
squeeze it, squeeze the heel,the more resistance it gives,
the better it is for a kid witha flat foot.
Now, is there any truth tochildren with flat feet that by
(09:30):
by walking around barefoot, itmay develop the muscles in the
feet and that may be protectiveor helpful in some way, bare
feet can be from for is walkingaround inside the house or
outside when you you can policethe grounds they're walking on,
is a reasonably good thing. Ithelps build the muscles of the
foot. The problem is we werenever meant to walk on hard
(09:54):
surfaces, like you're inside ofyour house or a playground. We
were meant to walk on sand and.
Grass and dirt, and our feet canreally adapt to those surfaces.
You took that same foot and putit on a really hard surface, and
now the surface requires thefoot to flatten to the foot
surface. I mean, I think to be alot fewer foot problems if we
(10:14):
could put two inches or threeinches of sand in every room in
your house, and then you couldlet the foot do its natural
motion. But to try and take thisfoot and put it on a hard
surface, we're asking fortrouble. That's
really good to know, and itmakes sense, because if anyone
tries to walk barefoot onconcrete, it just doesn't feel
comfortable. It's reallyhelpful, I think, for parents to
(10:36):
hear what to look for, to beaware of Flat feet. And it's
nice to know that there arethings that we can do and
looking for kid ethotics online.
How helpful to know that parentscan at least initiate treatment
on on their own at home andand, you know, we'll talk a bit
later about in towing and outtowing, but we even can get
kitty phthalics that have aangle of the front of the
(10:58):
orthotic that can take aninternal gait position and turn
the foot out just because theway the kid ethotic or the
orthotic is made, it'suncomfortable to walk with your
foot internal. If you havesevere in towing, sometimes the
two feet will hit each otherwhen you're running and playing.
(11:20):
If you can turn them out, theyrun a lot better.
That is a great tip to know. Solet's talk about that while you
brought up in towing, becausethis is a common, common
question that they get fromparents. They notice that when
their kids are running, theirtoes point inwards. Sometimes
they'll complain that theirchildren tend to trip a lot when
they're running. They seemclumsy. And most of the kids
that I see, this is a conditionthat they outgrow naturally, but
(11:43):
I would love to hear from youwhat things parents can do to
help that condition and what towhat to look for so that they
can help their kids as they asthey grow and become more sturdy
on their feet,an exam for in towing. One of
the simple things you can havethe child do is just walk
towards you, and either theirkneecaps will point straight
ahead or they'll be internal,and that tells you whether the
(12:09):
problem is at the hip or whetherthe problem is below the knee.
So if the child is walking in,then the kneecaps are straight
ahead and the feet are turnedin. Then it's either the leg
bone, the tibia, or it's thefoot itself being turned in. So
first off, that's part of theexam anybody can do to see
(12:29):
whether it's likely at the hipdevelopment through teenage
years will externally rotate atthe hip. Those kids are going to
do okay, but they need toprotect the foot from its
flattening effect of thisinternal rotation of the leg.
One thing I tell parents a lotabout the rotation at the hip.
(12:50):
We call it femoral anti version.
A lot of those kids tend to bethe W sitters, correct? They
tend to naturally sit in that Wposition. That's another way to
spot those kids that rotate atthe hip.
And for them skating, iceskating and inline skating. Ice
Skating is very good, becauseyou have to externally rotate
(13:12):
your hip in order to skate.
Stare straight. But yes, that'sand when the kneecaps are
pointing towards you, and it'sthe tibia, if it's severely
unrotated. They've already beenat the pediatric at the
orthopedist office, and I alsosee them with a foot metabuses
turn inward instead of straight,and that one needs an orthotic
(13:36):
so that internal positiondoesn't flatten the foot
severely. And I can unflattenthe foot with an orthotic, and
with the gate plate, I couldeven externally rotate it so
they're walking straight. Andyou know, because of their
deformity, they are, they aregoing to pronate. They are going
(13:59):
to have that too many toe sign.
They are going to be flat on theground, you can't get the pencil
in, they are going to have thekneecaps pointing towards each
other. They're going to have alittle more difficulty running
and jumping. And we can preventall that with a good orthotic.
That's great to know. And again,the signs that parents can look
for to know if their child, iftheir children, should see a
podiatrist.
Well, I would say number one, ifthey complain of pain, or if
(14:24):
they have that endurancedifficulty, they're just not
playing like they're neighboringkids, and you see that the foot
is flat and they're not doingwhat everybody else is doing,
certainly bring them in forthat. And second, if the parents
have really terrible feet, andthe kids look like they're going
(14:44):
to have their parents feet. Wecan keep a lot of problems from
happening. And so sometimes whenwe look at the kid, we go over,
look at the parent, and say, youknow, the the pronated pronating
apple doesn't fall far from thepronating tree. You,
it is so interesting how I see,you know, we know genetics are
(15:06):
strong, but it's something thatI definitely notice with the
feet of children. When a childhas something a little bit
different with their foot, and aparent brings it to my
attention, if you ask them, byany chance, does a parent or a
relative in the family also havethis issue with their feet very
often? The answer is yes. So nowtell me about Severs. You
mentioned that that was anothertop reason that people come to
(15:28):
see a podiatrist. Explain whatSievers is, what parents should
look for, and how you go abouttreating the condition of
Sievers. Rightin Sievers, we'll do a quick
picture of a foot here. Here's afoot back here is the heel bone.
The heel bone that starts out asa block of cartilage, and it
slowly fills in with bone here,and somewhere around eight, 910,
(15:52):
your body has a second spot backhere where it fills in with
cartilage that's called not agrowth plate, but it's an
Apophis, and it's a second siteof bone growth. And this little
piece of bone gets its bloodsupply from the big piece of
bone. And if a child is a yearround athlete with three sports,
(16:18):
they're going to break thelittle blood flow connections,
and then it looks on an x raylike this little piece back here
has died. It hasn't. It justgets white on an x ray and looks
like it's dead. And when theyfirst invented X rays, they
said, Oh, that bone is dead. Andso they call it an avascular
necrosis, but it's not reallydead bone, but if you rest it,
(16:40):
you can re establish your bloodflow connections, and then it
doesn't hurt anymore. So Sieversdisease is inflammation in the
back of the heel on an athlete.
