Children’s Feet Due to the complexity of the foot structure, our feet are highly vulnerable to injury and disease. Children’s feet are even more vulnerable and many adult foot problems can have their origins in childhood.
Childhood Lower Limb Development
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; • Followed by ‘cruising’ (walking sideways and stabilizing self on furniture); • And finally, walking independently at 12 months. If you have any questions regarding postural milestones seek advice from your general practitioner.
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 are a part of normal development which usually becomes apparent at about 2-3 years of age, and reaches a maximum deformity at approximately 4 years of age. It then usually tends to improve until 6-7 years of age, at which point the child be a little version of their adult alignment.
Nail cutting in infants
A baby’s 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. Our feet are often the most neglected part of our body. Yet from when we take our first step, our feet become our main mode of transport, carrying us on a journey of approximately 128,000 kilometres in a lifetime. The foot comprises of 26 bones, 35 joints, numerous supporting ligaments and layers of muscle.
Flexible flatfoot or a pronated foot is a condition in which the foot that appears as if the arch is flat or the ankles are rolling inwards. It is usually caused by loose ligaments within the feet and can occur in one foot or in both. Flat feet can sometimes cause aching feet or legs, especially during and/or after exercise. Other problems that can arise from flat feet include poor balance; poor coordination and frequent tripping over; bunions; heel pain; and knee pain. Treatment with foot orthotics may be indicated if symptoms are occurring or if the flat foot is severe and likely to cause symptoms in the future.
Heel Pain/ Severs Disease
There are numerous causes of heel pain in children. Severs disease is an injury to the growth plate of the heel bone where the Achilles tendon attaches. It most commonly affects active children between the ages of 10 to 14 years of age. Your child may experience pain at the back of the heel bone. This is worse with exercise (particularly running & jumping) and is often severe enough to make a child limp or stop sport. Initially, it is best to reduce sports /activity & ice the painful area. Also check the fit of your child’s footwear, as ill-fitting shoes or poorly constructed shoes can cause or exacerbate the problem. If pain persists, it is recommended to seek further opinion of management with a Podiatrist.
Knee Pain/ Osgood Schlatters
Osgood Schlatters is a common cause of knee pain in young children. Osgood-Schlatters causes pain, tenderness and swelling just below the knee, and down the shin (tibia). It is more common in boys, overweight children and from overzealous activities such as running and jumping. Osgood Schlatters will usually present with tenderness and swelling just below the front of the knee. Avoid activities which involve deep bending of the knee and apply ice to the affected area. If pain continues, seek a professional opinion from a Podiatrist or Physiotherapist.
Toe walking is a condition whereby a person walks bearing little or no weight on the heel of the foot. Instead they walk on the ball of the foot and appear as if they are tip-toeing. It is most commonly seen in toddlers and there are numerous causes for toe walking including habitual (idiopathic), shortening of the Achilles tendon and muscle spasticity. The later of these is most commonly seen in children with cerebral palsy and muscular dystrophy. Typically, health care professionals will diagnose toe walking. An assessment by a Podiatrist or Physiotherapist can determine the cause of the condition and direct further treatment options. In-toeing In-toeing or “pigeon toeing” is when the foot points inward instead of straight forward when walking. There are numerous causes to in-toeing including muscle imbalances and/or structural discrepancies at the level of the hips, thighs, legs or foot. A child that in-toes when walking they may present as clumsy and can trip over frequently. It can also cause leg pain and issues fitting shoes. It is important to see a Podiatrist if your child’s in-toeing is causing leg pain; one sided; excessive; and / or causing difficulty with performing activity.
Frequent Ankle Sprains
An ankle sprain is one of the most common injuries for children. It occurs when there is a sudden twisting motion at the ankle (either inward or outward) during weight loading. This can overstretch or even break the ligaments which support the ankle joint resulting in pain, swelling, bruising and the inability to weight bear. When ankle sprains occur frequently it is often the result of poor foot biomechanics. If your child sprains or twists their ankle frequently, a Podiatrist is able to manage this through exercises and the use of orthoses.
Growing pains are harmless muscle pain which can affect children from 3 years of age right through to their adolescence. They often occur of an evening and affect either the calf muscles, thigh muscles or behind the knee. There are numerous causes including muscle tiredness and poor postural control. Growing pains usually occur of an evening or at night. They can be infrequent and can be brought on by increased activity during the day. The pain is always gone by the morning. Growing pains do not affect the way a child walks or runs although lower limb biomechanics can be an attributing factor to the problem. Having your child assessed by a Podiatrist can help determine the underlying cause and fix any lower limb muscle imbalances, to stop symptoms from occurring. Growing pains DO NOT make a child unwell. If your child is unwell or their leg is swollen or sore to touch, it is important for you to seek medical attention as there may be a more serious underlying cause.
Importance of footwear
Making sure your child is fitted with the correct footwear can be a crucial step in minimising foot and leg pain as they develop and into adulthood. In order to ensure the footwear you are purchasing for your child is appropriate, use the following characteristics as a guideline and if still concerned about the fit, always consult with a podiatrist. Ideal characteristics for children’s school shoes include: • Straight last (the sole of the shoe should be straight NOT curved) • Flexible forefoot (the shoe should bend at the toe area to enable propulsion of the foot) • Firm at the heel • Adjustable with laces or Velcro straps • A strong shank (this means you shouldn’t be able to fold your child’s shoe in half from the mid-point of the sole!)