Most of baby’s BIG milestones involve the feet and the legs – crawling, toddling and cruising, and eventually walking. The development of baby’s feet is more crucial than a lot of new mums might realise, and so it is important that we do everything we can to support their development and get help when it is needed. As part of my baby health series, I wanted to interview a Podiatrist to give us a run down of all things related to baby feet: issues that a podiatrist might provide advice and support on; when mums should look at shoes for their baby’s feet; and if us new mums should worry about when our baby’s start walking! I chatted with the lovely Reche of My Pod Family And Sports Podiatry about all things baby feet related. I hope you enjoy our chat, and please share with the new mums you know! x
Hi Reche! Thank you for joining us this week as a part of our Baby Health Series. Tonight we’ll be looking at Podiatry, and what mothers might need to look out for in the development of their child’s feet/legs/walking. Before we start, could you tell us a bit about yourself and your Practice?
Hello Fi, thank you for the opportunity to be a part of the Baby Health Series to talk about something that I LOVE; foot health and children’s growth and development! I graduated from Charles Sturt University in 2008. I have spent the last 9 years in private practice in Sydney and the Hunter region. 2 years ago I opened my own practice in Newcastle. I have always been passionate about continuing education so that I am able to provide the best care to my patients. In the near future I will be pursing formal accreditation in the now recognised special interest areas of Paediatric Podiatry and Sports Podiatry.
Could you tell us a bit about being a Podiatrist and what it involves?
A Podiatrist is a registered health professional. We are trained to assess, diagnose and treat conditions of the foot and lower limb. These may include skin and nail problems, foot and ankle injuries, foot complications related to diabetes and other medical conditions, and problems with gait or walking. Podiatrists play an important role in monitoring disease and managing lower limb issues to maintain an active and mobile population across the lifespan. Therefore patient demographics can be diverse ranging from monitoring children’s growth and development, managing sports injuries, working with people with chronic disease, disability and the ageing population.
Common problems that I see include:
Injuries and Pain:
• Stress fractures
• Persistent heel pain
• Tinea and other fungal infections
• Cracked Heals
• Ingrown toenails
• Thickened nails
• Sports podiatry
• Flat/ high arch feet
• In toe/ out toe
• Toe walking
• Growing pains
• Flat feet
• High Risk Feet (diabetes related)
– numbness/ pins and needles
– poor circulation
– infections – poor wound healing
– Gout – Rheumatoid Arthritis
How does Podiatry fit in with babies and young children? When might mothers and fathers need to seek out the advice of a podiatrist?
There are a myriad of problems that babies and children may need to see a podiatrist for. Babies can be born with congenital foot/ leg or hip issues. Fortunately these are screened for and typically identified and well managed with initial screenings and appropriate early interventions here in Australia. Babies can have curly toes, overlapping or underlapping toes, and ingrown toe nails. Children and toddlers can suffer from a range of toe, foot and leg problems. Including heel pain, knee pain, flat feet, knock knees, in toeing, warts, ingrown toe nails, bunions, sprained ankles, toe walking, to name a few!
As to signs and symptoms: some common ones to keep an eye out for include clumsiness, tripping, activity avoidance, asymmetry in alignment or leg length, gait variations: toe walking, in-toe gait, etc., flat feet, c shaped feet, hypermobility, not keeping up with other kids, or a child that becomes tired when walking to the park to play. Many of these issues children will grow out of (different ones at different ages) but are worth having assessed and monitored. If at any time your child is experiencing pain this should be seen to.
It is important to ensure that your child’s feet are developing normally and have any problems attended to by a Podiatrist.
How early would you suggest mothers or fathers have feet or leg issues addressed? For example, babies standing on their tip-toes or having their toes facing inwards/outwards?
This is a tricky one to give a straight forward answer to. Pain or any of the above “signs and symptoms” should be assessed and monitored. This is not to say there is a problem that needs to be treated, however, these can be signs that may warrant further investigation. Children walk in-toe and out-toe for many reasons. For example a child with an in-toed gait may be due to a twisting of the thigh bone, shin bone or a curvature of the foot. Depending on the age of the child and what the in-toe is due to dictates as to whether it is normal, needs monitoring or needs treatment. Parents should see a Podiatrist if their child is tripping from their leg position when their child is school-aged, if one leg turns substantially more inwards or outwards than the other, or looks very different compared to the other. Flat foot is normal in infants and young children. At this age, in the absence of any associated symptoms (pain, hypermobility, rigidity, etc.), treatment is highly debatable. However not all “flat feet” are the same. If you have concerns it is important to get the child examined as there may be an underlying cause, which does warrant treatment.