When I went through podiatryschool, there were still books
that said it was a boy'sdisease, but now that girls are
(17:01):
every bit as active as boys,it's it's equally shared. Any
child who is too active is goingto get inflammation in the back
of their heel, and it reallyhurts. But in any event, zebras
disease is painful. Inflammationof that hypothesis that often
miss, often called a growthplate in the back of the heel.
(17:22):
Really painful. I have seen itso painful in kids that touching
it makes them cry. They haverefused to go to school because
they can't walk on it. It can bereally painful. Now, two good
pieces of news. It only lastsfor 18 months, and it never
causes long term problems, butit can cause short term problems
(17:47):
when the kid is complaining. AndI do reassure patients that, you
know, even if it's like theplayoff game, the last game of
the season, the kid has to playsoccer, it's really hurting if
they let them play, and the kidplays and it hurts, they're not
causing any long term damage.
(18:09):
But I don't recommend that youmake a child play when it hurts,
and you can't tell by lookingthat it's hurting that day, so
you have to take the kid's word,but even if the coach thinks,
well, they're just trying to getout of running because it's hot.
Sievers never happens to couchpotatoes. It only happens to
very active kids who really wantto play.
A lot of us pediatricians aretaught to do the squeeze test,
(18:31):
where we take our hands andsqueeze the back of the heel,
and if you see a child wince orshow signs of pain or
discomfort, it's almost Sieversuntil proven otherwise.
Correct. So I what we do is Ihave them put ice packs on it
four times a day. Especially, Itell the parents to bring an ice
pack to practice. So on the wayhome, the child can be putting
(18:55):
the ice pack on the heel. Ice isreally good. They should never
go barefoot. They should alwayswear a shoe which reduces the
pull of both the plantar fasciaand the Achilles tendon, and
many times in orthotic can behelpful. I've
seen parents use heel cups orheel pads that you can get
online to help with Sievers.
(19:17):
Have you found that to behelpful? Or is that something
that you ever recommend?
If it's helpful, of course,I think the way the heel cup
works is it's 1/8 of an inch ofheel lift. And I think that a
quarter inch heel lift isprobably better. You know, you
got to put it in both shoes, butraising the heel of four inch is
(19:40):
probably better. But if theeighth of an inch on the heel
cup works fine,that's great to know. I'm sure
it's disappointing foraccomplished athletes know that
they have to wait a while forSievers to heal, potentially,
but very helpful, very goodpoint to know that eventually it
will go away, that this is notsomething that they will have to
deal with long term.
No, I see a lot of plantar.
(20:02):
Warts? Yeah. First off, mostpeople don't know why they're
called plantar warts.
Yes. Why are they called plantarwarts? Because
it's if a wart was on the palmof your hand, it'd be called a
Palmer wart. If it's on yourface, it'd be a facial wart.
Anatomically speaking, thebottom of the foot is called the
plantar cervice of the foot. Soif a wart is there, it's going
(20:26):
to be a plantar wart. A callusis a plantar callus. You get a
little piece of glass stuckthere. It's a plantar wound. So
plantar just means bottom of thefoot. They're caused by a virus.
Sometimes they are very hard toget rid of. No doctor, no
pediatrician, dermatologist,podiatrist has ever made their
(20:47):
entire reputation on how goodthey are at treating plantar
warts. They always want to comeback, and they're hard to get
rid of, and you have to explainthat ahead of time, because when
your kids work, comes back, theygotta know it's not because you
didn't do the right treatment.
It's so true. I agree with you.
I wish there was an easier wayto treat warts,
a lot of a lot of dermatologistsand and pediatricians, because
(21:12):
they used liquid nitrogen forthe warts on the hand, they'll
use the same words on the bottomof the foot, and it doesn't seem
to work, because you can'tfreeze enough of the wart before
it hurts so much that the childwon't let you go any further.
And and you it's, it's, it'sreally difficult to freeze in my
(21:35):
office, I don't use liquidnitrogen. We do use, and I'm
sure you use too an acidpreparation. And you put the
acid press preparation on daily.
And then every two weeks, we usea scalpel blade to trim off all
(21:56):
of the dead skin down to thewart. And you know you've gone
far enough when you see little,tiny, pinpoint bleeding points.
Warts have lots of bloodvessels, but no nerves. If you
carefully pair the wart downwith your scalpel blade, it
doesn't hurt the patient, butyou stop when it gets the
pinpoint bleeding. We do thatevery two weeks until it's gone.
And the acid that you'rereferring to is that salicylic
(22:18):
acid.
Salicylic is one of the Yes,yeah. Now I have a secret remedy
for that too. Worts only live inhumans, and they're only in the
skin, which is 98 degrees. Ifyou can heat the wort to 105 to
109 degrees, I tell them to geta hot tub thermometer. They
they're thermal liable, and youcan start killing the warts with
(22:42):
the heat. So I heat the wort,they put the acid on, let it
dry, never drop, let it dry, andthen every two weeks I trim it
off,just so parents can know the
salicylic acid. You can purchaseit over the counter. If you've
ever heard of compound W, or StJohn's Wort compound w is
readily available, and you canuse it at home and put it on
(23:04):
your child's plantar wart andsee how that goes. So if
somebody comes to you to gettheir plantar wart treated, they
can expect for you to recommendan acid preparation every day
for two weeks, followed byparing it down with a scalpel to
remove that excess skin layer ontop of the wart, right?
(23:24):
And we also have a 1064, laser,a very special laser we got it
to treat fungal nails, but itworks great by a different
change of settings. For warts,you take the wart and you have
one pulse, boom. It feels like arubber band snapping on your
skin. The wart forms its ownlittle black blood blister
(23:45):
that's painless that paired awayin two weeks. And the big
advantage here is you can go tothe beach, you can get sand on
it. There's no open wound, andit's it's very effective. Our
1064 laser is great for treatingthese little warts. I
wish I saw you when I had myplantar wart. Every year I go on
(24:06):
a backpacking trip with somegirlfriends, and a few years
ago, I had a terrible plantarwart that I tried treating on my
own, admittedly, with the liquidnitrogen. And you're right, that
skin around the plantar wart arereally sensitive, and it was
really tricky to remove theplantar wart. I should have just
gone right to you one of my liferegrets, yeah, the
1064, laser. Boom. It's like youdon't need, you don't have to
(24:28):
anesthetize it. Just laser it,and it goes away in two weeks.
