Abnormal walking pattern (including toe walking, flat feet)
Children develop the muscles and position of their feet by using their feet more and more. Babies first have to get used to the feel of the floor against the soles of their feet. In the beginning, the feet are not at all "set up" to stand and bear weight. Once children start standing, they develop the shape and position of their feet. As the foot muscles get stronger, they gain better and better ankle stability. They can then better balance and unwind their feet. They need this to start walking and running. Especially in later life, this is necessary to function properly. In some children, this development is different from normal or sub-optimal. Signs for this may include:
- Flat feet: The foot is sagging, there is no obvious arch of the foot (pes planus). The foot may also be tilted inwards (valgus position). Pain and/or fatigue symptoms may occur in various places after prolonged walking and standing. If necessary, the foot position can be corrected with orthotics (inlays). Usually, the use of these orthotics is temporary and the foot position recovers. The paediatric physiotherapist, in collaboration with the podiatrist, will assess whether this is necessary (https://www.voetcentrumeindhoven.nl/.
- Heel feet: There is an elevated foot arch.
- Toe-walking: Children who toe walk do not wrap their feet properly while walking, they do not put the heel on the ground but the forefoot and toes. Many young children who start loose walking still walk on their toes. As they get older (and heavier), toe-walking normally disappears. There are several causes of toe walking and 2 types can be distinguished: idiopathic (with no known cause) and symptomatic (with a known cause) toe walkers. Toe-walking may have become a habit of a child (habitual toe-walker). They enjoy walking on their toes. In particular, children with autism or AD(H)D tend to walk on toes for longer periods of time. However, children without these conditions can also enjoy walking on their toes. Children who walk on their toes for long periods can develop pain in the foot, ankle or lower leg due to shortening of the Achilles tendons and calf muscles, among other things. Advice and exercise therapy can be useful in these cases. If necessary, the paediatric physiotherapist will consult with the paediatric orthopaedist about possible additional treatment.
- Walking with feet turned inwards: Some children walk with their feet turned inwards (Toeing in). These children may trip more often and pain may occur in the feet or knees, among others.
- Ankle instability: If children considerably twist their ankles, this is called inversion trauma (ankle distortion). There may then be considerable swelling. After inversion trauma, there may be permanent ankle instability, with children falling/stumbling more frequently or twisting their ankles again, resulting in pain.
The normal development of the child's foot
0 to 1.5 years
When a child is just starting to walk, there is still a layer of fat under the foot that fills the arch of the foot. Therefore, no arch of the foot is visible. The legs are in O-position and the feet are turned outwards, for more stability.
2 to 3 years
Around the second year of life, the O-position of the legs changes to an X-position of the legs, but the child still has flat feet. Baby fat disappears under the feet. Until the fourth year of life, it is normal for a child to stumble a lot; learning to walk involves trial and error.
5 to 8 years
From the fifth year of life, the X-position of the feet will slowly decrease. When your child is 7-8 years old, the legs and feet should be straight. The feet are still flat until the fifth year of life, from which time a foot arch can be seen. It may be that your child's feet and/or big toes are somewhat inward, this usually resolves itself before the age of 12. However, if this causes symptoms or causes excessive falling and tripping, it makes sense to have this checked.
When to make an appointment
In the following cases, it is wise to make an appointment with a doctor or paediatric physiotherapist:
- When falling or tripping excessively
- Unable or unwilling to walk for long periods of time
- Fatigue in the feet or legs
- Abnormal or crooked position of the toes
- Pain in the feet, ankle, knees or back
- Pain during sports
- If your child still has flat feet or X-legs after the age of seven
In case of an abnormal walking pattern or abnormal position of the feet or legs, we can examine and then advise parents (e.g. about shoes) and, if necessary, accompany them with (active) exercise therapy and exercises for at home. We will also refer parents for a check-up by a podiatrist if necessary. We work together with podiatrists and have a 'foot consultation hour' with them, in order to fine-tune treatment and have orthotics/inlays fitted if necessary.
As children develop in several areas, it is often necessary to take a multi-disciplinary look at the child's development. Since the arrival of Voetcentrum Eindhoven, we have opted for a combined consultation hour. It is the place for children with problems concerning the foot, the stature or a combined question where motor skills can also be mapped.
We look at it from our own knowledge and can therefore better understand and answer the child's question for help.
https://www.voetcentrumeindhoven.nl/