Children’s Feet FAQ’s | Ask Your Podiatrist

When it comes to children’s feet, it can be hard to know if what we’re seeing is normal, or if there’s cause for concern. As podiatrists that work extensively with children’s feet, we often have parents bringing their kids in for assessment and starting the conversation by saying “…so I noticed this happening more lately, and it doesn’t feel right to me, but I wasn’t sure…” If you’re feeling like this – let us assure you that if you’re concerned, or if something feels out of the ordinary, then having a foot health check is the absolute right thing to do. And to help with all of the concerns and questions, we’ve put together a few kids’ feet FAQs for you. If you’re wanting the answer to something specific – just let us know.

1. Is it normal for kids to have flat feet?

As young children, yes. Their foot muscles are still developing, the fat pads around the feet are more prominent, they’re still very flexible – so having flat feet at this age is not something to worry about in most cases. At school age is when we’d expect to see an arch start to form. Kids are constantly on their feet, their muscles are strengthening and lengthening, their ligaments are growing strong – so it’s common that we’d start to see arches form at this age, by around 7 years old. If arches haven’t developed by this age, there’s a good chance that they may not and your child may have a flatter foot type.

2. Are there any warning signs that parents should be looking out for at home?

There are a few ‘common’ things we look out for, including:

Pain of any kind, including growing pains
Children that can’t keep up with their classmates when playing
Regular tripping or falling
Balance or coordination problems
Reluctance to take part in physical activity for no specific reason
Hesitation when asked to show you their feet

3. Can you fix feet that turn inwards (in-toeing)?

Yes, we work with children with in-toeing using a combination of a specialised kind of children’s foot orthotic designed to straighten the foot, supportive footwear, stretching exercises to loosen tight muscles that may be affecting regular foot function, and strengthening weak muscles to help maintain good foot positioning and alignment. In most cases, we are able to help restore a healthy foot position and function.

4. Why are my child’s knees so close together?

This is a condition called knock knees (medically referred to as genu valgum), and is often seen in children between the ages of 3 and 5. Walking in this position actually helps kids maintain balance as they develop their walking skills. Knock knees are usually a normal variation of growth and development, and this position is just how some children find their footing. However, this knee position also may be an indicator of an underlying condition such as rickets or osteomalacia. In these cases, knock knees may not develop until the child is six years old, or persist after the age of eight.

5. I’ve heard we must just wait through growing pains. Is this true or are growing pains treatable?

We’re not quite sure where the old wives tale of nothing being able to be done for growing pains came from, but thankfully it has no scientific backing. Growing pains are caused by irritation of the growth plate – the vulnerable part of your bone that is responsible for bone growth. It is also the weakest part of the bone and is weaker than the surrounding muscles, tendons and ligaments. Pain occurs when muscles pull on the area around the growth plate. By stopping this pull and tension on the growth plate, the symptoms can ease and resolve. This is where we can help.

6. Is toe walking normal?

Toe walking can be normal, especially in young children who are learning to walk and discovering what their bodies can do. Some kids can find the habit of toe walking to be fun without any issues. Others may be struggling with a shortened Achilles tendon, making it painful, uncomfortable, and sometimes not possible to place the heel in contact with the ground. If you’re worried, get your kids feet checked.

7. Which school shoes should kids be wearing?

There are several features we look for when selecting school shoes for children. These include:

A firm heel counter – this is the part of the shoe immediately behind the heel and often has a stitch or seam in this area. Heel counters should be strong to help control the movement at the heel and ankle, adding stability and helping control the position of the foot.
Laces or velcro – the fastenings on the shoe determine how much control you can have over the fit of the shoe, and laces and velcro are preferable as they give the best control.
Good toe box – the toe box is where you check for sufficient room and length, based on the longest foot and longest toe
Supportive, removable shoe liners – the insoles that come in the shoe should be comfortable, supportive through the arch, and removable – so that if your child needs orthotics at any point, they can easily replace the current innersole without needing new shoes.
Lightweight – heavy shoes can weigh feet down and contribute to tired and achy legs. Opt for lightweight materials where possible.