Wonderful. Okay, this is, theseare great tips to know about. I
also use blister beetle canthrow and can throw. It is
similar to the laser. It createsa blister, and it doesn't hurt
in the office, but it hurts whenthe child gets home. But for a
(24:50):
lot of people, when I use thesalicylic acid, I put the
salicylic acid on one drop, letit dry. One Drop let it dry.
That's After heating the work to105 208 then I do cover it with
a band aid. You can use ducttape. I often will take a
regular band aid and I take thesticky part of the band aid and
put it right over the wart. Butyou can use duct tape too. I've
(25:13):
alsoheard that the when the band aid
comes off, it's removing the toplayer of skin, which can also
help get to the wart easier,excellent. Okay, this is great,
I'm sure. And anyone who'slistening, who's dealt with the
war will really appreciate allof these wonderful tips. So
thank you so much. Now, I get alot of questions from parents
about toes. Some toes curl, ortheir like, one toe will be over
(25:38):
the other toe. Is this ever aproblem? And when should they
see a podiatrist?
Of course, it could be aproblem. Now, first thing you'll
notice, a lot of kids will haveone toe that's really elevated
above everybody else, and whenit's the second toe you want,
you want to really get that toedown, because otherwise the big
toe, the bunion toe, can move inplace where that toe used to be.
(25:59):
Many of these are going to beproblems that will be corrected
once the child is skeletallymature. You don't want to
intervene unnecessarily insurgery until you know where all
the little body parts are goingto be, and as they grow,
sometimes it changes. But yeah,I think you can leave the minor
(26:20):
things alone. Quite often, thefourth toe gets curled under the
third toe and causes painbecause there's a blister that
forms between the two toes. Soyou can tape that toe out so it
doesn't cause problems. So we Iuse the tape to mitigate little
(26:41):
problems and little aggravationsuntil they're old enough to do
something aboutit. Now, some other just common
questions that I hear fromparents about feet in general.
When you see kids that havepeeling skin on their feet, what
are your go to? Recommendations?
Usually it's caused byhyperhidrosis. That means sweaty
(27:02):
feet, and sweaty feet causes thesuperficial layers of the skin
to start peeling. And you canuse a couple things. Use an
antiperspirant material, not adeodorant, but an
antiperspirant, like certain dryhas a heavy duty anti per
sprint, you can put it on theskin, and then moisture wicking
(27:25):
socks are great. Now cotton isnot good because the cotton sock
absorbs moisture, and then forthe rest of the day, it's acts
like a wet wash cloth next toyour foot. So there are socks
like thorlow and Dry Max socksthat with the moisture away and
keep the skin very, very dry.
And they even make some of thosein pediatric sizes, and they're
(27:55):
very helpful. An adult producesabout half a pint of moisture a
day in their feet, and that'sdivided between the two feet,
that's a lot of moisture, andusually as you walk along, you
squeeze the moisture out of yourshoe, but the sock has to absorb
all that. Once it absorbs it,it's done. It can't absorb more.
So these types of socks thatwick the moisture to the air are
(28:17):
really helpful, and they'rehelpful for these little kids
with this kind of peely,sometimes odory skin. Now, if,
if stinky feet, a lot of youngteenagers, boys, especially
1314, 15, the parents is like,it's just reached high heavens,
and they'll use various kinds ofathlete foot creams, even
(28:37):
cortisone creams. Nothing helps.
It's a particular bacteria, atype of coronary bacteria, that
is really smelly, and if you usean antibiotic cream like your
person on the foot, boom, thesmell goes away.
This is the best tip I get thisquestion all the time, because
(28:59):
when I examine patients fortheir physicals. Very often I
look at their feet, and parentsare embarrassed that their kids
have such smelly feet. And Iknow it's normal, but I never
knew there was something that wecould treat it with. So that's
very helpful. Inour office, we have a Woods
lamp, which is a certainwavelength of ultraviolet light.
(29:20):
Many times if you shine it onthe foot, you can see a
beautiful, interesting coral,red fluorescence in a darker and
that is this exact coronarybacteria. And it's a wonderful
diagnosis, because you can showthe parents look at this
beautiful coral red between thetoes, and then is your
antibiotic cream, and it's gone,and you're a genius. Do you
(29:44):
recommend using it until thesmell goes away? Or Should
parents be using it, you know,on a regular basis? What do you
recommend? Surprisingly,these boys, it's often boys are
more embarrassed about this thanyou think, and if they know
that, by putting it on twice aday, they can get rid of that.
Mail so that they're not goingto be made fun of by their
girlfriend. They'll use it 10times a day and and whenever it
comes back, you just useit that. That might be one of my
(30:12):
favorite pieces of advice thatI've heard yet on my on this
podcast. So thank you very much.
So and then, in general, do youhave hygiene advice for patients
that you see to take so they cantake good care of their feet,
just the general things that youwould normally think about.
Obviously, wash the feet everyday, mild soap, but you got to
wash between the toes, becauseif you use your wood lamp,
(30:34):
you'll see that these anaerobicbacteria love to live between
the toes, and so drivecompletely even between the
toes. Again, cut the toenailsacross with a little rounding on
the edge. You might want to geta separate toenail clipper for
each kid in the family soeveryone gets their own. You
(30:58):
should change the socks everyday, and I try not to wear the
same shoe two days in a row,because every pair of shoes has
a little different area where itrubs the foot. And if you wear
the same shoe over and overagain, you keep rubbing that
same spot on the foot, and itstarts to hurt so and you think
of if you have two pair of shoesand you switch off, they're each
(31:20):
going to last twice as long. Foradults, you want to change it
every quote, 400 miles. Endquote. So if you walk three four
miles a day, that's going to beevery three months. But for
kids, they're below six, youwant to measure every three
months. If they're above six,every six months, and make sure
that the shoes are the rightsize. That's
fantastic. My mother in law, wholistens to this podcast
(31:42):
sometimes, she teases gently herhusband, who likes to change his
shoes very often. So he will bevery happy to hear you say that
changing shoes is a recommendedpractice, coming straight from
the mouth of a podiatrist. So Iknow he'll appreciate that
advice. I also get a lot ofquestions from parents about
kids that walk on their toes. Iknow for a lot of kids, it's
(32:04):
normal, and some kids maybenefit from seeing a
podiatrist. Do you have generalrecommendations that you give to
families when they first seeyou, when their children are
when their children are toewalkers?
