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Pediatric Podiatry - 18 months to 3 years

As long as the baby’s feet are healthy at birth most newborns won’t require special care for their feet; and caring for your baby’s feet is much like caring for the rest of their body. Periodic checkups and milestone markers to access early development. When your baby starts to walk, bare feet are best inside the house . Outside, put them in a good quality children’s shoes, lace or Velcro, to give them support and protection. If foot problems run in your family it is especially important to have the your child examined by a podiatric specialist. Certain foot deformities are inherited. Early intervention can often prevent problems from carrying on and worsening into adulthood leading to future lower extremity, knee and hip pathology.

By the age of 18 months your child should be seen by a podiatrist who will be able to clinically exam your child’s feet and ankles, evaluate their biomechanics and gait, recognize potential problems and offer guidance and recommendations to ensure the proper care and development of your child’s feet. Good milestones for your child’s visit are 18 months, 3 years and 5 years of age.

18 months to 3 years

One of the common concerns that many parents have about their children’s feet is flat feet or the absence of an arch. A baby’s foot can be fat, flaccid, floppy or flexible, but between 18 months and 3 years of age, and by then the arch should begin to form. Upon clinical examination, if there is evidence of compensatory changes resulting from pronation (flat foot) that significantly affect development in the muscles, tendons and bones of the foot, create pain or influence your child’s gait your podiatric physician may recommend prescription children’s orthotics.

Another concern many parents have as their child learns to walk is a rotational problem commonly known as in-toeing. In-toeing is a gait variation, not typically considered abnormal in infants and young children, it may be significant and does merit evaluation. Most in-toeing cases tend to present as asymptomatic (no symptoms), however some severe cases can cause issues with tripping, stability and balance and lead to more serious developmental problems.

There are several causes of in-toeing with different levels of treatment. It is important that the cause of in-toeing be diagnosed so consultation with a podiatrist is always recommended who will then advise you if your child requires any further treatment or if the condition will improve through natural development. The most common cause of in-toeing is internal tibial torsion - when the tibia (shin bone) has an internal twist and turns inward. Common in infancy and childhood, it normally improves with the majority of cases of in-toeing due to tibial torsion gradually resolving on their own.

A series of rotational changes in the lower extremities occur as children progress from crawling to standing to walking. But there are certain patterns of behavior that influence and may delay natural de-rotation that results in in-toeing. What causes the delay in de-rotation? There are a few causes but by far the most common would be when the child adopts sleeping and sitting habits such as these.

W sitting is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body. If you were to look at the child from above their head, his or her legs will look like the letter “W”. For many children this is the way they sit without even thinking about it. Oftentimes the added stability of this position allows them to play without falling over so it becomes their preferred way of sitting. Problems occur when children sit in this position for an extended period of time creating potential rotational problems, muscle development and issues with balance and laterality. There are certain behavioral changes parents can make at home that encourage other ways of sitting that can be helpful to correct this.

Sitting in the "W" Position

Sleeping Face Down or Snuggled Up

Your podiatric physician will want to rule out any underlying structural problems with diagnostic imaging to determine if the in-toeing is coming from the hips, legs, or feet. The child should be monitored every few months for signs of improvement and to ensure no secondary problems from the in-toeing occurs.

Toe walking , a condition where a child walks on his or her toes, or the ball of the foot is commonly observed in children who are just beginning to walk. Most children learn to walk normally by the age of three. Different factors may contribute to toe walking. If your child is still toe walking by the age of three, it is recommended that they be examined by a podiatrist. Also if your child continues to experience in-toeing or gait abnormalities past the age they should have outgrown these issues or if your child ’s foot appears stiff and not flexible or you child’s gait is limiting their function, further consultation and treatment may be needed.

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