Childen's Feet

There are many gait variations in children that may look different to other children but are completely normal. To understand what is normal and what needs a further opinion it is important to understand the normal motor milestones.
These milestones include;

 

Sit without support

6- 8 months

Creep on hands and knees

9-11 months

Cruise or bottom shuffle

11-12 months

Walk independently

12- 14 months

Climb up stairs on hands and knees

15 months

Run stiffly

16 months

Walk down steps

20-24 months

Walk up steps

3 years

Hop on one foot

4 years

Skip

5 years

Balance on one foot

6- 7 years


Some common conditions seen in children include;

Flat Feet
Flat feet. Most children have a flexible foot with normal arch on tiptoeing. Flat feet usually resolve by the 
age of 6 years. However if they remain flat and cause pain, treatment with an orthotic is recommended to minimise tissue stress and pain.

In toeing/Out toeing
In-toeing (feet pointed inwards) can be due to the way in which the femur or tibia is positioned and how 
much they rotate internally. Knock knees (genu valgus) is commonly associated with in-toeing This is common between the ages of 3 and 8 years old. Bow legs (genu varus) are common from birth to early
toddler-hood, often with an out-toeing gait (feet pointed outwards). Out toeing gait usually resolves by 18 months. If children frequently trip, are clumsy or complain of pain regularly, a footwear assessment is advised and an orthotic with a gait plate may be recommended

Toe walking
Habitual toe walking is common in young children up to 3 years. If toe walking continues a podiatry 
assessment is recommended to determine if muscle tone, range of movement around the feet and if the foot can be observed plantigrade (heel and toes on ground at same time). Toe walking can often be idiopathic and often behavioural exercises which encourage the child to walk heel- toe are helpful.
However toe walking can also be observed in spastic upper motor neuron neurological disease (cerebral palsy, muscular dystrophy) so it is important to have a check up if there is any cause for concern.

Knee pain (Osgood Schlatter's/ Tibial tuberosity apophysitis)
Knee pain is common in active adolescents and Osgood Schlatter's is the most prevalent, it is most frequently seen after a growth spurt. The tendon attaching the quadriceps muscle to the knee joint becomes tight, creating inflammation and micro fractures in the tibial tuberosity (growing bone) commonly when the quadriceps contract.

Treatment includes; 
- Rest
- stretching
– icing
– strapping and taping
– orthotics
– assessing footwear
– ultrasound and shockwave therapy

Heel pain (Sever's Disease/ Calcaneal apophysitis) 
Heel pain is commonly seen in active children aged between 9-13 years old, more frequently seen in makes but can be seen in females too. Sever's is the most common cause of heel pain and is caused by inflammation of the growth plate in the heel, it is most frequently seen after a growth spurt.

Treatment includes;
- Rest
- stretching
– icing
– strapping and taping
– orthotics/ heel raises
– assessing footwear
– ultrasound and shockwave therapy

Crooked/ curly toes
Crooked or curly toes are observed from birth and predominantly affect the third
and fourth digits but can affect all toes. This problem is usually caused by tight flexor tendons and most resolve with weightbearing by the age of 5 years old. Taping and otoform devices (toe moulds) are used to encourage toes to grow straight and prevent tucking under. However if still persistent and causing pain and pressure points on the toes, surgery to cut the flexor tendons may be necessary.