Yeah, it's it's tricky kids withautism, other issues like that.
Sometimes just, they just hatetheir feet touching the ground.
(32:27):
Sometimes it's these sensorymortar things that I don't
understand. But when I see a toeWalker, I try to see if I can't
get the kid to walk on theirheel either by thinking about
it, but I also try and get themrelaxed to see if they have
enough ankle joint dorsiflexionto do it. So you know that
(32:50):
there's some volitional toewalking going on. It's a tricky
problem. If it's just a littlebit of toe walking, I'll
recommend that they get a heel,a heel lift, or wear shoes with
a heel just to take the stressoff the Achilles tendon.
Physical therapists can do theirspray and stretch and their
(33:10):
activities. Yes,that's an that's very similar to
the advice I give parents. I'llsee if the child can voluntarily
put their heel down, and if theycan, that makes me feel
relieved. If the heel cordreally is very tight, then I
will refer them immediately tophysical therapy or pediatric
orthopedics. Sometimes I'llrecommend them to try high top
(33:32):
shoes, because that will keepthe heel down on the ground. But
usually I find that it's geneticas well. If a child is a toe
Walker, oftentimes there will bea parent that also walks on the
toes from time to time. I guessmy question always is, is it a
problem to walk on the toes fromtime to time? Does that cause
any damage to the feet?
(33:55):
No, that you are aware of. Idon't
think so. That's good to hear.
That's good to hear. Dr Zapf,I'm so grateful for you. Thank
you so much for taking the timeto come on the podcast. I really
appreciateit. It's been a great pleasure.
Thank you very much. Dr Hochman,thank
you for listening, and I hopeyou enjoyed this week's episode
of your child is normal. Also,if you could take a moment and
(34:16):
leave a five star review,wherever it is you listen to
podcasts, I would greatlyappreciate it. It It really
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
Bye.
Hi everybody. Welcome back to your child is normal.
I'm your host and pediatrician,Dr Jessica Hochman, so in
today's episode, we're going todive into an incredibly
important and often overlookedpart of your child's health,
their feet. I'm joined bypodiatrist, Dr Michael Zapf.
He's a foot specialist with over40 years of experience. We're
going to talk about all of thefoot related concerns that
(00:20):
parents ask me about the most,like ingrown toenails, flat
feet, in towing, toe walking,plantar warts, and even what to
do about smelly, sweaty feet. DrZapp shares smart, practical
tips that will help you knowwhat you can manage at home and
when it's time to see aspecialist. And also, before we
get started, if you could takethe time to leave a five star
review about this podcast.
(00:42):
Wherever it is. You listen topodcasts, I would greatly
appreciate it. Good reviews helpother people find the show, and
honestly, they make my day. Nowon to the podcast. Dr Zapp,
thank you so much for coming onmy podcast. I'm so excited to
talk to you. I have so manyquestions, believe it or not,
related to the feat. Lookingforward to being here and
talking with you. Thank you forthis opportunity. So
(01:06):
So tell me about the work thatyou do, because I think feet are
so important. When your feet arebothering you, it is really
bothersome. It's really annoyingbecause you have to walk in the
day to day life. So I'm sure yousee a lot of people that when
they need to see you. They wantto see you and get in quickly.
So I'm curious, what are themost common issues that you take
care of? Well, Iwent, I did recently because of
(01:27):
this question, I did a littleresearch on my patients, and the
five most common things that Isee are ingrown nails, flat feet
with or without pain, seversdisease in our young athletes,
intoing and toe walking andplant our warts. So you want me
(01:49):
to talk about some of these?
I would love that. Actually,those are probably the questions
that I get most often, come tothink of it. So absolutely. So
where do you want to start?
Should we start should we startin
that order? I'm going to startwith ingrown nails I have, yeah,
yes, thatwould be great to hear some
guidance in terms of preventionand what to do once you have an
ingrown nail.
(02:10):
Right? Because we're, we're kindof a retail specialty. A lot of
people come to us before theysee their pediatrician, but a
lot of times we get patients onreferral from pediatricians or
internists with ingrown nails.
Kids, especially get them when Isee them, they have often been
on an antibiotic for a week ortwo, and the nails still
(02:30):
persist. And from a podiatristperspective, the problem really
isn't an infection, it's thisnail poking into the side of the
toe that doesn't belong there.
So from our perspective, thequickest way to get it past that
is to remove the offendingborder of the nail. For older
(02:51):
kids, put a little anesthesia inthere and snip the edge of the
nail. For the really littlekids, it's almost easier just to
spray it with a lot of coldFreezy spray and snip the edge.
But once the nail is out ofthere, these kids are better the
next day. In fact, they onlyhave to remove the nail that you
can't see, the part that's underthe skin. My catch phrase is,
(03:14):
the only thing you miss is thepain. You won't miss that edge
of the nail. You need a bandaid. You can go back to school.
You can play soccer the nextday. In fact, it's easier to
play soccer or ballet the nextday than it is to have the
ingrown nail andafterwards. Do you recommend
things like Epsom salt, soaks,hydrocortisone, any ointments
that you recommend to aid in thehealing process? Well, my
(03:39):
post op care is to when theybathe their shower, to clean the
nail. I often give them an earbulb syringe, or if they're in
the shower, they can have theshower water hit the nail and
clean out all the debris, allthe dried blood, the leaves and
twigs, whatever is build up inthere. And then you put a band
aid on with an antibioticsolution. Mupirocin is my
(04:01):
favorite. And then two moretimes during the day, they'll
put a new band aid on with newmupirocin, and in 10 days, it's
all healed.
