Many parents who bring their child through our Podiatry Centre are concerned that they may have chosen incorrect shoes in the past.

They are worried that the shoes may have contributed to the problems their child is now experiencing in the feet or legs.

To assist parents in making the best choice we have put together  FEW ideas worth thinking about before purchasing shoes…….

How to choose the most appropriate shoes for your child……………

When Purchasing shoes for any age:

• Always get the size refitted each time; not only could your child’s feet have grown in size and / or width, but sizes vary amongst shoe maufacturers.
• It is best to buy shoes in the afternoon when you child’s feet are likely to be warmer and to have spread more through daily activity.  You will then be buying shoes when the feet are at their widest.
• Always have you child walk around when trying on shoes, as the feet will elongate as they stand.  Also walking in the shoes will give you an idea of any tight spots or areas which are slipping.
• When standing there should be a thumb space between the child’s longest toe  ( which isn’t always the big toe) and the end of the shoe uppers.  This allows ample growth room.
• When standing the child should be able to wriggle the toes freely and you should be able to ripple the leather over the toes.  This indicates the depth in the forefoot  is ample.
• Your child should wear the socks normally worn in the daytime.  If stockings are worn on the day of purchase, but thick sports socks are normally worn, then of course the shoes will be firmer.
• The shoes should be approximately the same shape as your child’s feet and should be made from a “last” to suit your child.  Your podiatrist will be able to tell you what type of shoe last your child needs.
• The sole of the shoe should be firm and only bend across the ball of  the  foot.  This also helps to limit excessive motion and allow the foot to act as a good lever.
• The upper should be of good quality, good breathing leather.

Are boots or shoes better for a growing child?

• We have all heard reasons for and against wearing either of these shoes.  Here are a few factors to go on when next trying to decide between the two.
• Children under the age of two have very flexible joints, feet and quite thin heels.  With the normal ” oxford” type of shoe, they simply tend not to stay on the foot well, no matter how good the shoe is.  It is primarily for this reason that the boot is typically recommended for this age group.  The uppers of the boot should be soft so as to not limit the ankle joint range of motion.  You may be concerned that the softness or flexibility of the boot will give any support to the ankle, and that they are not therefore much different to the oxford style.  However it is the foot posture which causes most instability in the ankle, rather than the shoe itself.  An inner support or insole would help in correcting any excessive instability.

Notes to remember:

• Worn our “hand me down” shoes are a definite “no-no”. The first owner has his or her own walking habits and WILL, therefore, wear the soles, uppers and inners in a particular fashion.  The second person then will be forced to wear and walk in the same way as the first person.
• While it is true that various aspects of the shoes can assist with an excessive motion problem, shoes themselves are not corrective devices.  If you suspect the need for correction, then please make an appointment at Total Care Podiatry.
• If you are continually faced with fitting problems or excessive or abnormal wear or distortion of uppers, this would be primarily due to the feet and not the shoes.  These would be indicators that is is time to see us at Total Care Podiatry.
• Dress-up shoes should be just that; for dressing up only and only worn occasionally.  A good fitting lace-up shoe worn most of the time is ideal for growing feet.  Not all “fashion” shoes will suit your children’s feet so be realistic.
• Our feet were made to walk on soft uneven terrain and doing so actually helps strengthen the muscles on the foot and leg.  However, with all the hard flat terrain about, it is best to protect your child’s feet from wanting to contour to this type of surface.
• Before the crawling stage, it is best to leave the child’s foot as free as possible, so that no restrictions are placed upon it – and it is allowed to develop freely.

Please note:  this advice is very general and an accurate diagnosis on the function of your legs and feet can only be made after consulting a podiatrist.

Nail Problems:

Children generally do not suffer the same nail problems that adults do, as many changes seen in adult nails are due to the aging process.

Problems with children’s nails are more likely to be as a result of injury.

• Trauma to the nail can cause discolouration or a blood blister under the nail plate. In some cases the nail may be so traumatised that it will fall off, however providing there is no permanent damage to the cells producing the nail, it should grow back again in time.
• Nail shape can cause problems if the nail is curved and growing into soft tissue, and an ingrown toenail develops. This is often very painful and can become infected, and can be further aggravated by trauma, and tight footwear.
• Treatment options can be discussed with a podiatrist and range from regular nail maintenance to surgical options.

Warts/ Verruca pedis

Warts can occur all over the body, but especially on the feet. Warts are more common in children than in adults, and are very contagious and contractable via direct or indirect contact.

What are they?

Warts are masses of benign growths on the skin caused by infection with the Human Papilloma Virus which causes the top layer of skin to overproduce skin cells, producing a hard mass.

Warts commonly occur on the sole of the foot, and may have a black dot in the centre. The normal skin lines will not be present across the wart area, and they are usually painful if squeezed from the sides. It is not uncommon to have multiple warts at one time.

How is the virus that causes warts passed on?

• The Virus is passed on via close skin to skin contact or even indirect  contact with objects that have been in contact with a wart.
• Through cuts or broken skin on the feet
• At public showers or pools where footwear is not worn

How do I get rid of warts?

