What you need to know about physiotherapy and podiatry.
We have many concerned parents fielding queries about children’s foot conditions. Here are the top 5 questions and our answers – may they alleviate your concerns!
Question 1: “My child’s foot does not seem to have an arch. Does he/she have flat feet? Can it be cured?”
Babies are commonly born with flat feet hence there is no need to be overly worried. A child’s bones and joints are flexible, and when they stand with weight on, the arch may appear collapsed. Toddlers also have fat pads on the inner border of their feet that may conceal the arches. You may notice the arches when they go on tip-toes.
Typically, ‘flat feet’ should ‘disappear’ by age 7 as the feet become less flexible and the muscles supporting the foot develops Nevertheless, there will still be about 10-20% of children who will continue to have flat feet into adulthood.
Flat feet do not always mean ‘bad’ feet. It is a genetic variance and there are people with flat feet who do not experience any pain or discomfort throughout their lives, because they can have good muscle strength and flexibility and/or optimal postural control that prevents symptoms development. Children who do not develop an arch may not necessarily need treatment, unless the foot is stiff or painful or if it leads to other alignment issues in the hips and knees. Treatment of symptomatic flat feet includes considerable muscular and gait training, and prescribed insoles if required. Podiatry treatment will not ‘unflatten’ the foot, but it can treat or relieve symptoms that arise from having flat feet, and prevent further developmental issues as the child grows.
Question 2: “Sitting in a ‘W’ position is not good for children. Is that true?”
The ‘W’ sitting position happens when a child sits with their bottom on the floor and their legs on the outside, forming a “W” shape. This sitting position is commonly seen in kids younger than 4 years old because most children are born with their thighbones turned in, a condition known as femoral anteversion. W sitting gives them a wider base to support their core, which is still developing. However, if the child still prefers W sitting after 4 years old, it is important that parents break this sitting habit, because the ‘W’ position places the hip joints into extreme ‘in-turning’. This tightens the muscles on the inside and stretches the muscles on the outside of the hips. As the knees and feet mechanics are connected to the hips, this extreme rotation can lead to a knock-kneed position and/or in-toeing of the feet. This places unnecessary stress on the joints and may affect balance and muscle coordination as the child develops. It may be time for you to nag at your child to sit cross-legged!
Question 3:“Are flip-flops bad for children?”
It is not harmful to allow children to wear flip-flops for short periods of time. But young children may find it difficult to grip and lift the flip-flops with their toes. They may resort to dragging their flip-flops, which can become a bad habit and lead to symptoms in their feet.
Flip-flops are not suitable for children with feet problems or have problems balancing.
Question 4: “Is it okay for my kids to wear hand-me-down shoes?”
The feet of a child over 3 years old may increase one-half sizes every four to six months. We understand that it is costly to buy new shoes every few months. So YES! If the hand-me-downs are in good condition, by all means go ahead. A pair of good shoes with a quality outsole should last between 6 months to 1 year. Make sure the soles are not slippery and not worn out on the outsole. Do clean the shoes and shoe-liners thoroughly before use to prevent fungus or warts developing.
Question 5: “My child seems to be falling down more often than his or her peers. Is he or she just clumsy or does he or she have a problem with walking?”
Frequent falls, bumps and bruises are to be expected of toddlers. They are growing rapidly and developing brand-new motor skills. The body has to train muscular control and learn how to process signals properly. While seeing scrapes on your precious child can be difficult (and holding him while he cries out hurt can be heart wrenching), not every bump is a cause for concern.
During growth spurts, coordination may seem to deteriorate briefly when your child is getting used to the growing body, while the brain is still judging and acting based on a smaller body it had before the growth spurt. The reality of the (slightly!) bigger body means each step is not the same — and a tumble may happen. That is perfectly normal, but if his or her coordination is persistently poor, it might be time to seek help.
Take note of how the child falls down the next time you see him or her in action. If the child tends to trip on the feet or have difficulty clearing the ground and result in a fall, then their walking should be examined by a medical professional. It can be due to alignment issues, muscular tightness, certain inherent habits and/or flat feet. A podiatrist, physiotherapist or a paediatrician will be able to assess any abnormalities.