Amazing, amazing. And what aboutin terms of prevention? Is there
anything that anyone can do toprevent ingrown toenails? I'm
sure pressure of shoes andathletic activities contribute
(04:22):
to the formation of them. Makesure the shoes have they haven't
outgrown their shoes. We'regoing to talk about shoes later,
but for as little as $10 you canbuy a shoe measuring guide from
Amazon, and maybe every threemonths, you should check and
make sure that the foot hasn'toutgrown the size of the shoe,
(04:43):
because your whole toe can growright into the side of the shoe,
pushing the skin into the nail,causing an ingrown nail.
And what about the way youactually cut the toenail? Does
that matter as well? Most of theingrown
nails I see are down below any.
Piece that you can cut on yourown. And it's just that it's
almost as if the nail is toowide for the toe. Certainly cut
(05:05):
the nail straight across, but II actually just sort of round
the edge a little bit. If youcut it straight straight across,
then there's this little gougypiece that, you know, catches on
your saw, catches on yoursheets. You got around it just a
little bit. I'm not a straightacross purist.
(05:26):
That's good to know. That's goodto know. More realistic. Now,
the next that you mentioned flatfeet, tell me about flat feet,
because that is something that Iget a lot of questions from
parents about. When shouldparents worry? Is this something
that naturally just occurs? Isthere ever a problem having flat
feet?
Absolutely, there's sometimes aproblem with flat feet.
There's a easy way to tellwhether the feet are flat. Have
(05:51):
the child stand on the groundand see if you can put the
eraser end of a pencil under thearch. So if the paint, if the
pencil cannot go under the arch.
It's probably a flat foot.
Another way is to look at theheel, the foot from behind, and
you should see one little toe,and if you see two toes, or
(06:12):
three toes, probably that's aflat foot. Flat feet are
unstable. Flat feet are hard towalk on. It's almost as if
you're walking on ice a littlebit. It's never good to have a
flat foot, but if your foot isnot too flat and you don't have
complaints of pain, it canprobably let that go. But if it
(06:33):
looks flat at all, you should atleast wear a good stable shoe,
not a sandal, not a jelly andsomething that when you squeeze
the heel of the shoe, it shouldbe give you some resistance,
nice and stiff, not, not like askateboarding shoe. I'm sorry,
these young kids loveskateboarding shoes, the
vans, you mean, and the I knowmy kids love those too, right?
(06:54):
Unfortunately,skateboarding shoes with no
support, I would say half of thekids have feet that can handle
those the other half, it'sprobably going to well, at least
not for sports. Maybe they canwear them casually, but when the
feet are too flat, you'll seethe kneecaps point towards each
other, and when you put the feetin a corrected position, the
(07:17):
kneecaps point more straightahead. When you see the kneecaps
pointing together from the feet,from the feet being flat, that
leads to poor poor leg and hipalignment. It leads to poor
jumping ability, poor endurance.
These are the kids that whenthey're three years old, will
(07:38):
want to be in a scroller atDisneyland after the first 30
minutes when all of their sameage friends are running around
being really active, kids withflat feet that have problems
don't complain of pain. Theyjust not as active. And so I
always say, yes, we need poetsand piano players too, but we
(07:59):
should not have the feet makethat decision. It should be the
child's inclination to not beactive. No,
that's a great advice. It's truethat if a child isn't naturally
active, you have to think what'sgoing on here, because that's
definitely not the natural stateof children.
If your child isn't as active asits friends, if they complain of
(08:19):
running, they don't want to runin school, and you see the
kneecaps pointing towards eachother. You can't put the pencil
under the arch. You can see thattoo many toes, they will really
do well with an orthotic. Beforetheir age of nine or 10, we
usually use a kid ethotic, alittle pre made device that
slips in the shoe. You can getthose online. You can most every
(08:43):
podiatrist sells them. A lot ofpediatricians sell them, and
it's kind of like a trainingdevice. So when they get to be
nine or 10 and have a real heelto toe gate and you need to
correct it with a real orthotic,they're already used to
something in their shoe, andit's easier to get them
accustomed to it.
Do you have any particularbrands that you recommend to
(09:04):
families, or do you stay awayfrom recommending brands? Well,
for young children, stride,right? We box always very stable
shoes. But if you go to the shoestore and you want the shoe that
squeeze it, squeeze the heel,the more resistance it gives,
the better it is for a kid witha flat foot.
Now, is there any truth tochildren with flat feet that by
(09:30):
by walking around barefoot, itmay develop the muscles in the
feet and that may be protectiveor helpful in some way, bare
feet can be from for is walkingaround inside the house or
outside when you you can policethe grounds they're walking on,
is a reasonably good thing. Ithelps build the muscles of the
foot. The problem is we werenever meant to walk on hard
(09:54):
surfaces, like you're inside ofyour house or a playground. We
were meant to walk on sand and.
Grass and dirt, and our feet canreally adapt to those surfaces.
You took that same foot and putit on a really hard surface, and
now the surface requires thefoot to flatten to the foot
surface. I mean, I think to be alot fewer foot problems if we
(10:14):
could put two inches or threeinches of sand in every room in
your house, and then you couldlet the foot do its natural
motion. But to try and take thisfoot and put it on a hard
surface, we're asking fortrouble. That's
really good to know, and itmakes sense, because if anyone
tries to walk barefoot onconcrete, it just doesn't feel
comfortable. It's reallyhelpful, I think, for parents to
(10:36):
hear what to look for, to beaware of Flat feet. And it's
nice to know that there arethings that we can do and
looking for kid ethotics online.
How helpful to know that parentscan at least initiate treatment
on on their own at home andand, you know, we'll talk a bit
later about in towing and outtowing, but we even can get
kitty phthalics that have aangle of the front of the
(10:58):
orthotic that can take aninternal gait position and turn
the foot out just because theway the kid ethotic or the
orthotic is made, it'suncomfortable to walk with your
foot internal. If you havesevere in towing, sometimes the
two feet will hit each otherwhen you're running and playing.
(11:20):
If you can turn them out, theyrun a lot better.
That is a great tip to know. Solet's talk about that while you
brought up in towing, becausethis is a common, common
question that they get fromparents. They notice that when
their kids are running, theirtoes point inwards. Sometimes
they'll complain that theirchildren tend to trip a lot when
they're running. They seemclumsy. And most of the kids
that I see, this is a conditionthat they outgrow naturally, but
(11:43):
I would love to hear from youwhat things parents can do to
help that condition and what towhat to look for so that they
can help their kids as they asthey grow and become more sturdy
on their feet,an exam for in towing. One of
the simple things you can havethe child do is just walk
towards you, and either theirkneecaps will point straight
ahead or they'll be internal,and that tells you whether the
(12:09):
problem is at the hip or whetherthe problem is below the knee.
