When your child starts their journey of growth and discovery, their small feet enable them to better traverse their environment and explore the world. However, it is not uncommon when parents have concerns about the shape of their little one’s feet. They may range from relatively minor problems which resolve with time to more complex conditions that require treatment at an early stage. It is important to understand common infant foot deformities, such as clubfoot, metatarsus adductus and flat feet if you are a concerned parent and these diagnoses have been put forward. Timely diagnosis serves two purposes – reassurance in straightforward cases that will resolve with time and early effective treatment for specific conditions such as clubfoot to ensure the healthy foot development and comfortable active life of your child.
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Understanding Foot Problem Development in Children
Foot development in infants and toddlers passes through several natural phases. The baby at birth has flexible feet, which might seem inward or outward or lack a pronounced arch. In most cases, this is a normal part of their development since their bones, muscles, and ligaments are still maturing. When babies learn to crawl and later on to walk (usually around one year of age), the alignment of the foot naturally adjusts itself.
Milestones like walking alone or taking those first steps are exciting, but they are also an opportunity for subtle abnormalities to become apparent and concern parents. Specific infant foot conditions may need close attention and monitoring. Understanding these foot problems in infants helps the parents to understand normal variation in children and potential signs of concern that need expert evaluation.
Common Foot Problems in Children
The childhood development involves addressing various physical changes, and the feet are not an exception. Probably the biggest question that most parents would have is how best to identify common foot problems in children. So let’s explore some of the most common concerns and how to approach their diagnosis and management.
I. Flat Feet (Flexible Flatfoot)
Does your child’s arch disappear when they stand? Do they complain of any pain when they walk longer or do some activity? If so, your child is likely to have a flatfoot. This is usually a normal condition during the early childhood stage, where the arch of the foot appears to flatten when weight is applied. The good news is most children outgrow this condition as their feet develop in the first decade of life. No particular treatment is required in most cases. However, some adolescents with flat feet can experience problems such as your pain or discomfort with prolonged walking. In such cases, a corrective orthotic or insole combined with physical therapy to stretch out tight calf muscles can significantly alleviate symptoms. In most adolescents with flexible flat feet, this may be all the treatment that is required. In certain cases of prolonged symptoms despite these above measures, consultation with a Pediatric Orthopedic Surgeon may be useful to assess if a significant deformity is associated with the symptoms which may be corrected with surgery.
II. Clubfoot (Talipes Equinovarus)
Clubfoot is a significant congenital condition in which one or both feet are turned inward and downward with stiffness restricting the flexibility of the foot from assuming a normal position when the child begins to walk. There are various clubfoot types, such as idiopathic, which is the most common type and is defined as idiopathic as we do not know the exact cause. Syndromic clubfoot ususally occurs as part of a more generalised genetic condition such as arthrogryposis. A Positional clubfoot is a very mild foot deformity caused by the position of the baby in the womb. Positional clubfeet completely stretch out to normal after birth and do not require any treatment other than simple stretches. A neuromuscular clubfoot arises due to muscle imbalance caused by selective muscle tightness or paralysis in conditions such as cerebral palsy or spina bifida.
Idiopathic clubfoot occurs in around one in a thousand births. Although it can be diagnosed even before a child is born with the help of prenatal ultrasound, in many cases it is first detected immediately after birth. It can be quite challenging to distinguish an idiopathic clubfoot which requires treatment from a positional clubfoot that will easily stretch out without treatment. For parents concerned that their baby may have clubfoot, seeing a pediatric orthopedic surgeon with sufficient expertise can be very reassuring in correctly diagnosing a positional clubfoot rather than commencing unnecessary treatment. Idiopathic clubfoot always has an element of stiffness which requires treatment more than simple stretching. The gold standard of treatment is Ponseti treatment with weekly changes of plaster casts to slowly correct the clubfoot followed by a simple clinic procedure to release the tight achilles tendon before the final cast. Bracing with boots and bar during the first few years of life is an important aspect of treatment to prevent the deformity from recurring.
III. In-Toeing and Out-Toeing
If your child walks with their feet significantly inward (pigeon-toed) or outwards, this could be concerning for parents. These gait patterns are common among toddlers and young children and are mostly caused by natural rotations of the Femur (thigh bone) or the tibia (shin bone) as they grow. Although these conditions may appear alarming, they usually resolve on their own without treatment. In certain cases, the rotation may be severe and may not resolve with natural growth. Occasionally they can give rise to knee problems if there are opposite rotations in the thigh and shin bones of the same leg. Parents are advised to see a Pediatric Orthopedic Surgeon if they have any concerns regarding the direction of the child’s feet when they are walking. Often examination by the Pediatric orthopedic doctor is all that is required to make the diagnosis and reassure the parents.
