It is important to inspect your children’s feet periodically to avoid lower extremity problems later in life. Because children’s feet are more flexible, conditions detected early can be treated more easily.

Infants and their feet

Baby’s feet change quickly in shape and size during their first year. Baby’s feet are flexible, too much strain can affect the shape of their feet. It’s important to allow babies to kick and stretch their feet freely. It is important that shoes and socks do not squeeze the toes.

Toddlers and their toes

Once walking begins, it is not unusually for most toddlers to have a pigeon-toe gait. Some initially learn to walk landing on their toes instead of their heels. Most children outgrow these walking pattern.

When is Foot Care Needed?

Children are normally flat-footed, however toe-walking, severe in-toeing or out-toeing can indicate other problems with the structures of the limb which may need assessing. In the case of in-toeing, a toddler may need to sit in a different position while playing or watching TV. If your child’s feet turn in or out a lot, corrective shoes, splints, or night braces may be prescribed.

The foot’s bone structure is well-formed by the time your child reaches age 7 or 8, but are not fully adult structure until age 14-16. During this development phase, if the growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With a podiatrist’s care, however, the risk of future bone problems is reduced.

It is important to check children’s shoe size often. Make sure there is space between the toes and the end of the shoe and that the shoes are roomy enough to allow the toes to move freely.

Some of the most common conditions that effect children include Calcaneal Apophysitis (Severe’s disease), flatfeet, high arch foot, in-toe, out- toe and knock knees.
What Is Calcaneal Apophysitis?

Calcaneal apophysitis is a painful inflammation of the heel’s growth plate that typically affects children between the ages of 6 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

While heel pain in adults usually subsides after a period of walking, heel pain in children generally doesn’t improve in this manner, and walking typically makes the pain worse.


Overuse and stress on the heel bone through participation in sports and dance is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable.

Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptomsmay include:
  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness

To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the podiatrist obtains a thorough medical history and asks questions about recent activities. Sometimes xray imaging may be necessary to make the correct diagnosis.

Treatment Typical treatment plan may include one or more of the following:
  • Reduce activity. The child needs to reduce or stop any activity that causes pain.
  • Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Nurofen), help reduce the pain and inflammation.
  • Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
  • Immobilization. In some severe cases of paediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.
Prevention: The chances of a child developing heel pain can be reduced by:
  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child’s ability.
During the first year of a child’s life, their feet grow rapidly, reaching almost half their adult size.

By 12, a child’s foot is about 90% of its adult length.