So if the child is walking in,then the kneecaps are straight
ahead and the feet are turnedin. Then it's either the leg
bone, the tibia, or it's thefoot itself being turned in. So
first off, that's part of theexam anybody can do to see
(12:29):
whether it's likely at the hipdevelopment through teenage
years will externally rotate atthe hip. Those kids are going to
do okay, but they need toprotect the foot from its
flattening effect of thisinternal rotation of the leg.
One thing I tell parents a lotabout the rotation at the hip.
(12:50):
We call it femoral anti version.
A lot of those kids tend to bethe W sitters, correct? They
tend to naturally sit in that Wposition. That's another way to
spot those kids that rotate atthe hip.
And for them skating, iceskating and inline skating. Ice
Skating is very good, becauseyou have to externally rotate
(13:12):
your hip in order to skate.
Stare straight. But yes, that'sand when the kneecaps are
pointing towards you, and it'sthe tibia, if it's severely
unrotated. They've already beenat the pediatric at the
orthopedist office, and I alsosee them with a foot metabuses
turn inward instead of straight,and that one needs an orthotic
(13:36):
so that internal positiondoesn't flatten the foot
severely. And I can unflattenthe foot with an orthotic, and
with the gate plate, I couldeven externally rotate it so
they're walking straight. Andyou know, because of their
deformity, they are, they aregoing to pronate. They are going
(13:59):
to have that too many toe sign.
They are going to be flat on theground, you can't get the pencil
in, they are going to have thekneecaps pointing towards each
other. They're going to have alittle more difficulty running
and jumping. And we can preventall that with a good orthotic.
That's great to know. And again,the signs that parents can look
for to know if their child, iftheir children, should see a
podiatrist.
Well, I would say number one, ifthey complain of pain, or if
(14:24):
they have that endurancedifficulty, they're just not
playing like they're neighboringkids, and you see that the foot
is flat and they're not doingwhat everybody else is doing,
certainly bring them in forthat. And second, if the parents
have really terrible feet, andthe kids look like they're going
(14:44):
to have their parents feet. Wecan keep a lot of problems from
happening. And so sometimes whenwe look at the kid, we go over,
look at the parent, and say, youknow, the the pronated pronating
apple doesn't fall far from thepronating tree. You,
it is so interesting how I see,you know, we know genetics are
(15:06):
strong, but it's something thatI definitely notice with the
feet of children. When a childhas something a little bit
different with their foot, and aparent brings it to my
attention, if you ask them, byany chance, does a parent or a
relative in the family also havethis issue with their feet very
often? The answer is yes. So nowtell me about Severs. You
mentioned that that was anothertop reason that people come to
(15:28):
see a podiatrist. Explain whatSievers is, what parents should
look for, and how you go abouttreating the condition of
Sievers. Rightin Sievers, we'll do a quick
picture of a foot here. Here's afoot back here is the heel bone.
The heel bone that starts out asa block of cartilage, and it
slowly fills in with bone here,and somewhere around eight, 910,
(15:52):
your body has a second spot backhere where it fills in with
cartilage that's called not agrowth plate, but it's an
Apophis, and it's a second siteof bone growth. And this little
piece of bone gets its bloodsupply from the big piece of
bone. And if a child is a yearround athlete with three sports,
(16:18):
they're going to break thelittle blood flow connections,
and then it looks on an x raylike this little piece back here
has died. It hasn't. It justgets white on an x ray and looks
like it's dead. And when theyfirst invented X rays, they
said, Oh, that bone is dead. Andso they call it an avascular
necrosis, but it's not reallydead bone, but if you rest it,
(16:40):
you can re establish your bloodflow connections, and then it
doesn't hurt anymore. So Sieversdisease is inflammation in the
back of the heel on an athlete.
When I went through podiatryschool, there were still books
that said it was a boy'sdisease, but now that girls are
(17:01):
every bit as active as boys,it's it's equally shared. Any
child who is too active is goingto get inflammation in the back
of their heel, and it reallyhurts. But in any event, zebras
disease is painful. Inflammationof that hypothesis that often
miss, often called a growthplate in the back of the heel.
(17:22):
Really painful. I have seen itso painful in kids that touching
it makes them cry. They haverefused to go to school because
they can't walk on it. It can bereally painful. Now, two good
pieces of news. It only lastsfor 18 months, and it never
causes long term problems, butit can cause short term problems
(17:47):
when the kid is complaining. AndI do reassure patients that, you
know, even if it's like theplayoff game, the last game of
the season, the kid has to playsoccer, it's really hurting if
they let them play, and the kidplays and it hurts, they're not
causing any long term damage.
(18:09):
But I don't recommend that youmake a child play when it hurts,
and you can't tell by lookingthat it's hurting that day, so
you have to take the kid's word,but even if the coach thinks,
well, they're just trying to getout of running because it's hot.
Sievers never happens to couchpotatoes. It only happens to
very active kids who really wantto play.
A lot of us pediatricians aretaught to do the squeeze test,
(18:31):
where we take our hands andsqueeze the back of the heel,
and if you see a child wince orshow signs of pain or
discomfort, it's almost Sieversuntil proven otherwise.
Correct. So I what we do is Ihave them put ice packs on it
four times a day. Especially, Itell the parents to bring an ice
pack to practice. So on the wayhome, the child can be putting
(18:55):
the ice pack on the heel. Ice isreally good. They should never
go barefoot. They should alwayswear a shoe which reduces the
pull of both the plantar fasciaand the Achilles tendon, and
many times in orthotic can behelpful. I've
seen parents use heel cups orheel pads that you can get
online to help with Sievers.
(19:17):
Have you found that to behelpful? Or is that something
that you ever recommend?
