Those tiny little feet that appear at the bottom of the babies legs are the future load bearers, from toddler stage right up to old age. It’s normal then for parents to be concerned at every ‘step’ about their child’s feet, movement and shoes.
Parents are naturally often concerned because their child appears to be for example walking flat-footed. In the early stages of development of a child this is quite normal and gives the child a more stable base until the legs and feet have gained strength. Babies’ feet are quite different in many ways: different shape (wider in the forefoot and narrow in the heel, withcurly toes) and their bones are at this stage undeveloped. At this age it is currently cartilage, so it is soft and pliable. We have 26 bones to develop in each foot. In a child, it only becomes bony by the age of 7 – 8 yrs old.
We should therefore not force a child to walk too soon as this could cause problems further down the line.
First independent steps normally occur between 10 – 18 months. The below table comes from British Medical Journal, published in March 2018 about normal motor milestones.
- Leg alignment: This varies with age and is often influenced by a family history.
- Habitual toe walking: Common in young children up to 3 years.
- In-toeing: This can be due to child walking with knee and feet pointing inwards, and knock-knees are usually associated.
- Out-toeing: Opposite of above. This is usually associated with Bowed-legs.Flat Feet is most commonly seen in children.
It is important a Podiatrist assess whether any of the above concerns requires support or not. Walking patterns need to be be assessed early. This will help identify common problems such as the above. By not addressing any of these problems it is highly likely that if not corrected the child may grow to have problems such as foot pain, bunions, knee pain and lower back pain.
A common question asked is “What is a crucial age of walking?” There is no crucial age, however development of a child is assessed in segments;
– between first steps to 4 years old
– between 4yrs to 9yrs
– between 9yrs to 16yrs
– and in some cases between 16yrs to 21yrs
If between these ages a child starts to show signs of limping, reduced time spent weight-bearing or is inactive and trips/falls regularly, seek medical care by a Podiatrist.
So, what about footwear?
Well, children’s feet grow two sizes per year.(yup, its not cheap). Then one size per year until growth is complete. The first shoe should be of good quality leather, allows a sensible amount of room in for future growth, and lastly is checked for size every 6 – 8 weeks. Stiff and compressive footwear may cause deformity, weakness and loss of mobility. You will notice a shoe is ill-fitting when your child starts to suffer from ingrown toe nails, corns and calluses, persistent curly toes or is not as active. The child will start to complain of pain when walking. If all these have been checked and the shoe is correct, then this is where you seek help from a Podiatrist. The main impact of footwear is in sports. In the Kensington borough, Ballet is very popular with our children so if bone and joint development is affected by ill-fitting shoes or more importantly their walking pattern is not normal then this will impact their ability to complete their sports activities such as Ballet and many more school activities. Foot movement is dependent on balance, good proprioception, flexibility plus strong lower leg muscles. These can all be achieved with regular stretching and strengthening exercises.
However if you are concerned then seek help from a podiatrist. Many parents already do.
This article is sponsored by Miss Alaa Razak (podiatrist) MSc, MChS, BSc (Hons) from Chelsea Pharmacy medical clinic and is available by appointment 7 days a week. Please call 0207 5898776 to make an appointment. Read more medical articles here.