The baby’s position will influence the position and alignment of the foot and legs. All children are checked at birth for congenital abnormalities such as dislocated hips and clubfoot. It is common to have a slight twist or turn in the lower limb. Most will correct in the first few weeks or may need some stretching and manipulation at nappy changes to further assist correction. If these deformities persist, treatment with casting and splinting may be required. If casts and splints are necessary, the earlier, the better because as the young foot and leg mature, deformities become more resistant to correction.

Children develop at different rates, and there are well-accepted normal variations in their activities, such as crawling, pulling themselves to a standing position, walking while holding on to something, and independent walking. For example, independent walking is normal anywhere from 10 to 18 months of age. Developmental delay due to problems such as cerebral palsy, down syndrome, and other medical problems may take much longer to walk. If your child is late to walk (i.e.,> 18 months), it would be advisable to have them assessed by a pediatrician to rule out any underlying developmental problem.

When children start walking, they will be flat-footed, bow-legged, and intoned, as this provides a wide, stable base. Over time, the knees, legs, and feet will change, and by four years of age, they will appear to have knock knees, the intoe will have reduced or disappeared, and the feet will not look so flat. Normal alignment will occur anywhere from 8-14 years where the knock knees will have straightened and there will be a slight amount of out toe and normal arch height.

The growth of children’s feet and legs occurs very rapidly in the early years. Correction of a deformity happens with growth, so if treatment is necessary, it is best during rapid growth in the early years. Growth in leg length contributes the most to an increase in height relative to body length. On average, by age 4, a child’s foot will already be half of its adult foot length, and their adult foot length is reached by age 14 in girls and age 16 in boys. Research has shown that children’s foot sizes are generally longer than a generation ago.

Some common issues that raise concerns with feet and legs in children include: –

Persistent intoe (pigeon toe) can be due to positional deformities that have not been corrected from birth. Intoe can arise from the hip, leg or foot. Shoes have little or no influence on them. Sleeping and sitting positions such as habitual belly sleeping or “W” sitting with the knees turned in and feet splay out can maintain intoed gait. Sleeping on the back or side and sitting cross-legged should be encouraged. Ballet, rollerblades, and skating are also helpful in encouraging our gait. While a degree of intoe is normal, a significant degree of intoe can lead to persistent tripping and falls, which is a problem and should be assessed.

Knock Knees and bowlegs sometimes occur but don’t very often cause problems unless they are severe. Extreme bowlegs can be due to vitamin deficiency, which is extremely rare in Australia. Knock knees can persist in overweight children. The only actual treatment available in severe cases is surgery, which is rarely indicated.

Toe walking may appear cute but is not to be encouraged as it can lead to contracture of the calf muscle. Persistently walking on tippee toes can be secondary to excessive muscle tightness or high muscle tone, which may need to be assessed to find the cause. Usually, it is habitual, and using rigid-soled shoes that are difficult to bend at the toes helps break the habit.

Flat feet in children is a much-talked-about condition and a frequent cause of concern for parents. Children don’t often have pain associated with their flat feet, but on occasions they do, the main concern is generally future problems. In the adult population, arch heights vary from low to relatively high. While flat feet are often a reason for pain and problems later in life, not everybody has problems. Other factors are also involved such as activity level. People with flat feet in a sedentary occupation may not have any problems, but somebody with the same foot type who is in a standing occupation or plays a lot of sports may have many problems related to their flat feet. As mentioned, babies will have flat feet, which is generally correct by age 8 to 12. In children whose ankles are rolling in or whose feet are excessively flat beyond what is regarded as normal, wedges can be glued into supportive shoes in children aged 1 to 5 years. After this age, an orthotic device is used, which can be transferred from one shoe to the other. The reason for using wedges in young children is that they are relatively cheap and as children’s feet grow rapidly, they need changing frequently. Orthoses, wedges, and footwear are designed to enhance normal growth. Wedges, footwear, and orthoses will necessarily change your child’s arch shape; genetics will essentially determine this. Footwear and orthotics, however, will assist in improving the function of the feet and legs. The treatment of flat feet in children is controversial, and to date, there is not yet any good scientific evidence to show if the treatment of flat feet in children will permanently alter foot structure. Occasionally, some children with flexible flat feet with discomfort or extremely abnormal foot function do not get relief from orthoses to a point that interferes with their daily activity and may require surgery to correct their foot deformity. Rigid, painful, flat feet may occur in the early teenage years caused by the abnormal fusion of two bones. This may lead to relatively long-term problems if not treated appropriately with orthoses, activity modifications, or surgery.

Curling Toes don’t cause too many problems in children but can be a problem in adults, leading to hammer toes, which may lead to painful corns and calluses. In Young children, the toes can be corrected by tapping them into position. Silicone toe props can also help correct them in older children. Surgery to release tight tendons in the toes may be required.

Growing pains, as often called, happen when first settling at night, usually in the leg muscles, between the ages of 4 and 7. Little is known about growing pains, but recent research has shown that there may be a correlation with flat feet. Massage, hot water bottles, and Panadol assist them. If they occur frequently, it is best to have them assessed by a podiatrist.

Correctly fitted shoes are essential. Shoes are not required to assist with walking unless a problem exists. It is best to allow babies to go barefoot and only use shoes to protect their feet outdoors. Footwear for children can be pretty expensive as growth means shoes may need to be changed every 4-6 months. Socks should also not be allowed to get too tight.

• You will often hear people say don’t worry, they will grow out of it. While this is true in most children, those with feet and legs outside of the normal range for their age may not. If a problem is not outgrown, then its permanence is assured
• As maturity and strength develop, one may expect normal limbs to resist deforming influences and the deformed parts to resist correction
• Children at an early age with pronounced deformities will end up with normal feet and legs because they are recognized and treated. Those with mild to moderate deformity often go unrecognized or untreated and enter adulthood with feet and legs that are abnormal
• As it is often difficult to decide what it is too much and what is normal for a given age, this will frequently lead to differing opinions from health professionals.
• If in doubt, have it checked out.