Children’s foot health: common problems and when to see a podiatrist

How children’s feet develop

A baby’s foot is soft and partly made of cartilage. The bones harden gradually through childhood, and the growth plates, the areas near the ends of bones where growth happens, don’t finish until the teenage years. That’s why children’s feet look and move differently from adult feet, and why many things that would be a problem in an adult are normal in a child.

Most children take their first steps between about 9 and 18 months. Early walking is wide-legged, flat-footed and a little unsteady, and a heel-to-toe walk develops over the next couple of years. Walking barefoot at home, on safe surfaces, helps children build strength and balance.

What’s usually normal, and what’s worth a checkup

At any age, a child who stops doing something they could do before, such as walking flat-footed, running or climbing stairs, should see their pediatrician promptly.

Flat feet in children

Babies and toddlers almost always look flat-footed. A pad of fat fills the arch, their ligaments are loose, and the arch develops gradually through childhood. Many children keep flexible flat feet into adulthood without any trouble.

A flexible flat foot is flat when your child stands but shows an arch when they sit or rise onto their toes. If it doesn’t hurt, it doesn’t need treatment, at any age. Studies have found that special shoes and inserts don’t change how a child’s arch develops, and flexible flat feet don’t generally hold children back in sport. Inserts can still help a child whose feet ache.

Have flat feet checked if your child has:

• foot, ankle or leg pain, or tires much sooner than other children
• a limp, or avoids running and sports
• a stiff foot, or an arch that doesn’t appear on tiptoe
• a flat foot on one side only
• repeated ankle sprains

In older children and teens, a painful, stiff flat foot can be a sign of a tarsal coalition, where two bones in the back of the foot are joined by bone or tough tissue. Our guide to flat feet explains the tiptoe test and treatment in more detail.

In-toeing (pigeon toes)

In-toeing means the feet point inward when your child walks. It’s one of the most common reasons parents bring a child to a doctor, and it almost always improves on its own. There are three usual causes, and each shows up at a typical age:

• Curved feet (metatarsus adductus) in babies: the front half of the foot curves inward. Most improve over the first 4 to 6 months of life. A stiff foot that can’t be gently straightened may need stretching or casting.
• Twisted shin bone (internal tibial torsion) in toddlers: the shin bone twists inward, often more noticeable when a child starts walking. It almost always improves on its own, usually before school age.
• Twisted thigh bone (femoral anteversion) in young children: the whole leg turns in from the hip, and it’s most obvious around age 5 or 6. Children with it often like to sit in a “W” position. It usually improves gradually as they grow.

Special shoes, braces, night splints and exercises don’t correct in-toeing. Children who in-toe may trip a little more at first, but most run and play normally, and in-toeing on its own doesn’t cause pain or arthritis. Surgery is rarely needed, and only for severe cases that are still causing problems at around 8 to 10 years old.

Get in-toeing checked if it causes pain, swelling or a limp, affects one side only, is getting worse, or your baby’s foot is stiff.

Out-toeing

Out-toeing means the feet point outward. Babies often turn their feet out because of how they were positioned in the womb, and this usually settles within the first year or two of walking. In older children, out-toeing can come from an outward twist of the shin bone or from flat feet.

One pattern needs prompt attention: a new limp with pain in the hip, thigh or knee in an older child or teen, especially if one foot turns out. It can be a sign of a slipped growth plate at the top of the thigh bone (slipped capital femoral epiphysis), which is most common between about 10 and 16 years old. Get it checked the same day, and keep your child off the leg until then.

Toe walking

Walking on tiptoes is common while toddlers are learning to walk. Many children who keep doing it out of habit, with no underlying cause, grow out of it gradually.