8. Why does my child have warts on their feet?

Warts are caused by the HPV virus, and is often transmitted in childhood through sharing surfaces when barefooted – particularly in swimming areas. For your child to have foot warts, they must have come in contact with this virus at some point in their life.

9. Can orthotics help kids?

In the right context, absolutely. We use orthotics as part of a treatment plan for a range of children’s foot problems and conditions. Orthotics work by adjusting the position of the foot in the shoe, and therefore changing how the feet and legs work together to produce movement. We don’t prescribe orthotics without a valid clinical reason, however, if your child is suffering from pain, aches or other problems, we will assess if orthotics may be a good solution to help with their symptoms, recovery or future injury prevention.

We Work Extensively With Children

Children’s podiatry is one of our specialities here at Perform Podiatry. We work extensively with kids and love helping them with a range of foot and leg problems from growing pains to ingrown nails to tired, achy legs. Book your appointment with our experienced podiatrists by calling 09 523 2333 or book online here.

Helping Auckland Families With Growing Pains

Growing pains are one of the most common pains that we see and treat in kids. While some mistake growing pains for when active kids overuse the muscles of the feet and legs to a point where they are very tired, achy and sore, this isn’t the case. Others have been told that growing pains aren’t treatable and must be waited out or just put up with – which also couldn’t be further from the truth! Growing pains affect children aged between 8 and 16 years and get their name because they can only be experienced while they’re still growing, meaning that these pains can’t affect adults. Most often, but not always, the painful symptoms come on during a growth spurt and while it’s often in kids that are active – it’s definitely not always the case

Understanding growing pains

To understand how and why growing pains can develop, you must know that the way that all our bones get bigger as we grow is through areas in the bones called growth plates. These growth plates, medically known as apophyses, these are the areas to which your body adds new bone. As these areas are constantly in ‘development mode, they aren’t as strong as the surrounding bone, meaning that when the bones are placed under strain and tension (like during exercise!), these growth plates are more vulnerable to damage and the painful symptoms that come with them.

While the bones grow, the attaching muscles grow too

While our bones are growing, so are our muscles – and lengthening to keep up and support them both functioning as a healthy and strong team. While our muscles and bones will ideally grow at a similar rate, at times the muscles won’t keep up and the result will be tight muscles that create a pull on the bone – particularly during running, running sports and exercise. When this tension happens near a growth plate in the bone, the growth plate can become irritated and leave your child with pain and swelling.

Where do growing pains develop?

The knees, the heels and the feet are the three areas in the body where growing pains affect kids most commonly. We help children effectively manage and relieve their symptoms in all three areas, so they can get back to doing the things they love and not sit out entire sports seasons!

Knee pain – Osgood Schlatters disease

Growing pains at the knees involve the irritation of the growth plate at the top of the shin bone. The patellar tendon, which is the one that runs from the front of your thigh, across the knee and attaches to the top of the shin bone, is the one that tends to create the tight pull and affect the neighbouring growth plate. Symptoms of Osgood Schlatters include pain and swelling when feeling below their kneecap. The symptoms are worsened by running and activities that bend the knee.

Heel pain – Sever’s disease

Growing pains at the heels occur in the very back of the heel, where the growth plate is located, next to the Achilles tendon. As the Achilles is the strongest and largest tendon in the body, if it is tight, it can place massive tension and strain on the back of the heel every time we walk and run. In adults, for some of us it even causes us to lift our heel up early off the ground or be unable to place our heels completely on the ground when the tendon is very tight. In Sever’s, pain is felt at the back of the heel and may radiate or shoot up the leg. There may be some swelling, and your child may limp when the symptoms are in full swing, until they can get some rest.

