The Child’s 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. Ingrown toenails can occur and will probably need treatment. Non-specific growing pains in the leg are a common complaint of children, often causing a deep ache like leg pain during the night. There are some specific causes of growing pains, especially in the heel, called Sever’s disease or calcaneal apophysitis and at the knee, where its called Osgood-schlatters disease. Clubfoot is a relatively rare deformity at birth that may still cause problems in later life after correction. Feet that sweat profusely or have a smelly odor can also be a problem in the older child.
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. Treatment with foot orthotics are indicated if its severe, causing symptoms and if both parents have flat feet, as this indicates that they may be less likely to grow out of it. More information, aimed at health professionals on flat foot in children is here.
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 correctfitting footwear.
In-toe and out-toe walking in children:
In-toeing means that the foot ot 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.
Some infants are born with feet that can bend inwards from the middle of the feet to the toes – called metatarsus adductus. It usually improves on its own without treatment. If the child reaches about 6 to 9 months and the condition is not improving special corrective shoes or casts are often recommended. Other articles on metatarsus adductus are in ePodiatry’s database.
A good book, called Is Your Child Walking Right?: Parents Guide to Little Feet is available with more information on walking or gait problems in children.
Toe walking in children:
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 its a mild shortness, stretching exercises and/or physical therapy may be necessary. If the toe walking is more severe or persistent, then consideration needs to be given to casting, botox injections or surgery. All cases of toe walking should be evaluated to rule out the causes other than just habit.