Have toe walking checked if:

• it continues most of the time past about age 2 or 3
• it happens on one side only
• your child can’t stand with their heels flat on the floor, which suggests a tight calf or Achilles tendon
• it starts after your child had been walking normally
• your child also seems clumsy, weak, delayed in other skills or is losing skills

A doctor will check how far the ankles bend and look for signs of a nerve or muscle condition. Treatment, if it’s needed, starts with calf stretches and physical therapy. Night splints or a series of stretching casts can help a tight calf, and surgery to lengthen the tendon is reserved for children who don’t improve.

Heel pain in children: Sever’s disease

Sever’s disease, also called calcaneal apophysitis, is the most common cause of heel pain in active children, usually between about 8 and 14 years old. Despite the name, it isn’t a disease. It’s irritation of the growth plate at the back of the heel, where the Achilles tendon pulls on it. It often flares during growth spurts, when bones grow faster than muscles and tendons can stretch.

Signs of Sever’s disease:

• pain at the back or bottom of the heel during or after running and jumping
• limping or walking on tiptoes after sport
• pain when you squeeze the sides of the heel
• one or both heels affected

It’s common in soccer, basketball, gymnastics, track and other sports with lots of running and jumping, especially in cleats with little heel cushioning.

What helps:

1. Cut back on running and jumping until the pain settles. Your child can usually stay active with swimming or cycling.
2. Ice the heel for 15 to 20 minutes after activity, with a cloth between the ice and the skin.
3. Stretch the calves every day. Tight calves pull harder on the growth plate.
4. Use cushioned heel cups or heel lifts in sports shoes and cleats, and avoid going barefoot on hard floors while it hurts.
5. Try an over-the-counter pain reliever such as ibuprofen or acetaminophen if needed, dosed for your child’s weight as the label says.

Most flares settle within a few weeks to a couple of months. It can come back during growth spurts, but it goes away for good once the growth plate fuses, usually in the early to mid teens, and it doesn’t cause lasting damage.

Get heel pain checked if it doesn’t improve after 2 weeks of rest, wakes your child at night, is there even at rest, or comes with swelling, redness, a fever or a limp that doesn’t go away. These can point to other causes, such as a stress fracture or an infection. Learn about sports medicine at Evolve Health.

Leg pains at night (growing pains)

Growing pains are aching or throbbing in both legs, usually the thighs, calves or behind the knees, in the evening or at night. They’re common between about 3 and 12 years old, and your child is fine in the morning and runs and plays normally. Gentle massage and warmth usually help.

See your pediatrician if the pain is in one leg only, is in a joint, is still there in the morning, causes a limp, or comes with swelling, redness, a fever, a rash or weight loss.

Ingrown toenails

Ingrown toenails are common in older children and teens. The edge of the nail grows into the skin, making the side of the toe red, swollen and sore. Cutting nails too short or rounding the corners, tight shoes, sweaty feet and stubbed toes all make them more likely.

• For mild redness, soak the foot in warm water for 10 to 15 minutes a few times a day, dry it well and keep it clean.
• Use roomy shoes or sandals until it settles.
• Don’t dig out or cut the corner of the nail. It usually makes things worse.
• Teach your child to cut toenails straight across, level with the tip of the toe.

See a podiatrist if there’s pus, spreading redness or a lot of pain, or if it keeps coming back. A podiatrist can numb the toe and remove the ingrown edge of the nail in the office. See our guide to ingrown toenail treatment.

Plantar warts

Plantar warts are rough, hard growths on the soles of the feet, often with tiny black dots. They’re caused by a common skin virus and spread easily on damp floors, such as pool decks, showers and locker rooms. They’re common in school-age children and teens.

Many warts in children go away on their own within a year or two, so a painless wart can simply be watched. Over-the-counter salicylic acid can help older children, if you follow the label and protect the skin around the wart. Don’t use wart products at home on a child with diabetes; see a podiatrist instead. Flip-flops in shared showers and pool areas help prevent them.

See a podiatrist if a wart is painful, spreading or bleeding, if home treatment hasn’t worked after a few months, or if you’re not sure it’s a wart. Our plantar warts guide covers treatment options.