• Warts usually resolve on their own within two years, however treatment can speed things up.
• Speak to your podiatrist about the best type of treatment for you or your child
• Your podiatrist may suggest any of the following: Salicylic acid treatment, Cryotherapy, Surgery, chemical treatments or alternative treatments.
• Treatment of warts usually takes both time and patience.

How can I reduce the chance of my child getting warts/ spreading them?

• Do not allow sharing of shoes, socks, towels or personal items with somebody who has a wart.
• Avoid spreading warts to other areas of the body by avoiding picking or touching them.
• Wear footwear in public pools and change rooms.
• Wear a bandaid over the wart when swimming.

Birth –2 years

The first year is a crucial time of development of your child’s feet, during this period they will grow to approximately ½ the full adult length and width.  So it is important that any observed abnormalities be referred to a suitably qualified and experienced podiatrist or health professional as problems noticed at birth will not always resolve.  It is recommended that these problems be assessed before the infant begins walking

As carer for an infant you can assist normal development by some recommended methods

(1)  Ensure that bed covers are loose enough to allow for normal movement

(2)  Exercising – kicking prepares the legs for weight bearing and walking

(3)  Alter the baby’s position frequently so legs and feet are not put under excessive and continuous pressure

WHAT IS NORMAL?

At the time of birth the baby’s legs will have a bow-legged appearance, this is normal and should disappear by the time the child reaches 2-3 years of age.

All babies have the appearance of “flat feet” during the first few months, this is due to the presence of a fatty pad within the arch, the arch is developing as muscles and bones strengthen so that it will develop till properly formed at about the age of 3.

WHAT IS ABNORMAL?

The position of the fetus in the womb can cause pressures on the feet, this or genetic predisposition may cause a baby to be born with its feet turned inward; this is may cause misalignment of the metatarsal bones and/or contraction of tendons and muscles.  This is known as Metatarsus Adductus.

Metatarsus Adductus

While severe forms of this condition are usually recognized immediately after birth, it may not be until your infant starts standing (8 – 12 months) that a less severe form of the condition is noticed due to in-toed shape and awkwardness on standing or stepping.

Early recognition may be corrected with stretching and manipulation, modification of sleeping habits or specialised booties.

An overriding 2nd digit is a common condition, especially in pre-walkers, it may correct itself as the infant begins to walk but it is advisable to seek professional assessment for this condition as if unresolved, future footwear fitting may be a problem. Early intervention can include taping or splinting.

An overriding 5th digit, is generally congenital and generally no treatment is required though future considerations can be corns or callous that will need ongoing attention.

FOOTWEAR NOW?

When your toddler begins to walk, shoes are not necessary to be worn indoors; in fact walking barefoot (or in socks) helps develop muscle strength. As toes grasp the ground, also it assists in normal foot development.

When walking outside feet need to be protected, so shoes that are light and flexible and are made of natural fibres are recommended.  It is not advisable for toddlers to walk barefoot outdoors as this exposes feet to cuts, contusions, also to viruses such as plantar warts.

Ages 2-4

WHAT IS NORMAL?

In this age group a child should be developing a more steady and confident walking. The bow legs posture normally is present by 3-4 years of age.  The child should be able to alternate feet while climbing upstairs, kick a ball, pedal a tricycle, climb and hop on one foot.

A child may exhibit signs of “toe walking”.  It is not uncommon in 2 and 3 year olds, but normal heel-strike should be demonstrated by the age of 4. Most commonly it is from weak muscles as part of their normal growth phase.

Toe walker

WHAT IS ABNORMAL?

If “Toe-walking” is present between 3-4, it is advisable to have the child assessed by a podiatrist or other qualified health professional as this condition may be due to

(1)  Muscle imbalance

(2)  Or may be related to a neurological disorder

Another common problem is of an “in-toeing or pigeon toe” gait style. It is important to note what part of the leg the internal rotation is coming from. Have your child stand in front of you in their underwear in a relaxed position.

• If the knees point straight or outwards and the lower legs and feet point inwards, your child needs to be seen before 4 years old.
• If the knees rotate inwards, this indicates it is from the hips and will probably self correct with age

If not sure seek qualified and experienced podiatry advice.

Ages 4-6 years

WHAT IS NORMAL?

A child of this age may have an appearance of knock-knees. If this doesn’t resolve by the age of 7, it may continue into adult life.  Therefore an assessment by a suitable health professional is advised.

As part of this, (as noted above), there may be an internal rotation of the legs from the hips. This can especially happen after or during a marked growth phase, as the hamstring muscles often become tight and as a result internally rotate the legs on the hips.

WHAT IS ABNORMAL?

If a child is still demonstrating structurally “flat feet” at the age of 4 –5 then this should be assessed by a podiatrist. Structural problems such as abnormally joined bones may be present, so tests such as X-rays, CT scans or other imaging techniques may be indicated.

Keep in mind that early diagnosis often means early treatment.

If the arch of your child’s foot excessively ‘rolls-in’, (pronates), it is advisable to have that cause of this identified by a podiatrist qualified and experienced with young children’s foot and leg conditions. Once the cause of the flattening is discovered, the condition can be addressed. This process of diagnosing WHY the foot rolls-in rather than just supporting the foot to improve it’s posture is most important for the future development of our child’s foot.

