Children's Feet - Foot Pain and Flat Foot in the Child

Children’s Feet

Child Development

Image of Children showing ther feet, Image by ModPod Podiatry

Parents can worry about their child’s teeth, eyes, but may not give as much concern to the developing foot.

The Childs Foot

The human foot is a very complicated part of the body and the feet of young children are soft and pliable, so abnormal pressures can easily cause the foot to deform. The foot of a child grows rapidly during the first year, reaching almost half their adult foot size. That first year can be very important in the development of the feet.

Foot Pain in the child:

Foot pain and symptoms in children is not common compared to adults due to the flexibility and resilience of the tissues.

Flat foot in the child

Flexible flatfoot or a pronated foot in children is usually painless in young children, but may cause an ache, especially if the child is overweight or older. In the very young child, there is often a ‘fat pad’ in the arch area of the foot which gives an appearance of a flat foot, when it is not. If the foot also rolls inward at the ankle (pronates), then this may be cause for concern. In the majority of cases, most will grow out of it, but some do not. As a general rule, the arch should have developed by approximately 6-7 years of age. If the arch has not developed adequately by this age, orthotics may be warranted to help support the arch and prevent potential problems.  Treatment with foot orthotics are indicated if the flat-foot is severe, causing symptoms and if both parents have flat feet as this indicates that they may be less likely to grow out of it.

In-toeing and out-toeing in children

In-toeing means that the feet points inwards instead of pointing straight ahead when walking. A common problem with children with in-toeing is that they can trip more often than other children. Most will probably outgrow the condition naturally. If in-toeing does persistent or is causing problems, special shoes, stretching exercises or other treatments could be needed. By about age 2, most children walk with their feet pointing straight ahead or slightly outward. Parents or other family members often worry about the way a child walks.

By age 2, most kids will walk with their toes pointed slightly outward. If the feet angle is excessively outwards, this is called out-toeing. It is not as common as in-toeing, but in most cases, it is also just part of normal development.

Often just reassurance is needed if a child is out-toeing or in-toeing, with treatment reserved for the persistent and severe cases. Sometimes the in-toeing and out-toeing does put abnormal pressures on the foot structure and function, so special shoes or foot supports may be required to protect the foot.

Bow legs

Bow legs is a common normal finding at birth and is associated with normal development in the infant birth approximately 2 years of age where they spontaneously correct.

Knock knees

Knock knees is part of normal development which usually becomes apparent at about 2 years of age and reaches a maximum deformity at approximately 4 years of age.  It finally tends to disappear by 6-7 years of age.

Toe walking

Toe walking (equinus gait) is usually normal in children, especially if they are just beginning to learn how to walk and everything else is normal. However, it can be a sign of a condition that needs further investigation (especially if the ankle joint range of motion is limited). Most cases of toe-walking are just a habit and the child will grow out of it. Toe walking can be caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy, leg length differences, spinal cord abnormalities and Achilles tendon shortness. If it’s a mild shortness, stretching exercises and/or physical therapy may be necessary.

Milestones

Developmental guidelines are used to show what the infant has the potential to accomplish (keep in mind pre-mature babies may be slightly delayed). If not at this moment, then in the near future as all babies are unique and meet milestones at their own pace. As a general guide, the four postural milestones are:

  • Sitting independently at 6 months
  • Crawling at 8 months
  • Cruising (walking sideways and stabilizing self on furniture)
  • Walking independently at 12 months.

If you have any questions regarding postural milestones seek advice from your general practitioner.

Nail cutting in infants

A babies toe nails are soft but can be sharp. Using a small set of clippers, trim the toenails straight across, then gently use an emery board to file any edges.

Importance of footwear

Many adult foot problems can have their origins in childhood, so attention to footwear in children can minimize the risk of these problems in adults. Poorly fitting children’s shoes can cause a number of problems in adults. Given the high level of pain and discomfort that these problems can cause, it is obviously logical to attempt to prevent these problems by ensuring that the child’s shoe is fitted appropriately. Foot problems in children are usually preventable by correct footwear.

Common Questions and Answers

When should a child go into their first shoe?

A child will be ready for shoes as soon as they are walking unassisted and regularly.

What type of shoes are best?

A sturdy closed in shoe with a firm heel counter. A fastening system over slip-on is preferable.

What is the best material for a shoe?

For a shoe that is worn regularly for long periods of time, i.e. school shoes, a natural breathable material like leather is best. For shoes which are worn occasionally any material is fine, i.e. rubber, thong/crocs.