Athlete’s foot and sweaty feet

Athlete’s foot is a fungal infection that causes itching, redness and peeling, often between the toes. It’s more common in teens than in young children, especially athletes with sweaty feet.

• Wash and dry feet every day, especially between the toes.
• Change socks daily, or more often if they get sweaty.
• Rotate shoes so each pair dries out.
• Wear flip-flops in shared showers and locker rooms, and don’t share shoes or towels.

An over-the-counter antifungal cream usually clears it. Check the label for the age it’s approved for, and see a doctor if it doesn’t improve within 2 weeks. Our guide to athlete’s foot creams explains the options.

Foot and ankle injuries in children

Children are always on the move, so sprains, bruises and stubbed toes are common. Their growth plates are weaker than the ligaments around them, so an injury that looks like a sprain can sometimes involve a growth plate or a small break.

Have an injury checked if your child can’t put weight on the foot, won’t walk normally after a day or two, has swelling or bruising that’s getting worse, or has pain when you press on a bone. Our guide to telling a fracture from a sprain can help, and Evolve Health podiatrists treat sprains and fractures with digital X-ray on site.

Choosing shoes for children

Babies and new walkers

Babies who aren’t walking yet don’t need shoes. Soft socks or booties keep their feet warm. Once your child walks outdoors, choose a lightweight shoe with a flexible, non-slip sole. At home, barefoot is best on safe surfaces.

How to check the fit

1. Shop late in the day, when feet are largest, and bring the socks your child usually wears.
2. Measure both feet every time. They’re often slightly different sizes, so fit the larger one.
3. Check the length with your child standing: about a thumb’s width, roughly half an inch, between the longest toe and the end of the shoe.
4. Check the width. The widest part of the foot should sit at the widest part of the shoe, with room to wiggle the toes.
5. Check the heel. It should fit snugly without slipping when your child walks.
6. Check the shoe. It should bend at the toes, not in the middle, and have a firm back around the heel.
7. Skip the break-in. Shoes should feel comfortable in the store.

Children’s feet grow quickly, sometimes a size in a few months during growth spurts, so check the fit every few months. Red marks, blisters or a child who keeps taking their shoes off are signs they’re too small.

Hand-me-down shoes

Passing on shoes is tempting, but worn shoes take on the shape of the first child’s feet. Hand-me-downs are fine if they’re in good condition, fit well and aren’t worn down unevenly. Sports shoes and cleats that get heavy use are best bought new.

When to see a doctor or podiatrist

Go to the emergency room if your child has an injury with an obvious deformity, a bone through the skin, or a foot that turns cold, pale or blue.

Get seen the same day if:

• your child can’t put weight on the foot after an injury
• a foot, ankle or joint is red, hot and swollen, especially with a fever
• an older child or teen has a new limp with hip, thigh or knee pain
• an ingrown toenail has spreading redness, red streaks or a fever
• your child has diabetes and a new wound, blister or color change on the foot

Book a visit if:

• foot or heel pain lasts more than a week or two, wakes your child at night, or keeps them out of play
• your child limps, or tires much sooner than other children
• a foot is stiff, or something is different on one side only
• flat feet hurt, or in-toeing is getting worse
• toe walking continues past about age 2 or 3
• an ingrown toenail keeps coming back, or a wart is painful or spreading

See your pediatrician promptly if your child is losing skills they had, such as walking flat-footed, running or climbing stairs, or seems to be getting weaker.

What a podiatrist can do

A podiatrist will ask about your child’s symptoms and activities, examine both feet and legs, watch your child walk and run, and look at their shoes. An X-ray is needed only for some problems, such as a possible fracture or a stiff, painful flat foot.

Many children simply need reassurance that their feet are developing normally. When treatment is needed, it usually starts simply: stretches, shoe changes, heel cups or inserts for aching feet, and care for nails and skin. An Evolve Health podiatrist can examine your child’s feet, check how they’re developing and recommend treatment if it’s needed, so your child can stay active and comfortable. You can find a podiatrist near you and book online.