Babies and children’s feet

Bow legs and knock knees
All children go through a phase of bowlegs (genu varum) and then knock knees (genu valgum) as they grow. Both are a part of development. Babies are born with bowlegs, and they straighten of their own accord as bones grow, typically resolving by the age of two to three years. The appearance of knock knees is often most obvious between the ages of three and four. Legs gradually straighten to an adult shape by age 10-12. Being overweight can increase stress on children’s bones and joints, potentially worsening the appearance of knock knees.

Curly toes or overlapping toes
One of the most common problems podiatrists see in babies and young children is curly and overlapping toes. These can correct themselves when your baby starts to walk. Many babies are born with overlapping/ curly little toes, it is usually congenital and runs in the family, no treatment is normally required. Ensure correct fitting footwear is worn so that any overlapping toes do not rub and become sore.

Flat feet
All newborn children have flat feet. Children have low arches because they are loose jointed and flexible. They have 22 soft, cartilaginous bones instead of 26 hard ones, with a fatty pad mimicking an arch. This gradually develops into a proper arch by the age of six, however children’s feet will take after their parents so if parents have flat feet then children are more likely to have flat feet as adults.

Growing pains
Growing pains are a common, harmless source of leg pain in children aged three to 12 years, often occurring in the evening or at night and resolving by morning. The exact cause is unknown but may relate to bone growth outpacing muscle growth, you can ease discomfort with gentle massage, a warm bath, heat packs, gentle stretching and children’s pain relief.

Some children can suffer growth plate abnormalities, these can present as heel pain (Sever’s disease), knee pain (Osgood Schlatters disease) and less commonly pain in other bones of the feet. Seeing a podiatrist for treatment can help in these cases.

Hypermobility
Hypermobility in children is an increased range of movement in the joints due to ligaments being more elastic than normal. This leads to flexible joints that can move beyond their typical range.

Children with hypermobility are more likely to have joint aches and pains or growing pains than children without hypermobility.

While many children have hypermobility, it is often a normal trait that improves with age as joints become less mobile. However, if it causes frequent pain, fatigue, or difficulty with daily activities, it may be symptomatic and warrant a medical assessment, as it can be a sign of an underlying connective tissue disorder.

In toeing
In toeing is very common in toddlers. It is often described as being ‘pigeon toed’. In most cases this corrects itself as your child becomes a more confident walker. If your child is not in pain or tripping over a lot it does not require any treatment. Around 30 per cent of children in-toe at the age of four years, but this persists in only four per cent of adults.

Nail problems
Babies toenails are often very soft and grow very slowly. This is normal and nails will become stronger as baby grows and becomes more active.

Toe walking
Toe walking (equinus gait) happens in babies and toddlers, especially in those just learning to walk. It is normal in younger children and usually corrects itself. Most cases of toe-walking are just a habit and the child will grow out of it. If toe walking persists and there is limited movement at the ankle some treatment may be required. In some older children toe walking can be linked with neurodiverse and sensory issues.

If you are concerned about any part of your child’s development, a problem seems persistent or if your child appears to be in pain, talk to your health visitor or doctor who may refer you to see a podiatrist.

Each child is unique and will develop in their own time. Your child will begin to walk at around 10 to 18 months of age.

When your child first begins to walk, shoes are not necessary indoors. Going barefoot allows the foot to develop strength and the ‘grasping’ action of toes.

Your baby’s feet will appear flat as children are born with a fatty pad in the arch area. The foot and leg muscles are not developed enough to support their arches when they first stand. The arch does not begin to develop until the age of two, and will not be fully developed until around age six.

First shoes

Once walking is established your baby is ready for their first pair of shoes.

• Make sure their feet are measured by a trained professional.
• Feet should be measured every two to four months to allow room for feet to grow.
• Choose shoes with natural linings and socks with a high natural fibre content to allow feet to breathe.
• Make sure shoes have some kind of fastening. Hook and loop or Velcro fastenings may be easier than buckles and laces. Do not force your child’s feet in and out of shoes without unfastening them.

Baby grows, sleep suits, tights and socks
Make sure the foot part of the baby grow is long enough and does not squeeze the foot. Tights and socks should fit at the heel and the length at the toes should be checked regularly.

Pram shoes
Should only be worn for special occasions. They are difficult to size. The best way to keep the feet warm is with socks or bootees.

Bootees
Are a good way to keep the feet warm. Make sure they are big enough and if they are knitted ensure the weave does not get tight around the toes and stop the circulation.

Shoes for early walkers and toddlers
A young child’s foot is triangular in shape unlike an adult’s foot which is rectangular. Shoes should be fitted by a trained professional and should allow the foot to function normally.

School shoes
Again these should be fitted by a trained professional. The toe area should be foot shaped and deep enough for the toes to move freely. They should fit snugly around the heel, have a heel height of no more than 1.5cm and have some form of fastening.

Plimsolls
It is hard to measure feet for plimsolls and they do not come in half sizes. The materials they are made from encourage sweating and then athlete’s foot. Many plimsolls are slip on, which can encourage toe deformity.

My baby’s feet always seem to be cold. Is this normal?
Babies lose heat very rapidly so care should be taken to insulate feet with socks and bootees.

What socks are best?
Socks should fit well; natural fibres such as wool or cotton are the best as they allow the foot to breathe. Avoid 100% nylon socks as they will cause your baby’s feet to sweat.

How often should I cut my baby’s toenails?
Rate of nail growth varies from child to child but length should be checked weekly.

Should I buy a baby walker?
They are not recommended, a baby will walk when it is ready. They have been banned in some countries, due to the number of accidents they have caused.

When should I buy baby’s first pair of shoes?
Your child does not need shoes until they are walking competently. In order for the foot to develop well they should be barefoot for as long as possible.

Do I need to get my child’s shoes fitted every time?
Yes, if there are fitters at the shoe shop.

How often should I change my child’s shoes?
This depends on the child and their age. Children’s feet grow, on average two sizes per year in the first four years of life. To ensure shoes fit properly they should be checked every eight weeks.