Children’s feet: signs worth checking

A child’s foot is not a miniature adult foot. Shape, plantar fat and neuromuscular control change through growth. An “odd walk” at three is not read the same way as heel pain at eleven, and a flexible flat foot is not treated like a rigid foot that will not form an arch on tiptoe. Paediatric podiatry is about telling developmental findings from what needs examining: pain, falls, asymmetry or a shoe that wears out on one side only.

At Podología Priego we see the child in school shoes and sport shoes, not the brand-new pair. Families often arrive afraid of “insoles for life” or, conversely, convinced that everything will grow out. The clinical middle ground is to observe, explain and treat only when there is a clear goal.

What is common and what deserves a visit

Many children in-toe or look flat in the early years and do well with time, varied ground and activity. Not every paediatric flat foot needs an orthosis. A flexible, pain-free flat foot with a good heel raise is followed, not “corrected” for appearance. Do seek assessment for:

• Pain when walking or running, or at the end of the day, or a limp not explained by a recent bump.
• Repeated falls, refusal to put the heel down, or toe-walking that has not faded at an age when it should.
• Very uneven shoe wear, rubbing, blisters or recurrent ingrown nails.
• A clear difference in size, shape or loading between the two feet.
• A stiff foot, or one that does not form an arch on tiptoe.
• A history of clubfoot, neurological issues, motor delay or conditions the paediatrician already follows.

Heel pain in active school-age children and early teens (often 9–13) is a classic reason to attend and often corresponds to Sever’s disease: inflammation of the calcaneal growth plate. It is not “just growing”: off-loading, stretching, footwear review and, if needed, an orthosis that limits impact can help. We cover this in more detail in the article on children’s heel pain.

Gait, sport and school shoes

School and after-school sport load the foot for many hours. A stiff, narrow uniform shoe or a football boot that is already spent explains more rubbing and ingrown nails than “bad luck”. In dance, gymnastics or athletics, volume rises in certain seasons: pain then is not always an underlying deformity; sometimes it is overload on a skeleton that is still growing.

Watching gait in clinic is not theatre. We look for a side the child avoids, whether the heel contacts, clawing of the toes, or hip or tibial rotation the shoe is compensating. A more detailed study is not the first step in a pain-free three-year-old.

Working with families and paediatrics

Foot review sits alongside the paediatrician; it does not replace them. Fever, night limp, weight loss or a story that does not fit mechanical overload is not “insole first”. We examine flexibility, symmetry, skin, nails and real footwear. Custom orthoses are considered for pain, progressive deformity or sport that overloads an immature structure, with a review plan: the foot grows and treatment must be allowed to change.

Avoid copying adult treatments or supermarket insoles “just in case”. A poorly indicated device can rub or give a false sense that the problem is covered while pain continues. If there is pain, a limp or any of the signs above, book at Podología Priego and bring school and sport shoes.

Guidance for families. Diagnosis and treatment are decided in clinic, with paediatrics when needed.