If it's helpful, of course,I think the way the heel cup
works is it's 1/8 of an inch ofheel lift. And I think that a
quarter inch heel lift isprobably better. You know, you
got to put it in both shoes, butraising the heel of four inch is
(19:40):
probably better. But if theeighth of an inch on the heel
cup works fine,that's great to know. I'm sure
it's disappointing foraccomplished athletes know that
they have to wait a while forSievers to heal, potentially,
but very helpful, very goodpoint to know that eventually it
will go away, that this is notsomething that they will have to
deal with long term.
No, I see a lot of plantar.
(20:02):
Warts? Yeah. First off, mostpeople don't know why they're
called plantar warts.
Yes. Why are they called plantarwarts? Because
it's if a wart was on the palmof your hand, it'd be called a
Palmer wart. If it's on yourface, it'd be a facial wart.
Anatomically speaking, thebottom of the foot is called the
plantar cervice of the foot. Soif a wart is there, it's going
(20:26):
to be a plantar wart. A callusis a plantar callus. You get a
little piece of glass stuckthere. It's a plantar wound. So
plantar just means bottom of thefoot. They're caused by a virus.
Sometimes they are very hard toget rid of. No doctor, no
pediatrician, dermatologist,podiatrist has ever made their
(20:47):
entire reputation on how goodthey are at treating plantar
warts. They always want to comeback, and they're hard to get
rid of, and you have to explainthat ahead of time, because when
your kids work, comes back, theygotta know it's not because you
didn't do the right treatment.
It's so true. I agree with you.
I wish there was an easier wayto treat warts,
a lot of a lot of dermatologistsand and pediatricians, because
(21:12):
they used liquid nitrogen forthe warts on the hand, they'll
use the same words on the bottomof the foot, and it doesn't seem
to work, because you can'tfreeze enough of the wart before
it hurts so much that the childwon't let you go any further.
And and you it's, it's, it'sreally difficult to freeze in my
(21:35):
office, I don't use liquidnitrogen. We do use, and I'm
sure you use too an acidpreparation. And you put the
acid press preparation on daily.
And then every two weeks, we usea scalpel blade to trim off all
(21:56):
of the dead skin down to thewart. And you know you've gone
far enough when you see little,tiny, pinpoint bleeding points.
Warts have lots of bloodvessels, but no nerves. If you
carefully pair the wart downwith your scalpel blade, it
doesn't hurt the patient, butyou stop when it gets the
pinpoint bleeding. We do thatevery two weeks until it's gone.
And the acid that you'rereferring to is that salicylic
(22:18):
acid.
Salicylic is one of the Yes,yeah. Now I have a secret remedy
for that too. Worts only live inhumans, and they're only in the
skin, which is 98 degrees. Ifyou can heat the wort to 105 to
109 degrees, I tell them to geta hot tub thermometer. They
they're thermal liable, and youcan start killing the warts with
(22:42):
the heat. So I heat the wort,they put the acid on, let it
dry, never drop, let it dry, andthen every two weeks I trim it
off,just so parents can know the
salicylic acid. You can purchaseit over the counter. If you've
ever heard of compound W, or StJohn's Wort compound w is
readily available, and you canuse it at home and put it on
(23:04):
your child's plantar wart andsee how that goes. So if
somebody comes to you to gettheir plantar wart treated, they
can expect for you to recommendan acid preparation every day
for two weeks, followed byparing it down with a scalpel to
remove that excess skin layer ontop of the wart, right?
(23:24):
And we also have a 1064, laser,a very special laser we got it
to treat fungal nails, but itworks great by a different
change of settings. For warts,you take the wart and you have
one pulse, boom. It feels like arubber band snapping on your
skin. The wart forms its ownlittle black blood blister
(23:45):
that's painless that paired awayin two weeks. And the big
advantage here is you can go tothe beach, you can get sand on
it. There's no open wound, andit's it's very effective. Our
1064 laser is great for treatingthese little warts. I
wish I saw you when I had myplantar wart. Every year I go on
(24:06):
a backpacking trip with somegirlfriends, and a few years
ago, I had a terrible plantarwart that I tried treating on my
own, admittedly, with the liquidnitrogen. And you're right, that
skin around the plantar wart arereally sensitive, and it was
really tricky to remove theplantar wart. I should have just
gone right to you one of my liferegrets, yeah, the
1064, laser. Boom. It's like youdon't need, you don't have to
(24:28):
anesthetize it. Just laser it,and it goes away in two weeks.
Wonderful. Okay, this is, theseare great tips to know about. I
also use blister beetle canthrow and can throw. It is
similar to the laser. It createsa blister, and it doesn't hurt
in the office, but it hurts whenthe child gets home. But for a
(24:50):
lot of people, when I use thesalicylic acid, I put the
salicylic acid on one drop, letit dry. One Drop let it dry.
That's After heating the work to105 208 then I do cover it with
a band aid. You can use ducttape. I often will take a
regular band aid and I take thesticky part of the band aid and
put it right over the wart. Butyou can use duct tape too. I've
(25:13):
alsoheard that the when the band aid
comes off, it's removing the toplayer of skin, which can also
help get to the wart easier,excellent. Okay, this is great,
I'm sure. And anyone who'slistening, who's dealt with the
war will really appreciate allof these wonderful tips. So
thank you so much. Now, I get alot of questions from parents
about toes. Some toes curl, ortheir like, one toe will be over
(25:38):
the other toe. Is this ever aproblem? And when should they
see a podiatrist?
Of course, it could be aproblem. Now, first thing you'll
notice, a lot of kids will haveone toe that's really elevated
above everybody else, and whenit's the second toe you want,
you want to really get that toedown, because otherwise the big
toe, the bunion toe, can move inplace where that toe used to be.
(25:59):
Many of these are going to beproblems that will be corrected
once the child is skeletallymature. You don't want to
intervene unnecessarily insurgery until you know where all
the little body parts are goingto be, and as they grow,
sometimes it changes. But yeah,I think you can leave the minor
(26:20):
things alone. Quite often, thefourth toe gets curled under the
third toe and causes painbecause there's a blister that
forms between the two toes. Soyou can tape that toe out so it
doesn't cause problems. So we Iuse the tape to mitigate little
(26:41):
problems and little aggravationsuntil they're old enough to do
something aboutit. Now, some other just common
questions that I hear fromparents about feet in general.
When you see kids that havepeeling skin on their feet, what
are your go to? Recommendations?
