Pediatric feet are adorable, complex and always changing.
Common concerns that prompt parents to seek medical attention for their child’s feet are flatfeet, abnormal or painful gait, toe-walking and ingrown toenails. All of these concerns can be addressed by your family podiatrist. The majority of conditions with children’s feet are easily treatable.
The adult foot is composed of 26 bones, but infants are born with only 22 of them. The remaining bones usually develop by age three. Infants continue to develop their skeletal foot structure over time. Parents should check that their infant’s foot is flexible. A rigid/non-flexible foot in a newborn/infant should be a “red flag” and prompt you to seek medical attention for evaluation and treatment.
Infants and toddlers’ feet may be positioned inward, a common condition known as metatarsus adducts. It is often caused by intrauterine position (especially in breech positions). Many cases resolve spontaneously and do not require any treatment. However, if an in-toed position or gait persists, an exam is paramount. In some cases, your child may need physical therapy, shoe therapy, or serial casting.
As your infant grows and begins their independent gait, you may notice a “wide stance” and “out toe” (abducted) gait, which can continue into their early toddler years. The osseous and ligamentous structures have not developed fully, so toddlers widen their stance for balance. For a beginner walker, a flat foot strike, wide base of gait and abducted foot position are completely normal. Your child should be independently walking by 18 months.
Toe-walking may be observed in a toddler 12-18 months old. However, if your toddler exhibits sudden onset of toe walking, make sure to inspect the foot for any blisters, foreign bodies, or other skin lesions such as warts. It is not uncommon to discover they may have stepped on something and are avoiding putting weight on the heel. A child that continues toe-walking should also prompt parents to seek medical evaluation and treatment.
Ingrown toenails in infants and toddlers are also common and can be easily treated. Topical anesthetic and trimming of the nail usually resolves the issue. Epsom salt soaks can also be helpful to soften the nail and alleviate inflammation or mild infection. If the ingrown toenail is severe, a portion of the ingrowing nail may need to be removed in the doctor’s office. Topical anesthetic is applied to your child’s skin in advance to help eliminate pain. To help prevent ingrown toenails, check your toddlers shoe size and fit often. Shoes that are too small or have a narrow toe box can make toes susceptible to ingrowing nails because of crowding.
Overall, infants and toddlers usually grow out of a majority of foot conditions. If you’re concerned about your child’s feet, an exam by a podiatrist can help identify and treat problems early and help put your mind at ease.