Podopaediatric foot problems can appear very early. They require attention, because the bones in a child’s foot are soft and pliable and easily damaged by constricting shoes, socks and even bedding. Shoes that fit are especially important for a young child’s rapidly growing feet. When choosing shoes for your child make sure the shoe shape matches the foot shape and the upper is firm in the heel area but is flexible around the front of the shoe. No one brand will suit all feet. The upper of the shoe should be made of leather or material, which will allow air to circulate around the foot. Don’t use hand-me-down shoes.
Parents have to be on the alert for early developmental problems, since children do not usually complain about them. Check with Christian De Brennan at the first sign of excessive toeing in or out, flat feet, walking or standing strangely, stumbling, “growing pains”, or tiring easily and / or wanting to be carried all the time.
Video on Children’s Feet by the Australian Podiatry Association (NSW)
Brochure on Children’s Feet by the Australasian Podiatry Council
Poster on The First Steps To Foot Health by the Australasian Podiatry Council
A Walk Through Life
On our “walk through life,” our feet undergo many changes. The most critical period is the first three years of life, when the feet are rapidly developing. While learning to walk, one-year-olds tend to turn their feet outward to widen their base for stability. By age three, however most children walk with their feet straight ahead.
If the unborn baby lies with its feet pressed against the womb the wrong way, it can be born with its feet, legs or hips turned inward. This may make learning to walk difficult and can result in the child toeing-in.
Other causes of toeing-in are abnormal sitting and sleeping positions. Frog or ‘W’ sitting, sitting on the feet and sleeping on the tummy can delay or stop the normal development of the leg, knee, thigh and hip. In the short term this may lead to toeing-in, night pains and gross motor problems. In the long term the child will probably turn the hip out to bring the feet into a more forward position but if the underlying problem is not corrected knee and foot pain may result.
If the inward twist is in the foot, treatment should begin as soon as possible and must be completed by the age of two. This may involve using plaster casts, night splints, day / night foot splints or exercises to change the foot shape.
If the twist is in the leg, knee, thigh or hip toeing-in can often be corrected through stretching or strengthening exercises. Christian can teach parents some simple exercises that can help. The exercises take minutes a day and they are performed until the problem is corrected. However if the twist in the limb is the result of an abnormal sitting or sleeping position, correction will not occur until the child stops these habits.
Toeing-out is more likely to be inherited than from an abnormal position in the womb. This is also unlikely to be the result of abnormal sitting positions but some children may twist their leg bone (tibia) out too far by ‘w’ sitting.
The problem is often an over-rotation in the hip or leg. Exercises sometimes help with the problem if treatment begins at an early age.
Many babies naturally appear flat-footed. Usually, this will disappear as the baby begins to stand and walk.
Children with flat feet, or low arches may not be able to keep up with other children because of the added strain on feet and legs.
There is no way of giving a child an arch if they have a true flat foot but many children who appear flat-footed have a normal arch but flatten it when they stand. This movement is called ‘pronation’ and may cause a variety of painful symptoms, making the child tire easily or have problems with gross motor skills. If a child is pronating his/her feet orthotic devices may be useful to improve foot movement and relieve any painful symptoms.
Bow legs are normal at birth but should disappear. The bowed appearance may be caused by a curve in the leg bone ‘tibia’ or may involve the entire limb. This curve may cause the foot to roll or may place extra strain on the knee joint.
The bow itself is not correctable but if pain occurs in the knees or feet orthoses may be useful to relieve any symptoms.
Knock-knees are normal in children aged from two to seven years. Some children may become knock kneed again around puberty. If the problem has persisted from the age of seven, it may be permanent. Like bow legs this leg position may cause the foot to roll or may place strain on the knee joint.
Sometimes using orthoses to straighten the foot can help straighten the leg but this may be a long-term treatment. If pain in the feet or knees occurs orthoses can be useful to relieve symptoms.
This is also called hypermobility, ligamentous laxity or low tone. There are several simple tests for this problem:
Thumb to wrist
Elbows extending past a straight line
Knees extending past a straight line
Finger extending past a straight line
When testing at home care is needed, as most very young children will be flexible enough to show a positive result from these tests but be quite normal. If you are unsure of the result you should have your child examined by a podiatrist.
Treatment for flexible joints is needed if the child is having difficulties with gross motor skills or complains of pain in the feet or legs. Orthoses are usually very effective for pain relief or improving stability in these children but there is no way of permanently ‘curing’ the looseness in the ligaments.
If your podiatrist recommends orthoses for your child he/she will often need to take a plaster cast first. This will be taken with the child’s foot held in a corrected position and will be used to make the appropriate appliance. This procedure is not painful and only takes about 15 minutes.
Progressive casting can be used, to coax a baby’s feet back into a more normal position. Just as braces gradually reposition teeth, casts gradually reposition feet. The casts are changed periodically until the Podiatrist determines that the feet are properly aligned.
Orthoses (Orthotic devices)
Orthotic devices can be used to maintain proper foot support. They are made of plastic and must be re-made as the child grows older. Orthoses help to realign the foot and distribute body weight evenly. They can be used for a variety of problems including pain, poor stability and gross motor problems. These devices are not simple arch supports and need to be custom-made for each individual.
Have Problems Checked
If you suspect any foot problems, have Christian – Podiatrist, your GP or Paediatrician examine your child.