AGES & STAGES - DEVELOPMENT OF CHILDREN’S FEET

Sometimes children walk with their feet pointed inwards (in-toeing) or outwards (out-toeing). In most cases, these variations in walking are normal. Most children will grow out of these walking styles by the age of two; however, it can sometimes take until the age of 12.

If your child is not keeping up with their friends, a podiatrist may be able to assist. Children under the age of three may sometimes walk on their tiptoes, and this is a typical developmental stage. Any child over the age of three and still walking on their tiptoes (toe walking) should be assessed by a podiatrist.

Growing Feet

A child’s foot grows in length and changes in shape with growth. Arch development is an individual process, and arch height, or a lack of an arch, does not always indicate that a child will have problems with their feet. If your child has pain or has one flat foot that differs from the other foot, a podiatrist can assist. Due to rapid growth in length and width while young, frequent changes in the size of shoes and socks may be necessary. Do a size check at least every one to three months up to the age of three, every four months up to the age of five, and every six months from five years onward.

Skin and Nails

Problems with the skin and nails on your child’s feet may occur from time to time. Some conditions (ingrown toenails, Athlete’s foot and warts) require treatment from a podiatrist, while others may be helped by changes in hygiene or shoes. Children also tend to be more susceptible to warts than adults. A plantar wart is often on the sole of the foot and appears to be hard and flat, with a rough surface and well-defined boundaries. If the wart is causing discomfort, a podiatrist can assist with treatment.

Footwear

Shoes should, above all, protect your children’s feet. Allowing children to go barefoot or to wear very soft shoes helps the foot to typically develop and assists in strengthening muscles.

Practical school shoes

Girl's school shoes

Fit school shoes properly

Professional fitted school shoes

Fitting Footwear

Always have both feet measured for length and width. The shoe should fit the natural shape of the foot, especially around the toes. The toe of the shoe should allow toes to move freely and not be squashed from the top or the sides. Make sure there is about 1 cm growing room for children between the end of the longest toe and the end of the shoe. Shoes should fit comfortably around the heel and not be too loose or too tight. Having shoes fitted by a store that offers trained assistants can help ensure the correct size and shape to keep little feet running and jumping.

Professional Advice

A check-up with a podiatrist is recommended if:

• You notice uneven shoe wear.

• You notice any skin rashes, hard skin, lumps or bumps on your child’s feet.

• Your child complains of recurrent pain in the feet and/or legs, which also increases with activity.

• Your child is frequently tripping or falling.

• Your child walks on their tiptoes.

• Your child’s walk does not look symmetrical (or the same on both feet and legs).

• Or you have any other concerns about your child’s feet.

Common Paediatric Problems Affecting Children

1. Flat or Pronated Feet: Over-pronation, characterised by inward rolling of the feet and ankles, either as a result of flat feet or other causes, can result in ankle, knee, hip and lower back injuries, with serious implications for long-term gait and biomechanics. These conditions can sometimes resolve with age; however, prescriptive orthotics are recommended to provide support and to prevent serious damage and long-term ill effects on the rest of the body.

2. Severs Disease: In teens, pain around the heels is usually a sign of Severs disease, a condition caused by the Achilles tendon placing extra strain on the heel bone and swelling in the growth plate around the heel. Severs disease will ultimately resolve as the growth plate around the heel bone fully develops and the bones fuse by approximately age 15, but damaging foot problems can develop through altered biomechanics. Early treatment can relieve discomfort and prevent the incidence of additional injury.

3. Osgood-Schlatter's Disease: This variant of knee pain is often caused by poor biomechanics of the lower leg. The prescription of corrective orthotics can reduce or eliminate pain.

4. Ingrown Toenails: Ingrown toenails can be present at birth and are common in growing feet, particularly as shoes become too tight. Clinical treatment is recommended to avoid infection, and minor surgery may be required for more serious cases.

5. Viruses and Bacterial Infections: Warts and Athlete’s foot are the most common virus and bacterial infections affecting children. The prevalence of these conditions is via unsanitary conditions at swimming pools and similar environments where viruses and bacteria can easily be contracted by barefoot walking on wet floors.

6. Conditions: Including in-toeing, out-toeing, bowed legs and knocked knees are seen to varying degrees in children under the age of four years. Early diagnosis and treatment of these conditions is crucial to avoid long-term biomechanical problems.

Children's Feet

In the average lifetime, a person will walk 108,000 miles. Many adult foot problems have origins in childhood, so it is important to get your child’s feet checked regularly by a podiatrist to keep feet healthy and functioning correctly.

The feet of young children are soft and pliable, which means abnormal pressure on their feet can lead to deformities. Your child may appear to have flat feet for a period of time, which can be a normal stage in their development; however, if this remains so, this can become a cause for concern.

Don’t just dismiss consistent aches and pains as “growing pains”, as this can sometimes be due to poor foot or leg posture.

Starting To Walk

When your child first begins to walk, usually between 10 and 18 months, shoes are generally not necessary unless a problem is detected. Once your child has been walking independently for several weeks, they should aim to start wearing shoes. It is very important that they are fitted by an experienced shoe fitter.

What To Look Out For

• Walking in an unusual or awkward way

• Early fatigue

• Unusual wear patterns on shoes

• Consistent complaints of pains or aches

Children's Shoes

Each child is unique and foot types can vary considerably. Without the right advice on the appropriate footwear style, children may be wearing uncomfortable and potentially damaging footwear. Ill-fitting footwear can hinder normal development and be the cause of some problems faced later in life; these problems can be caused by neglect from as early as our school years.

Tips for Buying Shoes

• Fit shoes whilst wearing socks

• Stand up to tie laces and check the length and width

• Check the length from the longest toe (not always the big toe)

• Never buy a shoe too large for the child to grow into

• Look for a shoe which has a firm heel counter and arch region

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