We often think of and treat children like little adults. This is not recommended, so that we recognize the uniqueness of every child. Just as children cannot be treated as little adults, neither should their feet -- as every child is special, so are their feet.
Children's feet are different from adults because they are not yet fully formed. At birth and in early childhood, the feet are fat, round and floppy and will eventually grow and change into the shape we recognize as normal feet. At six months of age the child's foot is still mostly cartilage and some of the final bones do not start to form until age three. A child's foot will double in size by the age of one and is approximately half their adult length by 18 months. By age 18 years most bones in the body are fully formed.
During this period of development, a child's foot is flexible and is at risk of injury and deformity due to abnormal pressures from ill-fitting footwear. Care should be taken when choosing shoe types and shoe fitting for children.
Nearly all children appear to have flat feet when they first start walking. This is partly due to posture and fatty deposits in the foot. When babies walk, they have to balance a relatively large head and torso so they walk with the knees bent, legs wide apart and the feet turned outwards. Parents are often anxious about when their child will walk, but they must know their baby will walk when they are ready to walk. The average age to begin walking is 10 to 15 months. When your child first begins to walk, shoes are not necessary indoors, however, when walking outside or on rough surfaces the baby's feet should be protected in lightweight, flexible footwear made of natural materials. On average, children's feet grow two sizes per year in the first four years of life, and one size per year thereafter until growth is complete, around age 14. This is not written in stone, however, and sometimes a child's foot may not grow for a considerable period of time and then grow several sizes quickly.
Many of the problems with children's feet are associated with growth, overuse, weight gain and postural changes. Genetics also play a crucial role in the development of your child's feet. Some children walk with their toes pointing inwards (in-toeing) and some outwards (out-toeing), and others even walk on their toes (toe-walking). It is estimated that 10 to 20 percent of children have flat feet. Most children grow out of in-toeing, out-toeing and toe-walking by 24 months of age. If the child's feet are causing pain, discomfort or affecting mobility this is not normal, and all children with foot pain and any persistent foot complaint should be seen by a podiatrist.
When to see a podiatrist
Besides foot structure, the main cause of foot problems and possible deformities is ill-fitting footwear. If you notice any problems with your children's feet they should be seen by a podiatrist; foot problems may include foot, leg or heel pain, swelling, limping, flat feet, foot deformities, skin rashes, hard skin, lumps, bumps on the feet, nail complaints, tripping or stumbling, child not wanting to walk and asking to be carried instead. It is best to make an appointment to see your podiatrist if you have any of these concerns, other concerns, or questions about your child's feet. The podiatrist can help your child by providing a comprehensive examination, diagnosis of any foot problems, and then either managing the condition or referring to an appropriate consultant. Treatment may take the form of footwear prescription or advice, assessing how the foot functions, orthoses (special insoles) to be worn in the shoes, special shoes, bracing, etc. Researchers have found that giving correctional foot support to children with insoles or orthotics between the ages of two and five years of age can significantly improve foot development and functioning later in life. After age five, correctional support can help, but there can be no more changes to the basic foot structure.
Feet care tips
Always have your child's feet measured for length and width before buying shoes. Always fit shoes with the child standing, because the foot spreads on weight-bearing.
o Check the size of their socks and shoes regularly for fit, condition and wear. Check shoe sizes every one to three months up to age three, every four months to age five, every six months from five years onwards.
o If possible, do not put your child in the same shoes every day. Alternate the child's shoes to allow them to dry out, especially if the feet are sweaty.
o Be especially careful and check the feet after wearing new shoes, they can cause blisters and sores if they don't fit properly.
o Inspect feet regularly for inflamed nails, red pressure areas on the top of the toes, below the ankle bones and at the back of the heel.
o Good foot hygiene is vital. Wash their feet daily with simple soap and water and dry well, particularly between the toes. After drying, a small amount of talcum powder or moisturizer can be used. Some children have naturally sweaty feet, but smelly feet may be an indication of poor hygiene or an infection.
o Toenails should be inspected regularly and trimmed as required. Cut the nails straight across and never cut down into the corners or cut them too short.
o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996, or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport, Grand Bahama, telephone 373-7400.
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