Foot pain – Iselin’s disease

Growing pains in the feet occur on the outside-middle edge of the foot. Run your fingers along the outside edge of the foot – if you feel a bony bump around the middle, that’s where your child will feel their painful symptoms, swelling and tenderness. It is the peroneus brevis tendon that travels down the outer leg, across the outer ankle, and attaches to that bony bump (your ‘styloid’) that causes the growth plate irritation in this case. This tends to be the least common growing pain of the three – though we still see it in plenty of children every year!

Is your child experiencing pain in their feet or legs?

Pain is never a normal part of growing up – it’s always an indication that something is wrong – and in most cases, this something can be treated when it has a clear cause – which it definitely does in growing pains. Often, there are a number of factors that contribute to the increased strain from the muscles and tendons – including the structure and function of the feet and legs, footwear, the way they walk, muscle strength, and more. We’re parents too – and we understand how important it is to get the very best care for your child – and that they can enjoy the experience too! Our podiatry team starts each appointment by understanding exactly what’s going on and causing the pain – and then puts the right care in place to both treat your child’s current symptoms and to prevent the problem from recurring in the future. We’re here to help. Book your appointment online here or call us on 09 523 2333

Growing Pains Explained!

Many of us have heard of or even experienced growing pains, but very few know what they actually are – aside from a pain that occurs while we’re still growing. When it comes to the feet and legs of kids and teenagers, there are two types of growing pains we often treat. Pain at the back of the heel (Sever’s Disease) and pain at and just below the knee (Osgood Schlatter Disease). Note: Growing pains are also mistaken for active kids overusing muscles of the feet and legs to a point where they are very tired, achy and sore. The cause is very different and treatment will vary too. If you’re unsure what your child is experiencing, bring them in for a check with your Podiatrist.

What are growing pains and how are they caused?

Growing pains are caused by tension and strain on the vulnerable part of your bone that is currently growing and lengthening. This vulnerable area is called a growth plate. It is the weakest part of the bone and is weaker than the surrounding soft tissues (tendons, ligaments, muscles). When a muscle or tendon attached to the bone is tight and pulls on the growth plate, it causes pain. Because during growth spurts our bones and muscles may lengthen at slightly different rates, we may end up with a muscle that is very tight for a time (until it lengthens) and so will trigger the pain with every step taken, and particularly with running and physical activity.

What and where exactly are these growth plates?

Growth plates (medically known as epiphyseal plates) are areas of bone located at the ends of long bones in kids. When we reach maturity, these growth plates turn into solid bone and we stop growing. Every long bone (such as our thigh bone, femur, or leg bone, tibia) has at least one growth plate on each end of the bone. New bone is added to these areas by the body while we grow.

What are the symptoms?

Depending on which part of the foot or leg is affected, symptoms can include:

Sharp, stabbing pain
Mild, dull aches
Pain that comes and goes
Cramping
Pain that wakes you up at night
Pain exacerbated by physical activity including running, jumping and sports

What can be done for growing pains?

We often hear from patients and parents who have been told there’s nothing that can be done for growing pains, aside from waiting them out and avoiding activities that trigger the onset of pain. Thankfully, when it comes to the feet and legs, there definitely are things that can be done to ease the pain and discomfort. Often, we can also reduce the time it takes for the pains to disappear, meaning your kids can get back to doing the things they love. The best options will depend on your child’s symptoms, but may include:

Custom prescribed orthotics to keep the foot in a position that places less force from tight muscles onto the bone
Footwear that supports the foot in the best position and doesn’t add undue stress or tension to the feet and legs
Pads specific to the area of pain, such as heel raises for pain at the heels
Stretches that support the affected muscles and bones, working to ease the overall tightness that may be contributing to the painful symptoms
Strengthening muscles and joints to support a good position of the foot that reduces strain on the affected areas
Massage (where appropriate) of the affected areas to help with muscle tightness and therefore painful symptoms

Which sports are best for your child’s development?

