The Childs Foot

The human foot is a complex structure of 26 bones which begin as soft cartilage and are fully mature by the age of 18. This means a baby’s foot is very pliable and abnormal pressures can easily cause the foot to deform. Children’s feet also grow quite rapidly during the first year, reaching almost half their adult foot size. So this time is very important in the development of your child’s feet and regular checkups are advised to eliminate any issues early on.

Importance of footwear

Many adult foot problems can have their origins in childhood, so attention to footwear in children is important. Poorly fitting, too loose or too tight shoes can restrict Children’s feet, causing them to grow abnormally or causing unnatural movement patterns. A small problem as a child can cause larger issues as an adult, causing a high level of pain and discomfort. Luckily these types of issues are often prevented and treated with appropriate footwear.

Common concerns for parents

Children’s feet have just the same problems with skin and nails as adults, such as ingrown toenails and athlete’s foot. Whilst these may sometimes require treatment from a podiatrist, often these are helped by a change in hygiene or shoes.Children are however more susceptible to warts than adults. Plantar warts are quite common and appear on the sole of the foot. These tend to be hard and flat, with a rough surface and well-defined boundaries. If left untreated, they can grow into clusters and cause quite a lot of pain. There are various treatments available and your podiatrist will discuss which is the most appropriate.


When your child first begins to walk, shoes are not necessary for indoors. Allowing babies to go barefoot or to just wear socks helps the foot to grow normally and promotes the grasping action of toes. When buying a shoe consider a sturdy closed-toe shoe with a strong back to provide support around the heel and anchor it into the shoe to prevent slipping. Shoes that lace up or secure the foot into them are going to provide much better support and comfort than slip-on styles. For shoes that are worn for long periods of time, natural, breathable material like leather is best. For shoes which are worn occasionally and for shorter periods of time, thongs or rubber crocs are fine.

Flat foot in the child

Flexible flatfoot is usually painless in young children, but can lead to issues if this does not improve as the child grows. Infants usually have a fat pad in the arch of the foot, which gives the appearance of a flat foot but this too will disappear as the child grows. With flat feet, the foot will normally roll inward at the ankle (pronation), due to weak muscle tone and flexible ligaments. Most children will improve as they grow and their feet and ankles become stronger but monitoring to ensure normal foot growth will allow early intervention to help prevent any severe deformities as an adult. As a general rule, the arch should have developed by approximately 6-7 years of age. If the arch has not developed adequately by this age, orthotics may be warranted to help support the arch and prevent problems. Flat feet can be hereditary, especially if both parents carry this trait. All this can be discussed with a Podiatrist to ensure the best treatment is given to your child.

Knock knees

Many young children develop knock knees, which is most apparent at the age of 4 and tends to correct by the age of 7. Knock knees can cause pain in the legs, hips, feet and knees if it does not correct. Orthotics, amongst other treatments may be used to straighten out the feet and ankles, so that the legs are better aligned.

Bow legs

Bow legs in infants is normal, straightening out as children learn to walk and their legs strengthen and develop. In some cases this does not correct and treatment may be necessary.
To monitor this condition, parents are encouraged to take a photo of their children’s legs every 6 months and compare the images.
If the bowing is getting worse or if one side is more bowed than the other, treatment should be given immediately to prevent further bowing and potentially painful flow-on effects to the hips, knees and feet. This can also be an indication of an underlying disease so promptly seeking medical advice is important to correct and prevent further issues.

Treatment can include orthotics, corrective shoes, leg braces and surgery or a combination of all. Your Podiatrist will work out the best treatment plan for your child.

Toe walking

Toe walking or Equinus Gait is when the toes are used to walk on, with the heels off the ground. This is not unusual in children learning to walk, however, it can be a sign of a more serious condition, particularly if there is a limited range of motion in the ankle. Most cases of Toe Walking are just a habit that children will grow out of as their legs and feet develop but can be caused by more serious conditions such as cerebral palsy, muscular dystrophy, leg length differences, spinal cord abnormalities and Achilles Tendon shortness. A mild shortness in the Achilles tendon can be corrected with stretching exercises and physical therapy.

In-toeing and out-toeing in children

Commonly referred to as being Pigeon-Toed or Duck-Footed respectively. In-toeing means that the feet point inwards instead of pointing straight ahead when walking and Out-toeing, the opposite, is when the toes point outwards.

In-toeing in more common in young children and most often corrects as children develop. Children with In-toeing may trip more than other children and be less stable on their feet so supervision during high activity is needed. If in-toeing persists beyond the age of 2 or is causing problems, stretching exercises or special shoes, could be needed.

By the age of 2, most children walk with their feet pointing straight ahead or slightly outward. Just as the toes can point inwards at one stage of a child’s development, they can point outwards at another and will usually straighten as children develop.

Because these are so common and do not affect children’s feet or walking long-term, treatment is not usually given unless the case is severe or persistent. Treatment may include corrective shoes, foot supports or physical therapy.

Nail cutting in infants

A baby’s’ toenails are soft but can be sharp. To avoid infants scratching themselves, their nails must be clipped regularly. Using a small set of clippers, trim the toenails straight across, then gently use an emery board to file any sharp edges.

Foot Pain in the child

Foot pain and symptoms in children is not common compared to adults due to the flexibility and resilience of the tissues.

If a child is complaining of foot pain or appears agitated by their feet, a number of investigations can be made to ensure the cause is identified and appropriate treatments are being given. An appointment with a Podiatrist will help to ensure your child’s feet are healthy and pain free.


Developmental guidelines are used to benchmark children against others of the same age and determine if their development is progressing normally or if there may be issues. Premature babies may be slightly delayed but this should not be a cause for concern.

All children are unique and will meet milestones at their own pace but as a general guide, the four postural milestones are:

  • Sitting independently at 6 months
  • Crawling at 8 months
  • Cruising (walking sideways and stabilizing self on furniture)
  • Walking independently at 12 months

If children are not meeting postural milestones within a reasonable timeframe, seek advice from your general practitioner.