IV. Toe Walking
Have you noticed your child walking on the balls of their feet, resembling a ballet dancer? This is known as toe walking. Although it is normal for children learning to walk to experiment with the style of gaits, frequent behaviour of toe walking, particularly when both feet are involved or it is accompanied by stiffness, might be a sign of an underlying neurological condition. In most cases, it may be a simple developmental issue which arises due to tight muscles from growth but it is important to see a Pediatric Orthopedic doctor to rule out the possibility of an underlying neurological condition.
Treatment options for children’s foot and ankle problems
a. Non-Surgical Interventions
For almost all foot problems in children, non-surgical methods are the first line of treatment and include:
- Physical therapy – to stretch out tight muscles
- Plaster cast application to stretch out foot deformities such as clubfoot
- Bracing with splints to hold the foot in a corrected position
- Corrective insoles to help restore the arch for teenagers with painful flat feet
Conditions like positional clubfoot resolve with simple stretching alone. Idiopathic clubfoot and toe walking may benefit from weekly cast application to slowly correct the deformity which can then be braced in a specialised splint to prevent the deformity from returning with growth. Many teenagers and young adults with flat feet that become uncomfortable from prolonged walking experience considerable symptom resolution with physiotherapy to stretch out tight calf muscles and a corrective insole to restore the foot arch into a comfortable position.
b. Surgical Treatments
In severe deformities or situations when continued non-surgical treatment has led to an insufficient response to deliver expected improvements, surgery may have a role in correcting foot deformity and improve both comfort and function. Specific examples include:
- Surgery for relapsed clubfoot in walking age children. IN cases where a clubfoot has returned in an older child, a tendon transfer procedure can help rebalance the muscle forces to the foot to improve alignment, comfort and function.
- Foot deformity in neuromuscular conditions such as cerebral palsy and spina bifida. Certain foot deformities arise from a muscle imbalance pulling the foot into a deformed shape. Surgery to correct the shape of the foot by changing the shape of specific bones, lengthening tight muscles and re-routing muscles to help pull the foot straight can give patients significant benefits in terms of improving painful foot deformities.
- Severe painful flat feet. Flat feet that remain painful despite an adequate course of non-operative treatment with physiotherapy and insoles may benefit from surgical correction to improve the foot shape, alignment and comfort.
The decision for surgery is always made collectively by the Pediatric Orthopedic Doctor, patient and their family through detailed discussion regarding the potential benefits and risks of the procedure. Post-surgical care is crucial, and a custom recovery plan, including pain management, physical therapy, splintage and a gradual increase in an activity level, is needed to ensure optimal long-term results.
c. Supportive Measures
The supportive measure is a vital aspect to ensure long-term foot health:
- Monitoring of foot alignment in conditions expected to improve as the child grows.
- Educating parents on selection of footwear and need for corrective insoles.
- Structured follow up in conditions such a idiopathic clubfoot which require routine surveillance to detect any possible recurrence of deformity.
- Repeat assessment as a child grows to ensure that their corrective splint is appropriately sized and is still fulfilling the desired biomechanical goals.
If you have concerns about your child’s feet, we recommend you to contact us for expert advice or to schedule a consultation.
Related Conditions to Be Aware Of
It’s also important to be aware that certain foot issues can sometimes be linked to broader skeletal development concerns. Any condition which affects your child’s leg alignment can give rise to foot problems. Holistic assessment is crucial to ensure that any associated condition or underlying cause has not been overlooked. Early diagnosis and a coordinated, multidisciplinary effort between specialists helps to ensure comprehensive care and the best results for your child.
Conclusion
Infants and children can experience foot problems such as flat feet or clubfoot, which can range from minor to more serious concerns. Early detection of foot abnormalities can make a great difference and ensure a child’s long-term mobility and comfort. Dr Assad Qureshi, a leading paediatric orthopaedic surgeon in Dubai, offers the expert diagnosis and treatment to facilitate healthy foot development. With his specialised expertise, your child can walk, run, and grow with confidence to achieve an active lifestyle that is not hindered by problems with their feet.
Dr. Assad Qureshi
Dr. Assad Qureshi is a highly experienced Pediatric Orthopedic Surgeon specializing in musculoskeletal disorders in children. With a focus on early diagnosis and advanced surgical techniques, he is committed to restoring function and improving the quality of life for his pediatric patients.
