Looking after little feet

Are you worried about your toddler’s bandy legs or knock knees? Or flat feet, ingrown toenails, warts and other sores?

We don’t really consider our feet one of the most important parts of our bodies, but feet problems can influence your baby’s whole skeletal structure. Everything from his knees and hips to his spine’s natural curvature could be affected.

But rest assured that if your baby wasn’t born with a foot problem, there is plenty you can do to ensure he’s spared any complications later.

A design masterpiece

It’s not surprising that Leonardo da Vinci called the foot an engineering masterpiece. Consider:

• The average adult walks 18 000 steps a day – children do a lot more than that
• Every time your toddler puts his foot down on the ground as he steps, he places twice his body weight on it. When he runs, his feet carry triple his body weight
• Each foot has 26 bones, 19 muscles, over 100 ligaments, thousands of nerve endings and a complex network of veins

About 70% of all foot problems stem from wearing the wrong shoes and a lot of foot problems start in childhood.

If the shoe fits

It’s not a question of “if” the shoe fits, but making sure it does because your toddler’s developing feet don’t have much bone in them yet.

Developing feet

At birth there are only small specks of bone growth points in 3 of the foot’s bones – the rest is soft tissue and cartilage. The cartilage can take up to 21 years to mature into the 26 bones in an adult’s foot.

This makes baby feet particularly vulnerable to the pressure exerted by wrong or ill-fitting shoes.

And don’t think your baby will complain if his shoes are uncomfortable or hurt him. The cartilage is more pliable than bone, so he probably won’t notice but he will one day have to live with the consequences.

Just think of the deformed feet of Chinese women who had them bound as children. That’s how fragile and pliable a child’s foot is!

The importance of shoes

Shoes are important because your baby’s feet carry his whole body weight. When he’s standing still, his heels carry 50% of his body weight, the joints of his big toes carry 25% and the other 25% is distributed across the balls of his feet. The widest part of your child’s foot is over his toes, so his shoes have to be shaped like a triangle, allowing enough space for the toes.

Converting European shoe sizes to South African sizes:

• 18 – 0
• 19 – 1
• 20 – 2
• 21 – 3
• 22 – 4
• 23 – 5
• 24 – 6
• 25 – 7
• 26 – 8
• 27 – 9
• 28 – 10
• 29 – 11
• 30 – 12
• 31 – 13
• 32 – 1
• 33 – 2
• 34 – 3
• 35 – 4

Choose shoes for healthy feet

The South African Podiatry Society compiled these guidelines for children’s shoes:

• Length: The shoe should be 1.2 to 1.6cm longer than your baby’s foot (there must be space of at least an adult’s finger width in front of your baby’s longest toe)
• Width: You must be able to pinch a small fold of the front part of the shoe between your thumb and forefinger when the shoe is on your baby’s foot
• Heel height: 0 – 6mm for toddlers and no more than 15mm for older children
• Heel shoes: Without heels are the best but if you want to buy heeled shoes for your little girl, choose a wide heel, made of shock-absorbing material
• Shape: The front of the shoe should be shaped to fit around the toes
• Uppers: Choose natural materials like leather
• Toe room: Your child should be able to wiggle his toes comfortably in the shoes.
• Weight: Avoid heavy shoes; it places extra strain on small feet and can hinder normal development. Baby shoes shouldn’t weigh more than 30g each. Toddler shoes can weigh up to 110g and children’s shoes 260g per shoe
• Soles: have to be very flexible, especially under the ball of the foot, and made of shock-absorbing material. Because children run and jump around so much shock absorption is very important. The soles should be able to bend 55° under the ball of the foot. “It’s no use if the shoes can bend in half. That’s not where a person’s foot bends naturally. The ball of your foot stays on the ground, it’s the back part that needs to be able to bend,” says Durban podiatrist Anette Thompson.
• Avoid: Thick-soled shoes because they will inhibit your child’s movement and normal foot development.

