What is normal?
Watching your child learn to walk is one of the most exciting times for a new parent. But it can also be stressful. Every child is different and worrying if your child is ‘normal’ is an every day part of parenting. As much as we would like some concrete answers, there is no hard and fast rule for development of a child in relation to any milestone. So how do you know if your child is doing ok, or if there is something you should investigate further. Let’s take a look at the development of the foot and hopefully we can help put some concerns to rest.
In the Beginning
We all love those soft, chubby baby feet. They are well padded and highly flexible, but as a child begins to walk those characteristics change. Most children begin to walk somewhere between 8 and 18 months. At first they will appear to be flat footed, and may appear to be bow legged and stand with their feet wide apart. As the strength in their feet develops you will notice arches begin to form, usually at about 2-3 years. By the time your child is around 5, you should see distinct arches in the middle of the foot. Similarly, the pigeon toed look worsens between 3 and 5 years of age. By the time your child is around 7, their skeleton has reached structural maturity, which means that it will continue to grow in the shape it has taken on at that time.
Feet have 26 bones, many of them very small. In children, these bones have what we call a ‘growth plate’ at the end of them. These growth plates are made up of cartilage and determine the future length and shape of the bones. The bones grow until the end of adolescence, at which time the grow plates close and become solid bone. Cartilage, however, has much less tensile strength than bone, making your children’s feet more vulnerable to injury. Injuries involving the growth plate can cause misalignment and deformity if not treated correctly.
In our blog last year, Growing can be a Pain, we talked about growing pains and why they are not, in fact, growing pains. Whilst this condition can be painful and distressing it is entirely normal. The pain, which is normally in both legs, can be alleviated with stretching, massage, heat packs and exercises – the details of which you will find in our earlier blog. Normally, by the time your child reaches their teens the growing pains will disappear.
These conditions are more commonly known and pigeon toed and duck walking Generally these conditions are caused by rotation of the femur, tibia, fibula or foot and worsen up until the age of around 4. In most cases they resolve themselves as the child grows, and do not affect the athletic ability of the child, however it is important to try and reduce factors that can negatively impact proper growth and development, such as poorly fitted shoes or sitting with legs in the ‘w’ position.
Knock Knees/Bow Legs
Because of the way babies lie in the uterus, they are often born appearing to be bow legged. By the time children are three this has usually reversed and the legs may appear knock kneed. This may appear to worsen until the age of around 4, however it will generally resolve itself over time without any intervention.
Children generally walk on their toes when they first begin to walk. By the time they reach pre-school age they are most often walking normally. In rare cases toe walking continues, but rarely causes pain and so does not require treatment. If toe walking persists it is a good idea to rule out any neurological conditions. Some doctors suggest the surgical release of the Achilles tendon, however this only improves 75% of children, and in some cases it worsens. This type of intervention is not commonly recommended.
As with most things related to children’s development, the old saying ‘this too shall pass’ is very true. However, if you have a concern it is easy to set your mind at rest by booking an appointment with a Podiatrist. Call our Baulkham Hills clinic on 9639 7337 to make an appointment if you would like to put your mind at rest.