Children’s feet differ from those of adults, as they are not fully formed. Babies feet are mostly cartilage, around age three the last bone to start forming occurs and it takes until age 18 for most of the bones to be fully formed.
We all want the best for our children, this includes looking after their feet and legs. It is recommended to see a podiatrist if:
- There is report of pain in the feet or legs; pain is not a normal part of growing up
- There is uneven shoe wear
- Your child falls or trips a lot
- Your child walks on their tip toes
- Your child’s walk is asymmetrical (different on one side to the other)
- Your child has shoe fitting problems
Early identification is vital in preventing and reducing the severity of more complex pathologies later in life. A paediatric podiatry assessment includes:
- A detailed medical, pre/post natal and developmental history
- Range of motion studies
- Muscle testing
- Reflex testing
- Standing assessments including foot type (high arched or flat footed)
- Walking and running assessment
- Motor skills check including balance and hopping
- Footwear assessment: correct length, width and depth and analysis for supportive shoe features.
After an assessment is performed the podiatrist will discuss the cause and management plan of the presenting problem. Management can include:
- Footwear recommendations
- Stretching and strengthening exercises
- Orthotic therapy
- ‘Watchful waiting’ in the case of developmental problems
- A referral to a specialist
- Taping and padding
- Activity modification
- Heel raises
Some common foot conditions that a podiatrist manages includes toe walking, intoeing, flat feet and heel pain.
Toe Walking in Children
A gait pattern in which heel contact with the ground is excluded, either completely or periodically. Toe walking can be a developmental phase in young children or it may indicate an underlying pathology.
Differentiation between developmental/‘idiopathic toe walking’ and more serious entities is at the core of assessment of affected children.
The diagnosis of idiopathic toe walking is made through exclusion. Other causes of toe walking include cerebral palsy, autism, muscular dystrophy, sensory integration problems, developmental delay and triceps surae (a leg muscle) contracture or shortness.
Some of these conditions are not easily identified and therefore it can take until school years to be diagnosed.
Intoeing in Children
Some children’s feet turn in when they walk, this can be called intoeing or pigeon-toed gait. Intoeing may originate from a single cause or multiple factors including developmental, familial, neurological or orthopaedic factors.
An intoed gait is associated with an increase in tripping among children and it can be a feature of a more sinister pathology.
A screening process will identify children who have developmental and/or a musculoskeletal problem.
Flat Feet in Children
Other terms that mean someone is flat footed include over pronation, fallen arches, pancake feet, collapsed arches and rolling in feet.
Flat feet implies a foot lacks an arch, however, it is more complex than arch height. There are five other areas that are assessed to determine if someone has a flat foot or not, this includes the appearance that the heel or ankle rolls in and a bulging at the inside heel region.
Flat feet are very common in very young children, their feet are flexible and therefore collapse down when they stand, walk and run. Most children will develop an arch, some will not and it needs to be determined if they have a flexible or rigid flat foot.
If the podiatrist determines that the degree of pronation is outside the acceptable amount for the child’s age, management will be advised. This may include footwear changes, strengthening exercises and/or orthotic therapy.
Heel Pain in Children
Heel pain is common in children because there is a growth plate at the back of the heel. A common cause of heel pain associated with this growth plate is sever’s disease/calcaneal apophysitis.
The peak incidence of this is age 8-12 in girls and age 10-14 in boys. Sever’s disease is a self-limiting condition, this means, in time the pain will resolve when the growth plate closes off.
Contributing factors for sever’s disease includes muscle tightness, recent growth spurt, flat feet, excessive jumping, over training, hard playing surfaces, worn or inappropriate footwear and trauma to the area.
Management is aimed at resolving the contributing factors and enabling the child to continue with some sporting activities. It is unfair on a young person to stop all physical activities, particularly when pain can be reduced with podiatry management.
This may include footwear changes, orthotic therapy, stretching and strengthening exercises, heel raises, cushioned heel cups and activity modification.