Childrens Feet by David Webby
Children’s feet differ from those of adults, as they are not yet fully formed.
During the Fetal period, the lower limbs start to bud around 3 to 5 weeks, followed by the nerve plexus and muscles, at 7 weeks. Between 8 weeks and 40 weeks, the differentiation of the embryo undergoes marked changes, forming the toes and other parts of the foot, which starts at the heel and ankle at 9 weeks. The metatarsal and toes form during the period from 16 to 20 weeks. At 21 weeks the heel bone starts to change from cartilage to bone. And at 37 weeks, the cuboid bone starts to ossify, indicating maturity of the embryo.
At birth, 40 weeks, the average length of the foot is 7.6cm.
From birth to 12 months the feet and legs go through a series of remodeling and alignment to prepare for crawling and walking. At six months of age the foot is still mostly cartilage; in fact, the last bone doesn’t begin to form until children are about three years old.
From birth til age 6-7 years, dynamic changes occur in bone growth, alignment, muscular and neurological development.
Further final ossification of bone occurs, particularly the heel and Tibia bone, occur between ages 9 to 13, which children can experience inflammation of growth plates, eg Severs, Osgood Slatters. These conditions can be exacerbated by sporting activities.
By 18 years, most of the bones are fully formed, but they don’t fully fuse until 22-23yrs of age.
What to look for;
Certainly, if there is an abnormal development of your baby’s feet, it may be good to check with the Pediatrician or Podiatrist to see if development is normal or not. If there is any abnormalities, many occur before the 7thembryonic week.
Structural abnormalities are usually picked up at birth.
Neurological and muscular abnormalities are usually seen further down the track.
Baby feet only need protection in the cooler weather. Socks with soft natural fibres, should be used to keep feet warm and grow suits should always be loose around your baby’s feet, so they don’t cramp the toes.
Making time for your baby to kick freely will help with the development of the muscles in the legs and feet.
Children usually begin to walk at any time between 10 and 20 months of age. It is important to remember that each child is unique and will move through the developmental stages at their own pace. Children also roll, crawl, walk and run in their own time.
When your child first begins to walk, shoes should only be used when protection is needed from the ground. Allowing children to go barefoot or to wear very soft shoes helps the foot to typically develop and assists in strengthening muscles, and sensitivity and development of nerves.
Sometimes children walk with their feet pointed inwards (in-toeing) or outwards (out-toeing). In most cases, these variations in walking are normal. Most children will grow out of these walking styles by the age of two, however it can sometimes take until the age of 12. If your child is not keeping up with their friends, or their legs are tired or are experiencing pain in their legs and feet, then best to take them to see a Podiatriast.
Children under the age of three may sometimes walk on their tip toes and this is a typical developmental stage. Any child over the age of three and still walking on their tip toes (toe walking) should be assessed by a podiatrist.
A child’s foot grows in length and changes in shape with growth. Arch development is an individual thing and arch height or a lack of an arch does not always indicate that a child will have problems with their feet. If your child has pain or has one flat foot that differs from the other foot, a podiatrist can assist.
Due to rapid growth in length and width while young, frequent changes in the size of shoes and socks may be necessary. Do a size check at least every one to three months up to the age of three, every four months up to the age of five and every six months from five years.
Heel pain may also occur in growing children, usually between the ages of 8-14, and may be worse during or straight after sporting activities.
If your child is experiencing pain at the back of the heel that has limited their activity or causes them to limp, a podiatrist can help.
Other area that may require professional Podiatry assessment and treatment may include knee pain, such as Osgood Slatters, or patella tracking issues.
It is important to assess gait, as abnormal forces on joints of the feet may cause issues further down the track, including spinal problems, such as Scoliosis.
Poor fitting or insufficient supportive shoes can contribute to problems as well. Bring in several pairs of shoes to your visit so we can assess any abnormal wear patterns that could be related to their gait.
Skin and Nails
Problems with the skin and nails on your child’s feet may occur from time to time. Some conditions (ingrown toenails, Athlete’s foot and warts) require treatment from a podiatrist, while others may be helped by changes in hygiene or shoes.
Children also tend to be more susceptible to warts than adults. A plantar wart is often on the sole of the foot and appears to be hard and flat, with a rough or ‘Cauliflower’ appearance. A wart may cause discomfort, as it presses on nerves.
A wart is caused by a virus, which causes the skin cells to grow rapidly, thus the unusual appearance.
Best to see a Podiatrist for a correct diagnosis.
Always have both feet measured for length and width.
The shoe should fit the natural shape of the foot, especially around the toes.
The toe of the shoe should allow toes to move freely and not be squashed from the top or the sides. Make sure there is about 1cm growing room for children between the end of the longest toe and the end of the shoe.
Shoes should fit comfortably around the heel and not be too loose or too tight.
Having shoes fitted by a store that offers trained assistants can help ensure the correct size and shape to keep little feet running and jumping.
What can we do for you?
A check-up with a podiatrist is recommended if:
You notice uneven shoe wear
You notice any skin rashes, hard skin, lumps or bumps on your child’s feet
Your child complains of recurrent pain in the feet and/or legs which also increases with activity
Your child is constantly tripping or falling
Your child walks on their tip toes
Your child’s walk does not look symmetrical (or the same on both feet and legs).
Or you have any other concerns about your child’s feet, or posture.