Children’s Feet (Podopediatrics)

Like the rest of our body, most babies’ feet are fine at birth. Occasionally infants can have births defects like club feet or extra toes which are quite obvious and can be diagnosed and treated immediately. It is the more subtle developmental problems, which can be harder to diagnose and therefore go untreated. This is unfortunate in that the younger the individual, the more elastic their bones and joints are and as a result the easier to treat. Often times we have no clue until the child begins to walk between 9-12 months of age. So when do flat feet, duck feet, or pigeon-toed feet need to be treated?

There are indeed subtle clues that can raise a red flag that the baby/child should be checked:

  • If you see asymmetry (a difference) either in the structure or function of the foot and or leg, the child should be examined.
  • If there is a strong family history (parents, grandparents, siblings) of recurrent problems such as flat feet, which went on to create problems in adulthood, the child should be examined.
  • If the child is slow in their motor development, the child should be examined.
  • The child should start to be able to sit up independently and crawl around six months of age. The child should start to “cruise” (walk holding on to things) around nine months of age. The child should start to walk independently around twelve months of age. It should be remembered that each child is an individual and they have their own timetable, however, if the child is delayed by three months an examination is warranted.
  • If the child complains a lot about leg or foot pain and/or wants to be carried a lot these could be warning signs of a problem. They could also be a child who is stalling going to bed, trying to get attention, or lazy and wants to be carried. So as parents sometimes all you have is your innate intuition to go by. If the child has been walking for a while, say in a mall, and then wants to be carried, does not keep up with the children their playing with, or primarily engages only in sedentary (seated) activities it would be prudent to have the child examined.

The ontogeny (development) of the legs changes over time. What appears to be a deformity can straighten out during growth spurts. Remember most of these perceived growth disturbances are outgrown. The child is usually “bowlegged” (genu varum) from birth to the age of 3-4. Then the child can be mild to moderately “knock kneed” (genu valgum) between the ages of 2-5 and then straighten out as the child grows. If the genu valgum gets worse that could indeed be a problem.

So what if the child is symmetrically in-toed (“pigeon-toed”) or out-toed (“duck feet”)? Do they need to be checked? Most of us are initially in-toed at birth. All of the development of the lower extremity (femur and tibia) causes external rotation of the extremity with each growth spurt. Most of the external rotation is complete by the age of six. So if the child is moderately to severely out-toed at birth this typically worsens as the child grows and therefore should be checked. If the child continues to be moderately to severely in-toed beyond the age of six, after most of the external rotational development is completed, an exam is warranted.

Gait Plate orthotic for in-toed or out-toed gait

Gait Plate orthotic for in-toed or out-toed gait

Other potential warning signs include:

  • uneven shoe wear
  • rapid excessive shoe wear
  • shoes that become curved or C-shape
  • frequent tripping
  • bruised shins
  • sitting on the legs with the feet tucked under the buttocks
  • sleeping on the stomach with the knees bent and the feet tucked under.

These should all raise a “red flag” about a potential problem. If you are concerned it is better to be safe than sorry. “If in doubt, check it out.” It is easier to treat earlier than later. An evaluation is rather simple and typically does not require a lot of diagnostic testing.