Ages 6-12 Years

WHAT IS NORMAL?

A child of this age should be growing out of the knock-knee posture by 7-8 years old.

Sudden growth phases or spurts can lead to unusual walking patterns and postures, which while understandable taking into account the resultant tight and weak muscles, does increase the risk of injuries occuring.

Picture of excess pronated stance

Pronation

WHAT IS ABNORMAL?

If your child begins to complain about having pain in their legs or feet, especially during activities or has frequently trips or falls, it may indicate an issue that needs a podiatrist’s assessment.

Injuries such as a ‘pulled muscle’ or a ‘rolled ankle’ that occur regularly, especially for no known reason, or an injury that doesn’t fully get better is other indications of dysfunction.

Sometimes pain or problems occur in the leg from poor foot function, such as:

• knee pain
• shin pain
• ankle pain
• calf muscle cramps
• achilles tendonitis ( for more conditions see common foot problem section)

Treatment can include, stretching and strengthening of muscles, joint mobilisation, taping, footwear modification and orthoses.

It is actually very unusual for an infant to have structural flat feet even though it often appears that their feet are flat.
The flattened appearance of infant’s feet can be due to the following:

1. Up to the age of approximately 3 years there is a fat pad located in the arch and this can often mask the arch shape.

2. The joints of a child’s foot are incredibly mobile and its supportive musculature is weak, so if the body is heavy, the foot will tend to collapse to some degree;  so long as it is not extreme, this is normal.

3. There may be some structural issues in the legs or feet, where the body will use the large mobility to compensate.

When do I seek advice?

If the condition is normal and is just due to the first or second point above, you will note that the arch will be present when the infant or child is not taking any weight on their feet,  but becomes flat only when they are weight bearing.

If you note that the arch is always flat whether they are standing or not, an assessment from an appropriately experienced podiatrist should be sought.  Also if your child regularly trips over, has an awkward gait or  complains when walking for more than a slight distance,  an assessment would be appropriate.

1. Up to the age of approximately 3 years there is a fat pad located in the arch and this can often mask the arch shape.
2. The joints of a child’s foot are incredibly mobile and its supportive musculature is weak, so if the body is heavy, the foot will tend to collapse to some degree; so long as it is not extreme, this is normal.
3. There may be some structural issues in the legs or feet themselves where the body will use the large mobility to compensate.

When do I seek advice?

If the condition is normal and is just due to the first or second point above, you will note that the arch will be present when the infant or child is not taking any weight on their feet but becomes flat only when they are weight bearing. If you note that the arch is always flat whether they are standing or not, an assessment from an appropriately experienced podiatrist should be sought. Also if your child regularly trips over, has an awkward gait or complains when walking for more than a slight distance, an assessment would be appropriate.

Birth -2 years

The first year is a crucial time of development of your child’s feet, during this period they will grow to approximately ½ the full adult length and width. So it is important that any observed abnormalities be referred to a suitably qualified health professional as problems noticed at birth will not always resolve. It is recommended that these problems be assessed before the infant begins walking
As carer for an infant you can assist normal development by some recommended methods

1. Ensure that bed covers are loose enough to allow for normal movement
2. Exercising – kicking prepares the legs for weight bearing and walking
3. Alter the baby’s position frequently so legs and feet are not put under excessive and continuous pressure

WHAT IS NORMAL?

At the time of birth the baby’s legs will have a bow-legged appearance, this is normal and should disappear by the time the child reaches 2 years of age.

All babies have the appearance of “flat feet” during the first few months, this is due to the presence of a fatty pad within the arch, the arch is developing as muscles and bones strengthen so that it will develop till properly formed at about the age of 3.

WHAT IS ABNORMAL?

The position of the fetus in the womb can cause pressures on the feet,
this may cause a baby to be born with its feet turned inward; this is may
cause misalignment of the metatarsal bones and/or contraction of
tendons and muscles. This is known as Metatarsus Adductus.

While severe forms of this condition are usually recognized immediately
after birth, it may not be until your infant starts standing (8 – 12 months)
that a less severe form of the condition is noticed due to in-toed shape
and awkwardness on standing or stepping.
Early recognition may be corrected with stretching and manipulation, modification of sleeping habits or specialised booties.

An overriding 2nd digit is a common condition, especially in pre-walkers, it may correct itself as the infant begins to walk but it is advisable to seek professional assessment for this condition as if unresolved, future footwear fitting may be a problem. Early intervention can include taping or splinting.

An overriding 5th digit, is generally congenital and generally no treatment is required though future considerations can be corns or callous that will need ongoing attention.

SHOULD THEY BE WEARING FOOTWEAR NOW?

When your toddler begins to walk shoes are not necessary indoors; in fact walking barefoot (or in socks) helps develop muscle strength as toes grasp the ground also it assists in normal foot development.
When walking outside feet need to be protected, so shoes that are light and flexible and are made of natural fibres are recommended.
It is not advisable for toddlers to walk barefoot outdoors as this exposes feet to cuts, contusions, also to viruses such as plantar warts.