Children's Foot Problems - What's Normal and What Needs a Podiatrist

Parents frequently bring children to podiatry appointments concerned about something that turns out to be completely normal - and equally frequently, issues that warrant attention go unnoticed because they're assumed to be "just a phase." Knowing which is which saves a lot of anxiety and, in some cases, catches something early when intervention is most effective.

This guide covers the most common children's foot concerns, what falls within normal developmental variation, and the signs that indicate a podiatry assessment is genuinely warranted.

Normal Foot Development - What to Expect at Each Age

Children's feet develop rapidly and go through predictable stages that can look abnormal to an untrained eye:

• Birth to 2 years: Flat feet are universal in infants - the fat pad under the arch fills the arch space and the foot appears completely flat. This is normal and expected. The bony arch begins to develop as the child begins to walk and load-bear.
• 2-6 years: Flat feet remain common and are developmentally normal through this period. In-toeing (pigeon toes) is also common and in most cases resolves spontaneously. Bow legs (genu varum) typically self-correct by age 3.
• 6-10 years: Most children develop a visible medial arch by age 6-7 as the fat pad reduces. Persistent flat feet beyond age 7 warrant assessment. Knock knees (genu valgum) are common at 3-5 years and usually resolve by 7-8.
• 10+ years: By this stage, the foot has reached approximately adult proportions. Persisting deformities or asymmetries should be assessed.

Common Concerns - Normal vs Needs Assessment

Flat Feet in Children

Flat feet (pes planus) in children under 7 are developmental and rarely require intervention. If the arch appears on tiptoe (flexible flat foot) and the child has no pain, no awkward gait pattern and is keeping up with peers in physical activity - no intervention is needed.

Assessment is warranted when: the child is over 7 and still has flat feet; the arch does not appear on tiptoe (rigid flat foot); the child complains of foot or leg pain; the child fatigues quickly or avoids physical activity; or the gait looks noticeably different from peers.

In-Toeing (Pigeon Toes)

In-toeing before age 8 is usually developmental and resolves without intervention. It most commonly comes from one of three rotational factors: metatarsus adductus (forefoot turns inward - typically resolves by age 3), internal tibial torsion (tibia twisted inward - typically resolves by age 7), or femoral anteversion (femur rotated - typically resolves by puberty).

Assessment is warranted when: in-toeing is severe or causes frequent tripping and falling; it is asymmetric (one side worse than the other); it is worsening rather than improving; or the child is over 8 and still clearly in-toes.

Heel Pain in Children (Sever's Disease)

Heel pain in active children aged 8-14 is most commonly Sever's disease (calcaneal apophysitis) - irritation of the growth plate at the back of the heel where the Achilles tendon attaches. It's the most common cause of heel pain in this age group and is not serious, but it does require management to prevent it from limiting physical activity.

Any heel pain in a child that persists for more than 2 weeks, that is severe enough to cause limping or avoidance of sport, or that is affecting only one side should be assessed by a podiatrist. Sever's disease is manageable with heel raises, load management and occasionally orthotics - it resolves completely when the growth plate closes, typically by age 14-16.

Growing Pains

Growing pains are bilateral, typically night-time aching in the muscles of the lower legs, occurring in children aged 3-12. They're real, they're common, and they're benign - characteristically not present in the joints (if joint pain is the complaint, further assessment is needed), and typically resolving with massage and reassurance.

Growing pains that occur only in one leg, are present during the day, involve the joints rather than the muscles, or are severe enough to significantly disturb sleep should be assessed to rule out other causes.

Ingrown Toenails in Children

Children develop ingrown toenails for the same reasons adults do - nail cutting technique, tight footwear and nail shape. Any ingrown toenail that is infected (red, swollen, discharging), causing significant pain, or recurring after home management should be assessed. Ingrown toenail surgery (partial nail avulsion with phenolisation) is safe and effective in children and adolescents.

Children's Gait Abnormalities

A child who limps, who walks on their toes beyond age 3, who trips and falls frequently compared to peers, or whose walking pattern is clearly asymmetric warrants podiatric assessment. These patterns may be developmental and self-resolving - but they may also indicate a foot or lower limb structural issue, a neurological condition, or a hip problem. A clinical assessment will differentiate.

Does My Child Need Orthotics?

Orthotics in children are appropriate for symptomatic flat feet causing pain or fatigue, for Sever's disease management (heel raise component), and for some biomechanical conditions affecting gait. They are not routinely needed for flat feet that are asymptomatic and developmentally appropriate.

Children's orthotics are generally lighter and more flexible than adult devices, and they're remade as the child grows. An annual check is recommended during growth periods to ensure the orthotic prescription still matches the child's current foot structure.

NDIS and Children's Podiatry

Children with disabilities affecting their foot health or mobility may be eligible for podiatric therapeutic support under the NDIS. Podiatry is a recognised allied health support under the NDIS and can be funded where there is a clear connection between the child's disability and the podiatric need. Contact Bexley Podiatry to discuss NDIS access for paediatric patients.

Not sure whether your child's foot development is normal or needs attention? A single assessment gives you a clear answer and peace of mind - or an early intervention when it matters most. Book a children's podiatry assessment.