Children’s Foot Problems – Early Warning Signs

Kids’ feet change quickly so many variations are normal. Learn the signs that your child may have an underlying foot problem or abnormal way of walking that needs assessment. Persistent limping, pain, tripping, toe-walking, pigeon toes, pain, swelling, redness, uneven shoe wear, or refusal to play may all warrant early evaluation. Detecting issues early can help ensure your child maintains mobility, coordination, and optimal musculoskeletal development.

Common Variations in Children’s Feet By Age

Children can appear flat-footed early on since fat deposits hide their foot arch, and many foot bones haven’t fully ossified into hard bone yet. The arch typically becomes visible between ages 2 and 6. Even after the arch appears, children’s walking patterns aren’t fully developed until middle childhood.

Flexible flat feet are normal early in childhood due to mild pronation and wide-based walking patterns. Many kids will outgrow these variations as leg and foot strength improves.

Children usually begin walking independently between 9 and 18 months. Most kids ages 3-4 years have steadier gaits, while those ages 7-8 have similar walking patterns to adults. Keep in mind there is variation between children just like their parents. Genetics, activity level, footwear choices, and weight can all impact children’s feet.

Age-Specific Foot Variations to Expect

• Ages 0-12 months: Flat feet appearance, wide-based stance, excessive pronation, and intermittent toe-walking are normal in infants and toddlers. Many babies are born with metatarsus adductus (adducted forefoot), which generally resolves on its own.

• Ages 1-4 years: Flexible flat feet without rearfoot alignment issues are common in young children. Toe-walking may be normal in toddlers, but watch for tight heel cords. In-toeing (pigeon toes) from tibial torsion is also normal and usually corrects itself by age 5.

• Ages 5-12 years: Children’s arches typically develop by age 5. Rearfoot, ankle, and leg alignment will continue to improve with age. Painful flat feet, frequent ankle sprains, and asymmetry at this age is less likely to be normal.

Early Signs That Your Child Should be Evaluated

Concerning signs in children include:

• Recurrent foot or ankle pain that inhibits playing or sports

• Limping/Walking on toes after an injury or not improving with rest

• Toe-Walking that persists past 3 years old

• Recurrent tripping/clumsiness or multiple ankle sprains

• Swelling, redness, or warmth in one foot that doesn’t improve

• Shoes worn unevenly or quickly on one side

• Deformity that you notice worsening over time

Night pain, symptoms that appear to be worsening over time, or if only one foot is affected should be evaluated right away.

Causes for Concern with Children’s Foot Pain

Seek prompt care for your child if they are unable to bear weight after a fall, visibly deformed, or limping significantly. Pain with fevers, bumps, or bruises could be infected such as with Sever’s disease or osteomyelitis. Neurologic symptoms such as numbness/tingling, weakness, or bowel/bladder problems indicate something more serious like nerve involvement. Growth-plate injuries, infections, and some deformities have the best prognosis when caught early.

Diagnosis of Children’s Foot Pain

Physicians evaluate children based on their symptoms and physical exam. This will usually include watching them walk and examining foot alignment and stability. Your child may receive X-rays if there is concern about pain, a deformity that seems to be getting worse over time, or after an injury. Further imaging, such as an MRI or CT scan, may be needed for specific cases. If you are concerned about your child’s foot, we advise early referral to ensure they receive proper care.

Treatment Options for Children’s Feet

Orthopedic physicians manage most kids’ foot conditions conservatively. Shoes with structured heel counters and roomy toe boxes, icing, stretching, strengthening, activity modification, and occasionally orthotics can treat most symptoms. Physical therapy is often beneficial to address specific concerns like gait training and stretching tight muscles. Surgical interventions are rare in children and typically only considered for stiff or progressive deformities that limit activity.

Children’s Foot Evaluation at Wasatch Foot & Ankle Institute

Children’s evaluation at our clinic begins with understanding their developmental stage and unique needs. We aim to provide conservative care options when possible and ensure you get timely treatment when required.

Prevention and Parent Tips

• Ensure shoes fit well and are sized to your child’s larger foot. Kids outgrow shoes quickly, so check the fit every few months.

• Allow your child to go barefoot at home. Walking barefoot on grass or sand builds foot strength.

• Rotate your child through multiple pairs of shoes and replace shoes as they wear out.

• Encourage active play and gradually increase sport training intensity.

• Monitor your child for any changes in their walking gait, concerns with comfort or shoe fit, and check both feet!

Seek Care

If pain or limping is present for more than a week, your child is still toe walking past their toddler years, or you notice your child’s foot seems to get worse or limit their activity level, schedule an evaluation. Urgent care is necessary if pain is severe, you notice fever with their painful foot, inability to bear weight after injury, or other signs of infection.

Frequently Asked Questions

Q1: Are flat feet normal for kids?

A: Flexible flat feet without pain are very common in young children. As kids grow, their arches typically appear between ages 2-6. Painful flat feet need further evaluation.

Q2: Is toe walking normal?

A: Occasional toe walking is normal in toddlers, but if it persists after age 3 or is caused by tight heel cords, your child should be evaluated.

Q3: My active child complains of heel pain. What’s wrong?

A: Heel pain in active kids is often caused by Sever’s disease which is growth plate irritation. This is common in children ages 8-14 who participate in sports.

Q4: Should my child wear special shoes or orthotics?

A: Kids typically do well in supportive shoes that fit well. We often consider orthotics for children with pain, instability, or gait concerns that do not improve with stretching and strengthening exercises.

Q5: Why is early evaluation important?

A: While many childhood foot issues resolve with time, early intervention can prevent issues from becoming chronic and help ensure your child has the best development for mobility.