Buying shoes

• It’s best to shop in the afternoon, when your child’s feet are a bit swollen, to prevent his getting shoes that are too tight
• Let the shop assistant measure both feet every time you buy new shoes, to ensure you get the right size
• Everyone has one foot that’s slightly larger than the other. Buy shoes that fit the larger foot comfortably
• Don’t buy shoes that are too big for your child – it could cause him to slide around in his shoes and fall
• Never buy shoes that are too small
• Don’t buy shoes with smooth soles
• Don’t buy too many shoes at a time. Your toddler’s feet will grow, on average, 2 shoe sizes per year until age 4. Rather buy shoes more often, and check every 3 months that his shoes still fit well.

Most common foot problems and solutions

Debbie Claassen, a Gauteng podiatrist, says most of her young clients battle with the following:

Ingrown toenails

“This is one of the most common problems and can easily be avoided. Follow the shape of the toe when cutting your baby’s toenails, but always leave the corners straight – don’t cut down towards the bed,” she says. She also advises parents not to cut toenails into a V shape in the middle

Warts

Can spread through water or sweat Babies and children who go to swimming lessons or those who use public pools are most at risk. “It has to be treated correctly from the start, preferably by a podiatrist or dermatologist,” says Debbie

Pigeon toes (feet that are turned in)

“It can be hereditary and could have several causes,” says Debbie. One of the causes is muscles that are too stiff. The bones in the leg could also be turned – either the femur (thigh bone) or tibia or fibula (the 2 bones between the knee and ankle).

“All of this will have a radical effect on the position of the foot, and will affect the child’s way of walking.”

Walking on tippy toes

Sometimes this is learned behaviour, especially among little girls who imagine themselves as ballerinas. But it could also be due to Achilles tendons or calf muscles that are too short. “This is usually easily rectified with physiotherapy and foot exercises,” says Debbie

Clog feet

Debbie says these cases are usually referred to orthopaedic surgeons for surgery.

How are foot problems treated?

Soft tissue and cartilage problems can be sorted out with shoe inserts or leg braces, made according to your child’s measurements.

Debbie adds, “We can also recommend foot exercises, physiotherapy and occupational therapy to rectify things like muscles that are too short. Problems with bones will need surgery, but parents can rest assured that doctors don’t take foot operations on children lightly.”

When should I see a specialist?

“It’s quite common for a 2-year-old to have bandy legs. You might also think your baby or toddler has flat feet, but all babies and toddlers have feet that are fairly flat. The more they walk, the more their foot muscles develop and the shape of their feet change,” explains Debbie.

“From the age of 4, your child may appear to have knock knees again. A child only walks properly from the age of 6 or 7, and only develops a proper foot bridge from the age of 6 to 8.

“If any foot problems influence or hinder his walking or running, or if your child has sore feet, see a podiatrist or paediatrician sooner rather than later. Both will refer you for further treatments and if necessary to an orthopaedic surgeon.”

Barefoot or not?

“Yes please and as often as possible,” says Debbie. “It’s not only important for the development of his foot muscles, it also teaches your child proprioception, which gives his brain an indication of where his foot is in space. Walking barefoot also stimulates the sensory nervous system.”

Exercises for small feet

“Any walking, jumping or running activities are good exercise,” says Anette. “We, and other experts, see more and more children with bad muscle tone these days.” Debbie adds, “Don’t think feet are exempt from bad muscle tone. The more your child plays and runs around, the better for his foot development.”

More tips to help little feet get stronger:

• Let your child write the ABC with his feet, with pointed toes. It’s good exercise for his muscles and joints
• Invest in a basketball hoop in your back yard and let him shoot hoops. “Standing on your toes like that is great exercise to strengthen the foot bridge,” explains Anette
• Jumping on a trampoline is also great exercise for feet. But always keep an eye on your child when he’s on the trampoline.

Stinky feet? Try the following:

• Allow your child to walk around barefoot more
• Avoid “takkies” in summer
• Buy cotton rather than nylon socks
• Rotate shoes and let each pair air for at least 24 hours before wearing them again.

Resources:
The SA Podiatry Association: 0861-100-249 or www.podiatrist.co.za