Importance of footwear:
Parents so often worry about their children’s teeth, eyes, and most other parts of the body, but do not worry so much over the developing foot. As many adult foot problems can have their origins in childhood, attention to footwear in children can minimize the risk of these problems in adulthood. Foot problems in children are usually preventable by correct fitting. Custom made orthotics are often prescribed by your podiatrist for the many foot abnormalities seen in children with the correct footwear.
Fitting footwear for the child:
The most important factor in shoes for a child is that they fit.
Advice for the fitting of a child’s footwear:
- Generally, for a shoe to be correctly fitted, there should be a thumb width between the end of the shoe and the end of the longest toe.
- When looking at the bottom (sole) of the shoe, it should be relatively straight (not curved in) – the foot is straight, so the shoe should be straight. (Except in cases of the front of the foot deviated toward the inside (metatarsus adductus)
- The fastening mechanism (laces, Velcro, buckles) should hold the heel firmly in the back of the shoe (the foot should not be able to slide forward or out of the shoe).
- The heel counter (back part of the shoe) should be strong and stable.
- Leather and canvas are a better material – they are more durable and can breathe. Synthetic materials do not breathe as well, unless they are of the ‘open weave’ type. Avoid plastics.
- Check that the shoes have rounded toe boxes to give the toes more room to move.
- Shoes should not need to be “broken in”. If they do, they are either poorly designed or poorly fitted.
- An absorbent insole is helpful, as the foot can sweat a lot – children are very active!
Growth of the child’s foot:
Shoes are not necessary indoors when your child first begins to walk. Allow your child to go barefoot. This helps the foot to grow normally and develop its musculature and strength, as well as grasping action of the toes.
The Child’s Foot:
The human foot is a very complicated part of the body and the feet of young children are soft and pliable, so abnormal pressures can easily cause the foot to deform. The foot of a child grows rapidly during the first few years, reaching almost half their adult foot size.
Foot problems commonly experienced by children:
Foot pain and symptoms in children is not common compared to adults due to the flexibility and resilience of the tissues.
- Ingrown toenails can occur and will probably need treatment. Parents should never try to dig the nail out at home.
- Warts commonly occur in children and adolescents. You can seek a podiatrist for treatments.
- Non-specific growing pain or leg fatigue are a common complaint of children, often causing a deep ache like leg pain during the night. Most of leg fatigue problems are resolved rapidly with the use of orthotics. There are some specific causes of growing pains, especially in the heel, called Sever’s disease or calcaneal apophysitis (inflammation of the growth plate, most common between the ages of 8 until the heel bone is fully developed around 14) and at the knee, where it’s called Osgood-Schlatters disease. These syndromes usually respond very well to orthotic therapy.
- Clubfoot is a relatively rare deformity that is generally addressed at birth and that may still cause problems in later life after correction.
- Feet that sweat profusely or have a smelly odor can also be a problem in older children and the symptoms of all these can be treated by your podiatrist.
- Flat feet : Flexible flatfoot or a pronated foot in children is usually painless in young children, but may cause an ache, especially if the child is overweight or older. In the very young child, there is often a ‘fat pad’ in the arch area of the foot which gives an appearance of a flat foot, when it is not. Children over 3 years of age that still seem to be excessively flat footed should be examined by a podiatrist to determine if the degree of pronation (flattened arch) is normal for that age range or if it is a sign of a developmental abnormality. If it is extremely severe flat foot the child should be seen much earlier. If the foot also rolls inward at the ankle (pronates), then this may be cause for concern. Treatment with foot orthotics are indicated if it’s severe, causing symptoms and if both parents have flat feet, as this indicates that they may be less likely to grow out of it. The idea here is by supporting the unformed arch in a child, the foot is more properly aligned and as the bones fuse and the child develops, hopefully an arch will be formed and prevent osteoarthritis in the multiple joints of the lower extremity.
In-toe in children:
Intoeing is a very common condition and the parents are usually concerned for esthetic reasons or because the child trips a lot. The podiatrist needs to evaluate the cause of the problem.
It can come from:
- The hips (tight pubo femoral ligament)
- Thigh bone (internal femoral torsion)
- Knees (pseudomalleolar torsion)
- Leg (internal tibial torsion)
- Foot (metatarsus adductus)
Once we determine the origin (which may be one or more of those causes) we can address it accordingly. Different types of custom made orthotics can be fabricated depending on the cause of the problem. Your podiatrist is well trained to identify & prescribe the precise orthotic that your child needs, to the correct sitting position and to recommend some possible exercises and stretching.
When the child walks toward the outside, it can also have many origins
- Tight ligaments in the hips
- Thigh bone (external femoral torsion)
- Leg (external tibial torsion)
- Foot (highly pronated foot)
You need to see your podiatrist so he can evaluate the cause and discuss the appropriate treatment. It is important to note that in most cases of outtoeing, the child should never be told to walk toward the inside because he may develop osteoarthritis in his hip joints in the long term.
Toe walking in children:
Toe walking (equinus gait) is common in children, especially when they learn to walk. However, it can be a sign of a condition that needs further investigation (especially if the ankle joint range of motion is limited). Most cases of toe-walking are just a habit and the child will grow out of it but the bad habit should be broken as quickly as possible. All cases of severe toe walking should be evaluated to rule out neurologic or developmental causes.
Practically all foot imbalances, that podiatrists see stem from childhood. Bunions, for example, thought to be cause by poor-fitting shoe gear are, in fact, primarily caused by abnormal foot mechanics and aggravated by shoes. These imbalances are recognized as early as age three or four. If a child has feet that flatten or “roll in” excessively (called hyper-pronation) chances are that they will experience more serious problems later in life. At an early age, structures of the foot can be repositioned to grow in proper alignment. Often, children will not complain of foot problems, so a check-up by a podiatrist is a good idea for all children.
Book on children’s walking:
Is Your Child Walking Right?: Parents Guide to Little Feet