From the moment our children are born, we expect them to be perfect and beautiful. We count your toes, fingers and love everywhere. However, as most of us realize, perfection is not always the case. Some children have foot problems from birth, while others may develop problems in their early years.
Tiptoe Walking “Ballerina’s Feet” or tiptoe walking is one such problem. Causes of toe walking include strained heel tendons at birth, habitual toe walking, or neurological conditions such as cerebral palsy or Duchenne muscular dystrophy. Although many children learning to walk tend to tiptoe, if this continues after 18 months, a doctor’s consultation is necessary to determine the causes and treatment options. You may think the child looks cute walking on tiptoes, but that ballerina look will be the focus of teasing when the child reaches school age. Treatment options can be as simple as stretching tight calf muscles. Other options include serial cast, braces, or surgery. If a child only has a habit of walking on their toes but can change this behavior on command, intervention with serial casting or orthotics may still be necessary. The child may change this habit by being told repeatedly, “Don’t walk on your toes…don’t walk on your toes,” but soon both parent and child will tire of this necessary scolding.
Although casting or serial bracing may seem extreme, don’t let the title scare you off; it is only a short-term treatment to provide a slow, sustained stretch to tight muscles. Serial casting involves applying a cast to the lower leg to allow extended stretching on the strained calf and Achilles tendon. The cast is removed weekly and reapplied in a more optimal stretched position until it is adequate for the child to walk heel-first on initial contact during the gait phase. After the casts are removed, it may be necessary to place some type of orthotic in the shoes to reinforce the heel strike and continue the child’s progress. Other orthopedic options can be discussed with a certified orthopedist. Some might include orthotic inserts that go inside the shoes. These can help support the arch and also provide some stiffness to make it difficult to walk on your toes or plantar/equine flexion and ensure proper foot position. For a more supportive option, an orthotic device called an AFO (Ankle Foot Orthosis) can be customized and worn for as long as needed to prevent a recurrence of toe walking. If no neurological conditions are present, this time period is approximately 3-6 months. Flat Feet Another foot problem is flat feet (pes planus) or “Fred Flintstone feet.” This is something that can be and often is normal in young children. Arches develop over time. The foot muscles are actually exercised and strengthened best when walking barefoot. Flat feet may be considered a problem when the child complains of pain in the feet or lower legs after walking. Children may not always give you a clear picture of what they are feeling. So, as a parent, one must keep an eye on the way a child’s shoes wear out over time; paying special attention to the position of the heel.
If the shoe is worn more on the inside edge and the heel appears to be sitting further out, you may have a flat-footed child. Another basic test is to see what a wet footprint looks like. If you think of Fred Flintstone, you may have a flat-footed child! The most important thing is to pay attention to your complaints of pain after walking. Flat feet without pain do not necessarily indicate the need for treatment. Like toe walking, there can be many reasons for flat feet, other than an arch, not to develop normally, such as Down syndrome, hypotonicity (low tone), or developmental delay. If your child has any of these diagnoses, you may also need to discuss this with your doctor and decide if orthotics are needed as an adjunctive treatment. Flat foot orthotics are used to support the arches and provide a better mechanical advantage for the foot to walk properly. The feet are the structural foundation of the body, therefore supporting the feet in their optimal alignment allows the muscles in the legs to activate to their fullest. If you have questions about orthotics, consult your doctor and then find a board-certified orthotist who specializes in children.
