A Podiatrist on Kid Feet, Shoes, and Orthotics

This post from 2012 was lightly edited (photos added and resources updated) in 2020. For more information on kid and baby movement, read through our favorite resources at More Movement for Babies and Kids. For more information about feet, read through Our Favorite Foot, Shoe, and Walking Resources. 

When you’re a body nerd, you tend to have body-nerd friends. One of my besties is a podiatrist and we have spent years hanging out over anatomy books talking about feet, gait, alignment and the strategies of a game we play where you drop a quarter from your clothed-yet-clenched buttocks into a shot glass on the ground. (In case you were wondering, I achieved legendary status when I managed to do this the first time she ever taught a group of us this game at a BBQ. It was about three years ago and not fifteen like you might imagine. No one has ever accused me of being classy.)

Because I get so many questions from parents about their kid’s feet and how to make sense of the variety of information they've gathered, I ran some of my most-received questions by Dr. P.

Here are her answers:

What is the most likely reason a kid is brought to your office?

The most common thing I see kids for is their parents' complaint that the child has flat feet (followed by they "walk funny" or their feet are turned in). Rarely do the children complain of any discomfort or difficulty.

Why is it normal for kids to toe out as they first learn to walk?

As kids adjust to balancing their torsos as they move from four points of contact (crawling) to two (standing), they assimilate a new center of mass and often look to widen their base of support which can include turning out the toes and even bending the knees. This is normal in early walking but this can go on excessively if they are compensating for general lateral hip weakness.

Thanks for saying that. I think that professionals address the symptom (foot shape or position) but don’t always offer the mechanism. Foot issues very often tend to be the result of leg weakness, especially in the thigh and butt muscles, so the solution should often include stretches and exercises for north of the ankle. (See exercise below!)

So to clarify, various foot positions can be normal as gait is developing. Keeping that in mind, when should a parent seek professional treatment for their kid’s feet?

Though flexible flat feet are the norm, the degrees of both flexibility and flatness vary. Most concerning is a foot that is rigidly flat or one that appears so flat it looks convex on the bottom (like a rockerbottom). This could indicate an uncommon condition called vertical talus or tarsal coalition. These rare exceptions should be addressed in a timely manner as they often require surgery to change the structural position of the bones.

This question isn’t really about kids but adults who once were kids: Why were so many people put in braces as kids and why don’t they do that any more?

A child's in-toeing (in this scenario) is attributed to internal tibial torsion. We have learned a lot about how to move the shank without a brace but it takes a great deal of work. "A great deal of work" is a challenge when attempting to improve alignment in kids. It has been observed that most people "grow out of it." This likely just means we will put up with some amount of tension in the lower leg as long as the foot appears to be pointing in the right direction.

You seem to know a lot about feet. How many women were in your podiatry class?

In a graduating class of 75, one third were women.

Was that awesome or intimidating?

I didn't particularly feel outnumbered as a woman in school (is this therapy?) but residency was a different story. In a group of 12, I was the only female. The noticeable difference is in practice where the overwhelming majority are still men. In my county there are maybe two female DPMs.

Why do you think we get along so well?

We speak the same language on so many topics and you don't forget stuff and you have a lot of integrity. I could go on with many other mushy things but let's keep it more professional. I do wish you could catch better though. Did you hear Vin Scully signed on for another year? He was supposed to retire two seasons ago.

ZZZZZZZZZZZZZZZZZZZzzzzzzzz. Sorry. I fell asleep while you were talking about sports. Again.

Back to kids feet. What are three things parents can do to aid in their child's foot development?

1. Assist your child in massaging and stretching their feet if they are very young.
2. Be a good example of alignment for your children; get creative with the exercises and make them fun. Be committed to a daily routine.
3. Encourage barefoot play around the home and in safe environments.

What’s your most favorite shoe to see a kid wearing? If not a brand, characteristics?

For real small ones I think whatever simulates a minimal shoe: flexible thin sole for protection and movement, soft moveable upper with plenty of room in the toe box and nothing they will slip in.

What’s your least favorite shoe to see a kid in?

I especially hate to see new walkers saddled up with shoes that have rigid uppers and dense immoveable soles. Children just learning to ambulate have a challenging enough time and this just robs them of the sensory perception that is vital to their lifelong movement habits. Putting little girls in "little heels" is really uncool too.

(For the record I’d also like to mention that putting boys in “little heels” is also uncool. Just sayin’.)

If there is a “biggest mistake parents make when it comes to kids feet” what would it be?

Having kids in shoes before it is really necessary. See above.

Here's a longer comment from a reader. What is your take?

"My son's (3.5 year old) pediatrician and chiropractor suggested the use of orthotics in his shoes this winter to support the inner arch of his feet. If I see his growing feet/legs/etc as some sort of playdough that should be correctly molded, this makes sense. On the other hand, I imagine that this could lead to a development of his body that depends on these artifacts. Which of these perspectives is most important at this stage?

I'm having a lot of trouble in getting him to do any sort of exercise correctly, besides avoiding w-sitting. Stretching is painful and not fun, and any movement game can also been done incorrectly, and lead to no benefit."

I don't generally encourage the use of orthotics at such a young age. I understand that it can also be very challenging for some to follow a daily routine of what appears to be exercises. Which “exercises” are being performed? Can they be modified or can different ones be tried? Orthotics are not going to harm the child, but I really emphasize the stretching first. In older kids I may combine the two but show the patient and the parent that without stretching exercises and proper alignment, the orthotic will not correct changes needed further up in the leg. At best it will serve as a supportive cue.

Thank you, Dr. P!

//end interview

For all of you wanting something to practice right away, this is my favorite strength “game” to play with kids that can aid in hip and core strength with the specific purpose of work these along with the foot. P.S. This "wobble" pelvic list exercise is not only for kids, but is one of my personal favorites. I easily do it 10-20 times a day while I'm standing around working or talking.

This exercise uses a 1/2 foam roller, 12" x 6" x 3." You can find these in our store or at foamerica.com.

 

 

Note: It's common for kids (and adults, for that matter) to want to do this exercise in the way they already stands, i.e. with their feet turned out and knees bent.

But, in order to target the lateral hip, especially with respect to elevating the arch of the foot, a "straight" foot is required. To assist with this, I trace each kiddos foot (and, I write their name on "their" dome too or let them decorate it) so all I have to do is ask, "Is your foot in your foot print?" and let them notice and adjust.

 

I don't recommend approaching kid-corrective exercises in this way: Hey, Bobby, it's time to do your exercises (said with enthusiasm) so we can fix your feet! Kids, and people, probably, don't enjoy the idea of needing to be fixed. They want to play. Mostly with you. How about taking turns doing this exercise with your kids—letting them correct you, offer you advice. Then switch, and repeat!

Also, make your home more dynamic. Our house and yard are filled with balance stuff: half domes, a BOSU, logs of various sizes and shapes outside to walk along. Kids, and and people, probably, naturally gravitate towards these items but they need to be out in the middle of everything where everyone can come across them a hundred times a day.

Having special, set-aside times for "balance" and "strength" makes it seem like these aren't skills to be practiced every day, all day long. And, the more cluttered the home is with balance toys, the more likely the entire family is to practice a little stability now and then.