You may have noticed that when a child first starts walking, the way in how they manoeuvre themselves is very unlike how adults walk and it is even very different to how children just a few years older walk.
When a child first starts to walk they have no arch formation of the feet, they generally will look to have bowed legs and walk with a very wide base of gait. It is due to the in utero position that a child’s legs are rotated outwards and the wide base of gait is a technique to improve balance.
As a child grows and develops so does the foot, by the age of 3, some rising of the arch should be seen and you will see the legs tend to rotate inwards; sometimes causing a knocked knee or pigeon toed appearance of the lower limbs. By the age of 6 or 7 most children will have tend to walk more like a small adult, having their foot move from first landing on the heel to then bending at the big toe before they move forward. Often the knee will be fairly straight and the toes will point forward.
Although, as podiatrists we often see biomechanical variations including excessively flat feet, rolling in ankles, pigeon toes, knock knees or bowed legs after the age when this can be considered to be a normal part of development. We often also see children, who complain of tired legs, painful knees and feet or who struggle to do activities such as walking up stairs or skipping and hopping.
As podiatrists we are not only concerned with the treatment and elimination of pain for our patients but also inassisting them to have the best quality of life.
Many parents ask us, “Will my child have to wear orthotics for the rest of their lives?”
This is a very valid question and is one that has been under much debate in the podiatric world for many years and still is today. .
In our clinic every patient is assessed individually and if orthotics are advised there is always rationale to support our decision. Often the position of the foot can be linked to symptoms or perhaps there is a family history of pain from a certain foot type.
Pain in the feet or lower limb can often be attributed to the position of the feet. The position the foot sits in can influence the position and motion of the body further up, such as motion of the knees, hips and lower back. When assessing for pain, podiatrists not only take into account what is happening at the foot but also the entire body. It is our specialty area to assess lower limb biomechanics, how the body is moving and if it is doing so, in an energy efficient manner.
Everything is connected and it is for this reason that we often will work in conjunction with other health professionals such as osteopaths or physiotherapists to offer the best outcomes for our patients.
Long term, an excessively flat foot causes the line of motion to be deviated and therefore force is greatly increased on the inside part of the foot. Significant tension is places on the bones of the foot especially the talar head, navicular, cuneiforms, and the three medial metatarsals.There is also increased tension of the medial ankle ligaments and the plantar fascia. As the bones and tissues of a child are more mouldable and elastic these forces can actually cause changes that overtime can become permanent. The top part of the bones are under greater compressive forces than the bottom parts of the bones, leading to permanent remodelling of the soft bones of children. It is due to this remodelling of the bones during the first decade of life that can cause a lower arch height within the foot as adults (Kirby, 1992).
When the foot sits in certain extreme positions it also causes excessive stressors on the muscle and ligaments of the legs and feet. The body wants to sit in a straight and aligned position as it is in this position that it is most energy efficient and balanced, hence if naturally our feet are more rolled in, the muscles in our calves work very hard to try and pull the arches up and stop the rolling in from happening often leading to pain and overuse. Overtime the excessive work that these muscles do can lead to chronic fatigue of the muscles on one side of the leg and under activity of muscle on the other side and not to mention the changes that can occur in the joint.
With experience we have found that if a child has developed pain that can be attributed and treated with reference and influence to their foot position, they are more likely to suffer from other conditions later in life. Many overuse injuries are linked to a flat foot or pronated foot type and while an orthotic can alter the position of a foot, and help to prevent permanent changes from occurring it cannot permanently correct it entirely. Somewhat like how an orthodontic plate can straighten the teeth but only if it is worn consistently. If it is taken out for a long period of time the teeth can return to their original positions.
A child’s foot changes quickly as does every other aspect of their body. It is for this reason that we regularly need to review our patients and their orthotics to ensure they continue to do the best possible job for the developing foot. As the foot grows the position that the orthotic needs to sit in can change and overtime the effectiveness of an old orthotic is drastically reduced. Hence, it is necessary to replace them as they wear and your child’s foot changes.
There is very limited research on the subject; however it is of the opinion of many specialists in the area and from the experiences of our own Children’s Podiatry Clinic, that often, yes, your child may very likely need orthotics for the rest of their life, or at least until their foot and body is finished developing.
If you have any questions or concerns please feel free to contact the clinic or make a time to come in for an assessment.