Toe walking may be idiopathic (no known cause) or due to an associated medical condition. A recent study showed children with idiopathic toe walking were found to have had greater rates of complications during and after their delivery.
Pain in a child be it their foot or anywhere else in their body is never considered normal. I don’t believe in “growing pains”. Any pain that lasts more than a few days, or that is severe enough to limit the child’s walking, should be assessed by an appropriately qualified podiatrist.
Do you have many mothers talk to you about concerns for their child not walking at a certain age? What is your advice to them?
All children are different, they may begin to walk anywhere between the ages of 8 to 18 months. When this concern is raised it is important to assess the whole child; the mother’s pregnancy, the child’s birth history, family history and look at the developmental milestones of the child up to this point in time. A clinical examination of the child is also required. Reassurance and monitoring if the child is otherwise healthy and still falling within the normal ranges, referral to the GP/ paediatrician if there are any concerns.
When and what should mothers look for in choosing appropriate footwear for their babies/young children?
It is important to allow your child when they are learning to walk to go barefoot whenever possible, this will help them to develop balance, posture and coordination as they receive important sensory information from the soles of their feet. Shoes are only really necessary for protection from sharp objects at this early age. Parents need to be diligent to ensure shoes and socks are fitted correctly as children’s feet grow rapidly during development and may need updating every few months. Shoes that are not fitted correctly and are too tight can affect your child’s feet and gait, and cause problems.
Newborn/baby: don’t need shoes, their feet are very soft and pliable and are therefore vulnerable to damage. They just need to be kept warm with booties or loose socks.
Toddler: Once your child has established balance and begins to walk unaided then properly fitted footwear can be introduced. Have feet professionally measured both length and width!
• A sturdy soled shoe with a high heel counter, with plenty of room for their little toes
• Soft soled shoes are not recommended for children who are already walking as they can destabilise the child’s gait leading to more tripping and falling.
• Proper sturdy footwear can have marked effects on the feet. Foot development, alignment and thus function, including addressing some cases of toe walking, in toe.
Primary School: By age 5 your child will have developed all 26 bones of their feet but they will not be fully formed until the age of 8. Children’s feet can grow another half to full size rapidly it is important to have them measured regularly. It is common for one foot to be bigger than the other. It is important to have both feet measured and shoes should be fitted to the larger foot.
Do a size check at least every one to three months up to the age of three and every four months up to the age of five and then every six months until your child stops growing.
It can be quiet expensive in the early years but it is important to protect the health of your child’s feet and prevent any future problems which may not just be directly the feet but…. the foot bones connected to the knee bone, the knee bones connected to the hip bone and the hip bones connected to the back bone…..
Finally, what are your top tips or advice for parents in supporting their child’s feet and leg development?
Children’s feet are literally the foundation of their body. They are a complex network of bones, joints, tissue, muscles and nerve endings that all work together to co-ordinate motion in the rest of the body. When something is out of balance in that complex network, the impact can be felt throughout their whole system. It is important to always treat foot pain, have any concerns evaluated to avoid potential life-long problems.
Any queries regarding your child’s foot health and development should be evaluated by a Podiatrist. A full assessment can be performed to identify the source of the problem and whether the issue is nothing to be concerned about, warrants monitoring or requires treatment. Treatment is reassurance, treatment is advice, treatment is sometimes watching and waiting, sometimes footwear advice, stretching, taping, referral, orthotics and lots, lots more. Most of all, treatment is understanding the evidence behind the treatment and presenting it in a way that a parent understands and then is able to make an informed choice about what they want to do with their child.
Thanks so much for joining us for the Baby Health Series Reche! For more information about Reche and her practice, My Pod Family and Sports Podiatry, see below:
Dr. Reche Stevenson B. Hlth. Sc. (Pod).
Principal Podiatrist at My Pod Family and Sports Podiatry
– Accredited Podiatrist
– Member of the Australian Podiatry Association
– Member of the Australian Academy of Podiatric Sports Medicine
My Pod Family and Sports Podiatry
Practice location: 179 Brunker Rd, Adamstown. 2289. Newcastle. Australia
Phone: (02) 49561144
Website link HERE