Dec. 07, 2016
In the first few years of a child’s life, parents tend to march them to a paediatrician or GP dozens of times, what with all the vaccines, colds, flus and infections they have to contend with.
The doctors, in turn, check a child’s development, recording weight, height and growth, and ask about eating habits, sleep patterns and so on.
Which is why, according to Dr Jörg Stöbel, a German Board-qualified podiatrist and general manager of the Chiropody Center in Dubai, GPs and paediatricians are to blame for so often missing in children a diagnosis of valgus foot – a condition in which the foot is twisted out of normal position or there is an outward turning of the heel.
"How many times has your paediatrician taken a look at your daughter or son to make sure they are running properly?" he asks. "Probably never. This isn’t the case just in the UAE – this is a problem worldwide. It’s not part of the medical community’s education and there’s no awareness, so no one is checking for this."
This is very different from a diagnosis of flat feet – where the arch does not develop in the foot – which Stöbel says is actually a rare condition affecting only between 3 and 5 per cent of children. Valgus foot and valgus ankle is much more common.
In Europe, he says between 20 and 25 per cent of his patients are affected by a valgus deformity. But based on his own figures collected during two decades working in the UAE, he says 60 per cent of children suffer from the condition.
"There has been no medical research done to identify the reasons," he says. "But looking at my own internal statistics from working here for 20 years now, it’s not about wearing flip-flops and sandals more than usual, or not wearing closed shoes as much as you would elsewhere. It’s mostly just genetic."
However, it is often only when a child starts school that parents of children affected by the condition begin to notice something is not quite right in their child’s gait, as a result of the fact that most schools have a uniform policy stipulating proper, closed footwear.
That is exactly what happened two months into the current school year for Australian lawyer Katie Joukadjian, a mother-of-two who noticed that her 4-year-old son, James, had worn through his high-quality, leather school shoes.
"The top part of the leather was worn out all the way down to the white canvas, and considering that they were good shoes, that rang alarm bells for me – it was clearly not normal," she says.
Joukadjian, who lives in Abu Dhabi, took James to Stöbel during his twice-weekly visits to the Gulf Diagnostic Center. After examining the alignment of the boy’s feet and the way he was standing, he confirmed James was putting too much pressure on the wrong side of the foot.
Treatment, although straightforward, is long-term. Based on the individual child’s weight, balance and standing alignment, Stöbel creates a custom-made orthotic, or insole, which is designed to go into a proper pair of high-top shoes – similar to basketball shoes – that will provide strong support for the ankle.
"The insole is no good if the footwear the child is wearing is no good," Stöbel says.
The insoles cost about Dh750 and are made by Stöbel in his workshop in Dubai. They should be changed every two shoe sizes, but how long they last also depends on each child and factors such as their activity level and weight.
The insoles and high-tops provide about 40 per cent of the treatment plan. The remaining 60 per cent is a series of exercises Stöbel teaches. They should be carried out for five to 10 minutes a day.
"Both the insoles and exercises are imperative until the child finishes their growing phase – so about age 17 or 18," Stöbel says.
A week after the first visit, James’s insoles were ready and Joukadjian bought him a pair of black high-tops. Dr Stöbel fitted the insoles into them and James tried them out, with some initial trepidation.
"We’ve since convinced him that these are his superfast, cool shoes that will help him run faster, like a superhero, and he hasn’t resisted as hard as we thought he would, considering he is so eager to be independent and yet needs our help to wear the shoes or take them off," Joukadjian says.
The approach seems to have worked and the shoes have grown on James.
"These are my super-speedy shoes," he says. "When I wear them, I go faster on my scooter than everyone."
Making a girl with a valgus condition wear shoes that support her ankles can be a little harder, from a fashion point of view, says Anca Manea, mother of 3-year-old Mara.
Since she started walking, Mara has preferred to do so on her tiptoes. A visit to a paediatric orthopaedic doctor and a few X-rays found nothing wrong with her hip alignment. Manea was told everything was normal and her daughter would grow out of it.
"That made no sense to me – she was only getting worse," says Manea, who lives in Abu Dhabi.
"Then I noticed there was something wrong with her knees and they were going inward, and I couldn’t get her to straighten her legs out properly."
She said she had always dressed Mara in cute sandals.
"The climate is hot, and I want her to be comfortable – plus it’s fun to find fancy, cute, bling sandals for little girls. She never wears proper closed shoes here like she would if we were back home in Spain," says Manea, who is Romanian but married to a Spaniard.
When Mara received her insoles and began wearing high-tops that supported her ankles, Manea noticed an immediate improvement.
"We tell her she has to wear the good shoes so she can grow up to have nice legs like mummy," she says.
The danger of missing a valgus deformity, or not catching it early, by the age of 4, is that there is a chance it will be too late to fix it.
"I have a 95 per cent rate of fixing the feet when I catch it early," Stöbel says. "The older they are, the harder it is to fix. We have until puberty, so age 11 or 12, as our last chance to fix it – but after that, kids’ feet start growing like mushrooms."
Missing a diagnosis means that later in life, adults with a valgus deformity will have ankle-joint problems, as well as issues with their hips and knees. Stöbel is also concerned about the high rates of obesity in the UAE.
"Just get your child checked early on, like you would check everything else," he says. "It makes sense."