Your Child's Feet

 As parents, we all worry about our children’s teeth, eyes and other parts of the body, but other than counting how many toes our newborn baby has, how many of us actually worry about the development of our children’s feet? A baby's foot is not simply a smaller version of an adult's. At birth the 26 bones that will eventually make up the adult foot are mostly cartilage, making them pliable and therefore susceptible to damage. As parents, we must be concerned about these developing feet, which have to carry the entire weight of the body through a lifetime.

 

Many adult foot ailments begin in childhood and are present at birth. Neglecting foot health invites problems in other parts of the body, such as the legs and back. Any problem occurring in the foot can transfer problems to other parts of the body, as a result of our body’s compensation mechanism.

 

In my practice I see a large number of children with varying problems.  The most common being flat feet, in-toeing or out-toeing.

 

Flat feet:  For the first two years or so, your child’s feet will have seemingly low arches. 

During infancy and toddler-hood, parents should not be concerned that their child’s foot is “flat”. Most children are born with flat feet.  This is because the feet have numerous loose ligaments, weak muscles and a generous padding of fat.   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 to seven years of age, your child should have normal arches in both feet.

 

Feet that turn inwards (In-Toeing): 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 chiropodist for assessment. Excessive in-toeing may be caused by a variety of underlying difficulties, such as hip joint problems.

 

Feet that turn outwards (Out-Toeing): 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 chiropodist if you are concerned.

 

Problems that need professional attention:

 Symptoms of problem feet may include the following:

• 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.

 

Please see your doctor or chiropodist if one or more of this problems is noticed.

Your Baby's Feet

A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.

Here are some suggestions to help you ensure that this development proceeds normally:

 

  Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Deformities will not be outgrown by themselves.

  Cover baby's feet loosely. Tight covers restrict movement and can impede normal development.

  Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weight bearing.

  Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.

 

Starting to Walk

It is unwise to force a child to walk. When physically and emotionally ready, the child

will walk.  Comparisons with other children are misleading, since the age for independent walking ranges from 8 to 18 months.

 

 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. When the child first begins to walk, shoes are not necessary indoors (Beware:  our mothers will tell us likewise!). Allowing the child to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength.  Children only require shoes to protect their feet when walking outside or on a rough surface.   Shoes then, should be lightweight, flexible and made of natural materials.  Actually, recent research suggests that wearing shoes too early in childhood may be detrimental to the development of a normal arch.

 

 

Growing Up

Children under the age of 16-18 months grow more than half a foot size every two months. Toddlers from the ages of 16 to 24 months grow an average of half a foot size every three months. When they are 24 to 36 months old they grow approximately half a foot size every four months. Over 3 years of age, they increase half a foot size every four to six months.

As you can see, children's feet grow very quickly and their shoe size may need updating every few months to allow room for the feet to grow.  Although foot problems result mainly from injury, deformity, illness or hereditary factors, improper footwear can hamper your child’s walking, cause problems such as ingrown toenails, and can aggravate pre-existing conditions, such as bunions.

Tips for Fitting Footwear:

o    Measuring feet is only a guide. A good shoe store will always check the fit of both shoes on the feet.   The child should be STANDING when feet are measured and shoes are fitted.

o    Choose a shoe that gives stability and protection to feet, which are still soft and flexible. An ideal shoe should have a rounded toe and snug heel, with breathing leather uppers and laces or velcro to prevent excessive movement or slipping of the foot inside the shoe.

o    Choose a store that offers shoes in width fittings and half sizes and that has trained staff that can expertly fit them. Less than a third of children are 'average' fitting so foot measurement and correct fitting are vital to a pair of feet.

o    Fitted shoes have growing room to ensure good fit throughout the life of the shoe. It's not necessary to buy a larger shoe than one which is fitted. In fact, shoes that are too big can do as much damage as shoes that are too small. A proper fitting shoe should have one thumb’s width (1/2”) between the end of the longest toe and the end of the shoe, while standing.

Advice for Parents

Problems noticed at birth will not disappear by themselves. You should not wait until the child begins walking to take care of a problem you've noticed earlier.

 

Remember that lack of complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.

 

Walking is the best of all foot exercises, according to chiropodists. We also recommend that walking patterns be carefully observed. Does the child toe-in or out, have knock knees, or other gait abnormalities? These problems may be corrected if they are detected early.

 

Chiropodists have long known of the high incidence of foot problems among children. A thorough examination by a chiropodist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.   We recommend foot health examinations for children on a regular basis.

 

Whenever you have questions about your child's foot health, contact us.

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