Foot & Ankle Issues in Children: What Parents Should Know

As a parent, watching your child take their first steps brings immense joy. However, as children grow and develop, you may notice changes in their walking style or complaints about foot pain. Understanding standard foot and ankle problems in children can help you know when to seek help from a foot and ankle specialist. Early detection and proper care ensure your child maintains healthy mobility throughout their development.

Understanding Normal Child Development

Children's feet undergo significant changes as they grow and develop. During the first few years, their bones are primarily cartilage, gradually hardening into bone through a process called ossification. This natural development means that many apparent "problems" in young children are actually normal stages of growth.

Toddlers typically walk with a wide-based gait and may appear flat-footed or knock-kneed. These characteristics usually improve naturally as muscles strengthen and bones develop. Most children develop their adult walking pattern by the time they are seven or eight years old.

Furthermore, children's ligaments and muscles are more flexible than those of adults, which can lead to temporary foot positions that may appear concerning but typically resolve on their own. However, persistent issues or pain should always be evaluated by a healthcare professional.

Common Foot and Ankle Problems in Children

Flat Feet (Pes Planus)

Flat feet occur when the arch of the foot doesn't develop properly or collapses. While many toddlers appear to have flat feet due to baby fat in their feet, true flat feet persist as the child grows older.

Most children with flexible flat feet don't experience pain and don't require treatment. The condition often improves naturally as the child's muscles and ligaments strengthen. However, rigid flat feet or those causing pain may need intervention from a foot and ankle specialist.

Signs that warrant professional evaluation include persistent pain, stiffness, or difficulty with physical activities. Additionally, if flat feet run in your family, regular monitoring becomes more important.

In-Toeing and Out-Toeing

In-toeing, commonly referred to as "pigeon-toed," occurs when children walk with their feet turned inward. Out-toeing is the opposite condition, where the feet point outward while walking. Both conditions can stem from various causes, including hip rotation, tibial torsion, or foot shape.

Many cases of in-toeing and out-toeing resolve naturally as children grow. The timing of improvement depends on the underlying cause. Hip-related issues often improve by age two, while tibial problems may take until age four or older.

However, severe cases that interfere with walking, cause frequent tripping, or persist beyond expected ages should be evaluated. A foot and ankle specialist can determine whether treatment is necessary and recommend appropriate interventions.

Toe Walking

Occasional toe walking is normal in toddlers as they learn to walk. Many children experiment with different walking patterns during their early development. However, persistent toe walking beyond age three may indicate underlying issues.

Causes of prolonged toe walking include tight Achilles tendons, muscle weakness, or neurological conditions. Some children develop the habit and continue it even when they're physically able to walk normally.

Early intervention is often most effective in treating persistent toe walking. Stretching exercises, physical therapy, or other treatments can help children develop standard walking patterns before the condition becomes more established.

Growing Pains and Heel Pain

Children frequently complain of leg or foot pain, particularly in the evening or at night. True growing pains typically affect the legs and don't cause limping or interfere with daily activities. These pains usually resolve with rest and gentle massage.

Heel pain in children often results from a condition called calcaneal apophysitis, also known as Sever's disease. This occurs when the growth plate in the heel becomes inflamed due to repetitive stress. The condition commonly affects active children between the ages of 8 and 14 years old.

Unlike growing pains, heel pain that causes limping or interferes with activities requires professional evaluation. A foot and ankle doctor can diagnose the specific cause and recommend appropriate treatment strategies.

When to Seek Professional Help?

Determining when to consult a healthcare professional can be challenging for parents. Several warning signs indicate that your child's foot or ankle issue needs professional attention.

Persistent pain that interferes with walking, playing, or sleeping should always be evaluated. Additionally, if your child begins to limp or favor one foot over the other, a professional assessment is warranted.

Other concerning signs include swelling, redness, or warmth in the foot or ankle area. Changes in your child's activity level or reluctance to participate in physical activities they previously enjoyed may also indicate underlying problems.

Moreover, if you notice significant differences between your child's feet or dramatic changes in their walking pattern, consultation with a foot and ankle specialist is advisable. Early intervention often leads to better outcomes and prevents complications.

Prevention and Home Care Strategies

Parents can take several steps to promote healthy foot development in their children. Proper footwear plays a crucial role in maintaining foot health. Select shoes that fit well, offer adequate support, and provide sufficient room for growth.

For young children who are learning to walk, barefoot time is beneficial when it's safe to do so. Walking barefoot helps strengthen foot muscles and improve balance and coordination. On appropriate surfaces, barefoot walking supports natural foot development.

Regular physical activity promotes overall foot and ankle health. Encourage your child to participate in age-appropriate activities that strengthen muscles and improve coordination. However, monitor their activity levels and ensure they have adequate rest periods.

Additionally, maintain good foot hygiene by keeping feet clean and dry. Teach children to inspect their feet regularly and report any pain, cuts, or changes they notice. Early detection of problems enables prompt treatment and improved outcomes.

Treatment Options Available

Treatment approaches for pediatric foot and ankle problems vary depending on the specific condition and its severity. Many issues resolve naturally with observation and time. However, when intervention is necessary, several options are available.

Conservative treatments often prove effective for children's foot problems. These may include stretching exercises, physical therapy, orthotic devices, or modifications to activities. Most pediatric foot conditions respond well to non-invasive approaches.

Orthotic devices can provide support and help correct alignment issues in children's feet. Custom orthotics are sometimes necessary, but many children benefit from over-the-counter arch supports or heel cups.

In rare cases where conservative treatments fail, surgical intervention may be considered. However, surgery is typically reserved for severe cases that significantly impact a child's quality of life or development. A qualified foot and ankle specialist can discuss all available options and help determine the most appropriate treatment plan.

At what age should I be concerned about my child's flat feet?

Most children develop arches by age 6. If your child still has flat feet after the age of 6, especially if they experience pain or stiffness, consider consulting a foot and ankle specialist for an evaluation.

How can I tell if my child's toe walking is normal or concerning?

Occasional toe walking is normal in toddlers. However, if your child consistently toe-walks after age 3, walks on their toes exclusively, or shows signs of tightness in their calf muscles, a professional evaluation is recommended.

When should a doctor evaluate growing pains?

True growing pains don't cause limping or interfere with daily activities. If your child's pain is persistent, occurs during the day, causes limping, or is accompanied by swelling or a fever, seek medical attention immediately.

Are expensive shoes necessary for healthy foot development in children? 

Price doesn't determine shoe quality for children's foot health. Focus on proper fit, adequate support, and room for growth. Many moderately priced shoes provide excellent support for developing feet.

Don't let foot and ankle concerns affect your child's active lifestyle. Contact a trusted foot and ankle specialist in Lancaster today to schedule a comprehensive evaluation and ensure your child's optimal foot health and development.