Getting involved in sports from an early age has a myriad of benefits. It gets kids active, builds on their teamwork skills, forms new friendships and is great for their strength building and coordination – among the various other mental, physical, social and emotional benefits. We think that the Novak Djokovic Foundation words the benefits very well:

Kids’ character and moral principles are formed through fair play
Sports experiences help to build positive self- esteem in children
Sports bring people together from all over the world, regardless of their nationality, religion, culture, or skin colour
Teamwork and benefits of social interaction among children are best seen in sports
Playing sports enables them to create friendships they otherwise might not have formed
They view competitions on and off the field as opportunities to learn from their success and failure
They learn to respect authority, rules, team colleagues and opponents
Sport is an important learning environment for children
Participating in sports can be a helpful way of reducing stress and increasing feelings of physical and mental well-being

While any and all sports will help to harness these important skills and experiences, we at Perform Podiatry thought we’d shed some light on a question we occasionally get asked by parents around which sports are best for certain areas and stages of development. We thought we’d break it down by age category and the activities and functions that are typically learnt and built on within the age range.

Preschool Age

At this age, kids are still getting their feet planted firmly on the ground and are developing a good grasp on their coordination, balance and general motor function. At this age, it’s important to focus more on mastering the basics and less on ‘joining a team’ or looking at competing, if it’s just for the sake of it anyway. Swimming, dancing, running, side to side movements, catching, throwing and activities that look at improving balance and coordination, both at the feet/legs and the hands/arms, are encouraged. We remember playing bullrush and other games at preschool that while were played with others, thinking back on them now, really focused on developing each person individually as opposed to focusing on the team dynamics that become more important in the next age range. Spending time throwing and catching with your kids at this age can provide just as much (if not more) value, growth and development, so make the most of this time together.

Primary School Age

This is the time that kids can really enjoy and benefit from team sports and organised activities. They’re at school and building important social skills and a good understanding of how a team operates together. Mentally, they’re getting stronger and have a greater focus and drive. Physically, they’re also getting stronger and can run further for longer, throw better, and the like. They will have developed good coordination and at this age will pick up almost any sport with great ease, working on the skills particular to that sport, if they enjoy it that is. You can’t go too far wrong with the sports offered at primary school, some of our favourites include netball, tennis, cricket (and generally all bat/ball sports), soccer, handball, basketball, touch rugby, running and the like. It’s also a great time to start getting involved in activities like gymnastics, swimming and martial arts where you have a greater focus on yourself as part of the team and start honing new skills.

Intermediate School Age

There is a lot that happens during this time and age that has an effect on kids in sport. Kids start to get quite good, confident and skilled in the sports they’ve been playing or participating in for the years leading up to this. Part of this is their improved memory and understanding of techniques and strategies involved in sport, as well as their improved physical strength, speed, size and general ability. With this age comes growth spurts and unfortunately, for some kids, that also means growing pains. This means more time and care needs to be taken on warming up, cooling down and general conditioning of muscles. This is the age that kids also start getting involved in contact sports such as tackle rugby, that may have previously not been suitable due to inadequate strength in bones and muscles and hence a higher risk of injury. This does need to be considered on a case-by-case basis, as every child grows and matures at varying times. Alongside all of the previously mentioned sports, kids can start more technical sports like hockey and volleyball, if they haven’t already tried it sooner.

High School Age

At this age, the world is their oyster! They have good, refined motor skills that have built up over the last eight years. Kids (though they’re not so much ‘kids’ anymore) can pick up sports relatively quickly, especially if they’ve had experience playing similar sports. We remember starting sports like fencing and underwater hockey at high-school, both of which utilised the technical skills from various other sports and activities. Growing pains and growth-related injuries can still occur so be mindful and make sure your kids get the right treatment and adequate rest/recovery if they develop pain or injury. If you have any questions about this, are worried about your child’s development, or they’re experiencing pain or injury, give our team a call on 09 523 2333 or book online! We’re the kid’s foot experts in Auckland, located at the One Health Building on Remuera Road, close to Newmarket.