Development of a Childs Foot

As a recently new father, I now know the pressures and desires to give your child the best start in life and wanting to do the impossible of getting everything right the first time. The ideals of having a flat foot being bad for you has seemingly imbedded itself into not only the medical world but pop culture as well – ever since Root Theory was established in the 1970’s. The retail world has gained a lot from offering “supportive” footwear to patients or up-sell products such as generic insoles or padding devices for those who have been scared into believing that something is wrong with them based on visual observations, despite that fact of having nil pain. Therefore, seeing that your newly upright and walking son or daughter has flat feet can send alarm bells ringing for an emergency appointment with the GP or Podiatrist. To make things a little easier on you, the parents, lets touch on the basics of foot development to reduce those fear.

A child’s foot is not the same as an adult’s foot. A fully matured adult has 26 bones, 33 joints and over 20 muscles. A child’s foot has many more pieces of bone due to the foot not having reached full maturity and bone ossification. With so many joints within the foot, it is no wonder a child’s foot is so flexible. It has been found that the development of the medial longitudinal arch is associated with the age of the child, with quite rapid development occurring in the initial 5 years of life. Obviously, this is encompassing of the time where a child will learn to walk, strengthening the bones, muscles and connective tissues to for a mighty spring which can attenuate pressures and direct elastic energy in a useful way. Additionally, the child’s heel will begin to straighten slightly with the increase in strength from the generally accepted everted position (we will touch on the idea on straight feet in an upcoming article).

Most children will begin walking somewhere between eight and eighteen months and will tend to in-toe as they continue to learn this new phenomenon. Children shoe be allowed to play barefoot, whenever it is safe to do so as there are many benefits to barefoot play. Not only does it help to strengthen the child’s foot, but it also promotes proprioceptive feed back to the child which helps with balance and body awareness. Shoes should only be worn by a child when protecting their feet from dangers. When identifying the best possible footwear for child to wear, the following criteria is a great summary of what to look for:

• Wide toe box (all five toes should be able to spread out easily)
• Both foot length and width should be measured
• Flexible/ FLAT shoes
• Laces (elastic laces will allow better fixation if the child cannot tie them their self)

So we have looked at the fact that in general, it is normal for a child to have flat feet. With everything in life, there will always be an exception to the rule. So now let’s dive a little deeper into what constitutes a flat foot, the difference between flexible flat feet and inflexible flat feet, red flags to keep an eye on and what management plans may be put in place in addressing your concerns.

Root theory was established by Root et al 1971, suggesting that a vertical heel position provided more optimal biomechanics, however in recent years’ different models have been proposed to challenge the idea that a vertical heel is normal. The first is known as the Tissue Stress Theory and focuses on the individual tissues and their ability to cope with the stressors which they are being placed under – indicating that orthotic or offloading prescription does not necessarily have to target the rearfoot but be more specific to the area of concern. As discussed above, most children displaying a visually flat foot, will generally do so due to increased flexibility.

Flexible flat foot is generally seen as a physiological implication where as a rigid flat foot is seen to be pathological. The primary factor which looks to differentiate the too observations is the Jack’s Test; where the 1^st toe is passively pulled into extension to plantarflex the first ray and produce the windlass mechanism. A foot which is able to achieve the windlass mechanism while in a relaxed position is seen to be normal, whereas a foot which can be placed into talar-neutral and achieve the windlass mechanism is treatable. A rigid foot at such a young age is never a normal finding and surgical opinion should be sort.

The feet are designed to create a stable base for bipedal movement, although it is a part of natural development for a child to lose balance at times, regular tripping, falls and complaints of pain should be taken seriously. Children tend to respond poorly to structured exercise but when disguised as a game can find prescribe activities quite fun. Additionally, in-shoe offloading if done correctly can be beneficial in helping to develop habits and strengthen proximal muscles to address underlying weaknesses. Other treatment options include; varying footwear choices, night stretch splints and cast orthotics in extreme cases. The evidence for the use of orthotics in children with no signs or symptoms of discomfort is becoming clearer and clearer with two RCTs published finding no evidence for the use of foot orthotics, either generic or custom, in asymptomatic children.

Hopefully, the information displayed helps calm the nerves of some of the parents out there that have been worried about what their children’s feet look like. Although there can be major issues in a child’s development, very little is actually associated with flat feet. In fact, in many cases it is actually the opposite. Of course if you have any issues you are still not sure about, please make contact with your local podiatrist.  Keep an eye out in our coming articles where we delve deeper into the orthotics argument and the increase in foot specific training for rehabilitation, prevention and even performance.

Until Next Time,

Jackson McCosker
Director/Chief Editor

 

References

Children’s Feet. (2016, July 28). Retrieved from Better Health Channel: betterhealth.vic.gov.au

Evans, A., & Mathieson, I. (2010). Pocket Podiatry: Paediatrics. Adelaide: Churchill Livingston.