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10 February, 2010

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Feet - children

The foot is a complex structure of 26 bones and 35 joints, held together and supported by scores of ligaments. A baby’s foot is padded with fat and is highly flexible. Children begin to walk anywhere between eight and 18 months of age. Most toddlers are flat-footed when they first start walking, or tend to turn their feet inwards, because of poor muscle tone and weak ligaments in their feet. This will improve as the feet strengthen. Always see your podiatrist or doctor if you are concerned about your child’s feet or gait.

Wearing shoes
A child learning to walk receives important sensory information from the soles of their feet. Shoes, particularly those with hard and inflexible soles, can make walking more difficult. Your toddler doesn’t need shoes until they have been walking for a couple of months, and then only to protect their feet from sharp objects. It is important to allow your child to go barefoot regularly to help them develop balance, coordination and posture. Have your child’s shoes professionally fitted, which should include measuring each foot for length and width. Children’s feet grow very quickly and their shoe size may need updating every few months. Shoes that are too tight can hamper your child’s walking and cause problems, such as ingrown toenails and bunions.

Suggestions for shoes
Shoes for your toddler should ideally have features including:

Firm, comfortable fit both lengthways and widthways
Rounded toe
Plenty of room for the toes
Flexible, flat sole
Heel support
Laces, straps or equivalent to prevent excessive movement or slipping of the foot inside the shoe.

Flat feet
The sole of a normally developed foot has an arch, called the medial arch, formed by muscles and ligaments. For the first two years, your child’s feet will seem to have fallen arches. Flat feet are normal in a young child due to weak muscle tone in the foot, a generous padding of fat, and loose ankle ligaments that permit the foot to lean inwards. As your child masters walking, the ligaments and muscles will strengthen and the fat pads in the arch area won’t be so noticeable. By around five years of age, your child should have normal arches in both feet.

Feet that turn inwards
Many toddlers walk ‘pigeon-toed’, with either one or both feet turned inwards. In most cases, this is simply a sign of developing posture and balance, and should resolve by itself (without the need for medical intervention) somewhere between the ages of three and five years. However, if the in-toeing is severe, seems to involve the leg and hip as well as the foot, or isn’t improving by the time your child is around one and a half to two years of age, see your podiatrist for assessment. Excessive in-toeing may be caused by a variety of underlying difficulties, such as hip joint problems.

Feet that turn outwards
Very occasionally, toddlers walk with their feet turned outwards. This tends to be more common in children who were born prematurely. In most cases, out-toeing resolves by itself as posture and balance matures, but see your podiatrist if you are concerned.

Problems that need professional attention
You should see your doctor or podiatrist if you are worried about your child’s feet or gait. Problematic symptoms may include:

Abnormally shaped toes
Ingrown toenails
Bunions or other deformities
Stiffness in the foot
Limping
The child complains of pain while walking
Severe in-toeing or out-toeing
Flat feet beyond the age of five years
A sudden change in the way your child walks
If your child isn’t walking at all by two years of age.

Where to get help

Your doctor
Paediatrician
Maternal and Child Health nurse
Podiatrist
Physiotherapist
Maternal and Child Health Line, Victoria (24 hour) 132 229

Things to remember

Most toddlers are flat-footed when they first start walking because the muscles and ligaments of their feet are underdeveloped.
Toddlers should go barefoot as often as possible to encourage balance, posture and coordination.
See your doctor or podiatrist if you are concerned about your child’s feet or gait.

You might also be interested in:
Developmental coordination disorder.
Foot care - podiatrists.
Footwear for healthy feet.

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