Usually it's caused byhyperhidrosis. That means sweaty
(27:02):
feet, and sweaty feet causes thesuperficial layers of the skin
to start peeling. And you canuse a couple things. Use an
antiperspirant material, not adeodorant, but an
antiperspirant, like certain dryhas a heavy duty anti per
sprint, you can put it on theskin, and then moisture wicking
(27:25):
socks are great. Now cotton isnot good because the cotton sock
absorbs moisture, and then forthe rest of the day, it's acts
like a wet wash cloth next toyour foot. So there are socks
like thorlow and Dry Max socksthat with the moisture away and
keep the skin very, very dry.
And they even make some of thosein pediatric sizes, and they're
(27:55):
very helpful. An adult producesabout half a pint of moisture a
day in their feet, and that'sdivided between the two feet,
that's a lot of moisture, andusually as you walk along, you
squeeze the moisture out of yourshoe, but the sock has to absorb
all that. Once it absorbs it,it's done. It can't absorb more.
So these types of socks thatwick the moisture to the air are
(28:17):
really helpful, and they'rehelpful for these little kids
with this kind of peely,sometimes odory skin. Now, if,
if stinky feet, a lot of youngteenagers, boys, especially
1314, 15, the parents is like,it's just reached high heavens,
and they'll use various kinds ofathlete foot creams, even
(28:37):
cortisone creams. Nothing helps.
It's a particular bacteria, atype of coronary bacteria, that
is really smelly, and if you usean antibiotic cream like your
person on the foot, boom, thesmell goes away.
This is the best tip I get thisquestion all the time, because
(28:59):
when I examine patients fortheir physicals. Very often I
look at their feet, and parentsare embarrassed that their kids
have such smelly feet. And Iknow it's normal, but I never
knew there was something that wecould treat it with. So that's
very helpful. Inour office, we have a Woods
lamp, which is a certainwavelength of ultraviolet light.
(29:20):
Many times if you shine it onthe foot, you can see a
beautiful, interesting coral,red fluorescence in a darker and
that is this exact coronarybacteria. And it's a wonderful
diagnosis, because you can showthe parents look at this
beautiful coral red between thetoes, and then is your
antibiotic cream, and it's gone,and you're a genius. Do you
(29:44):
recommend using it until thesmell goes away? Or Should
parents be using it, you know,on a regular basis? What do you
recommend? Surprisingly,these boys, it's often boys are
more embarrassed about this thanyou think, and if they know
that, by putting it on twice aday, they can get rid of that.
Mail so that they're not goingto be made fun of by their
girlfriend. They'll use it 10times a day and and whenever it
comes back, you just useit that. That might be one of my
(30:12):
favorite pieces of advice thatI've heard yet on my on this
podcast. So thank you very much.
So and then, in general, do youhave hygiene advice for patients
that you see to take so they cantake good care of their feet,
just the general things that youwould normally think about.
Obviously, wash the feet everyday, mild soap, but you got to
wash between the toes, becauseif you use your wood lamp,
(30:34):
you'll see that these anaerobicbacteria love to live between
the toes, and so drivecompletely even between the
toes. Again, cut the toenailsacross with a little rounding on
the edge. You might want to geta separate toenail clipper for
each kid in the family soeveryone gets their own. You
(30:58):
should change the socks everyday, and I try not to wear the
same shoe two days in a row,because every pair of shoes has
a little different area where itrubs the foot. And if you wear
the same shoe over and overagain, you keep rubbing that
same spot on the foot, and itstarts to hurt so and you think
of if you have two pair of shoesand you switch off, they're each
(31:20):
going to last twice as long. Foradults, you want to change it
every quote, 400 miles. Endquote. So if you walk three four
miles a day, that's going to beevery three months. But for
kids, they're below six, youwant to measure every three
months. If they're above six,every six months, and make sure
that the shoes are the rightsize. That's
fantastic. My mother in law, wholistens to this podcast
(31:42):
sometimes, she teases gently herhusband, who likes to change his
shoes very often. So he will bevery happy to hear you say that
changing shoes is a recommendedpractice, coming straight from
the mouth of a podiatrist. So Iknow he'll appreciate that
advice. I also get a lot ofquestions from parents about
kids that walk on their toes. Iknow for a lot of kids, it's
(32:04):
normal, and some kids maybenefit from seeing a
podiatrist. Do you have generalrecommendations that you give to
families when they first seeyou, when their children are
when their children are toewalkers?
Yeah, it's it's tricky kids withautism, other issues like that.
Sometimes just, they just hatetheir feet touching the ground.
(32:27):
Sometimes it's these sensorymortar things that I don't
understand. But when I see a toeWalker, I try to see if I can't
get the kid to walk on theirheel either by thinking about
it, but I also try and get themrelaxed to see if they have
enough ankle joint dorsiflexionto do it. So you know that
(32:50):
there's some volitional toewalking going on. It's a tricky
problem. If it's just a littlebit of toe walking, I'll
recommend that they get a heel,a heel lift, or wear shoes with
a heel just to take the stressoff the Achilles tendon.
Physical therapists can do theirspray and stretch and their
(33:10):
activities. Yes,that's an that's very similar to
the advice I give parents. I'llsee if the child can voluntarily
put their heel down, and if theycan, that makes me feel
relieved. If the heel cordreally is very tight, then I
will refer them immediately tophysical therapy or pediatric
orthopedics. Sometimes I'llrecommend them to try high top
(33:32):
shoes, because that will keepthe heel down on the ground. But
usually I find that it's geneticas well. If a child is a toe
Walker, oftentimes there will bea parent that also walks on the
toes from time to time. I guessmy question always is, is it a
problem to walk on the toes fromtime to time? Does that cause
any damage to the feet?
(33:55):
No, that you are aware of. Idon't
think so. That's good to hear.
That's good to hear. Dr Zapf,I'm so grateful for you. Thank
you so much for taking the timeto come on the podcast. I really
appreciateit. It's been a great pleasure.
Thank you very much. Dr Hochman,thank
you for listening, and I hopeyou enjoyed this week's episode
of your child is normal. Also,if you could take a moment and
(34:16):
leave a five star review,wherever it is you listen to
podcasts, I would greatlyappreciate it. It It really
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
Bye.
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