Is your child knock-kneed, flat-footed or sporting a limp? These are common childhood foot problems.

The good news is that more than 80 percent of children will outgrow most of their foot problems. However, 15 percent will go on to have foot issues later in life, says Sean Pincus, a Cape Town-based podiatrist. So, if you suspect something is not right with your child’s feet, have them assessed by a podiatrist.

What’s afoot?

According to the Podiatry Association of South Africa, only a small percentage of foot problems are genetic, and many develop because of neglect or improper foot care such as wearing ill-fitting shoes.

Limping

If your child is limping, he’s doing it because his leg is sore and it’s almost always the result of a foot or lower limb problem.

Walking on tiptoes

Some children are habitual tiptoe walkers while others walk this way because of their short Achilles tendons. While it’s common for a toddler to walk on his tiptoes, if your child is still doing this after he turns three, have him assessed.

Intoeing, walking pigeon-toed, outtoeing intoers

Children with these issues are prone to tripping. While it can occur from birth, intoeing can also be caused by children sitting in a “W” position, so parents should monitor this. Children with this gait are compensating for problems with their feet or rotational deformities of the leg. This needs to be addressed as soon as it’s picked up. It is usually when your child starts walking, anytime between 10 and 16 months.

Flat feet and fallen arches

A child’s arches only really begin to develop at the age of three, so this would be when you’d spot it. Your podiatrist may recommend orthotics if the flat foot is causing problems.

Knock-knees and bow knees

Knees that go outwards (bow knees) and knock-knees that go inward very often correct themselves. But if they don’t, they will require orthotics, physiotherapy and even surgery to change the angle.

Athlete’s foot, plantar warts and ingrown toenails

Make sure that your child wears slops at public pools to avoid contracting athlete’s foot and plantar warts. While ingrown toenails can be congenital, they can also be caused by cutting the toenails incorrectly. Trim your child’s toenails straight across and leave them slightly longer than the tips of his toes. Don’t cut the corners or on the sides.

Sever’s disease

“This is probably the most frequent cause of heel pain that we see in children. Girls develop it around age nine and boys a little bit older, at about age 11,” says Pincus. It’s characterised by activity-related pain that occurs on the back of the heel where the Achilles tendon attaches on the heel bone. Your child may have swelling in the area, and it may be tender to the touch. They may limp or complain of heel pain, often when moving from one type of surface to another.

“We find it in children who do a lot of running, jumping, and other high-impact activities. It’s one of the foot problems that’s not congenital and has to be managed by controlling the amount of activity that your child engages in,” he says.

When to see a podiatrist

The Podiatry Association of SA recommends that you take your child to visit a podiatrist once a year. “You take your child for hearing and eye tests, and to the paediatrician for checkups, so why not check out his feet?” asks Pincus. As the foot starts to form properly from the age of three, arches begin to develop and foot problems may present themselves. “You want a podiatrist to follow your child’s development through his growth years, so that if something changes, you’ve established a baseline. Of course, if there’s an obvious problem, you need to see the podiatrist long before your child turns three.”

Barefoot is best

Pincus says barefoot is best, as long as your child is walking in a safe environment, such as grass without thorns, on the beach or inside. This is because a badly fitting shoe interferes with your child’s growth and development. Before the age of three, a child’s feet is made up of mostly cartilage so the younger a child is, the less bone there is in their feet. As the foot serves as an interface between the brain and the surface on which the child is walking, it shouldn’t be restrained by footwear.

The right shoe

Pincus suggests the following when choosing shoes for your child:

• The shoe must hold onto the foot, not the foot onto the shoe. Look out for soft flexible shoes that allow the foot to function. It should also be flexible across the ball of the foot while the heel counter should be firm and stable.
• Socks with rubberised soles work well for toddlers. Rigid shoes are a no-no as they interfere with foot development, as are sandals without a backstrap.
• Have your older child’s feet measured every three months – there are some shops that do this – and make sure that there is a thumb-width space between your child’s big toe and the top of his shoe.
• When it comes to buying a shoe for your older child, go with leather or non-sweat synthetic shoes. Also look for the Podiatry Association of SA’s approved swing tag.
• Never put girls younger than the age of 10 in high heels.
• Ideally, choose sport-specific shoes. There is no one shoe that will cover all the sports; the surfaces used and the nature of the games differ.

Tori Hoffmann