Story by: Jesse Moreton, BSc DC

As with many of my previous articles, the idea for this month’s topic stems from experiences I’ve had in practice.

Recently I’ve been approached by some parents with concerns about their children’s feet. I suspect there are other parents who have similar concerns.

Foot biomechanics are different in kids than in adults and thus their feet have to be treated differently.

It doesn’t take much observation to see that kids’ feet both appear and are used differently. As toddlers begin to “toddle,” they waddle under a wide base of support. Their legs are angled outward and their feet are flat.

Over time, arches develop and walking starts to become more adult-like.

The most common problems with kids are persisting flat feet and in-toeing. Parents should be reassured that having flat feet is normal. The main arch of the foot does not fully develop until six to 10 years of age. Orthotics should not be considered until at least age 6 as the foot is still undergoing development.

Some studies have shown that going barefoot actually reduces the incidence of having flat feet as an adult. The idea is that the foot needs motion and muscle activation for proper arch formation. When the foot is braced with rigid shoes, the foot loses motion and the muscles are inhibited.

If flat feet persist past six years of age, a flexible orthotic may provide benefit. Orthotics would especially be indicated if the child is athletic. Orthotics would support the arch and improve walking and running performance.

In-toeing is another common observation in kids. Many treatment options exist. None of them have been shown to be very effective. These include shoe modifications and exercising specific muscles. The best option is to have good shoes.

So what’s a good shoe? First and foremost, a child’s shoe should have a flexible sole. This allows for the mobility and muscle activation needed for good arch formation. The sole should also be non-slip.

There needs to be enough room for the toes and forefoot, and the upper part of the shoe should be light and breathable. Raised heels should be avoided. Whether the shoe has princesses on it or not should be the last consideration. (Try telling that to a four-year-old girl.)

In summary, let kids run around in bare feet as much as possible. When shoes are needed (as is often the case when going out), follow the guidelines listed above. If you notice persistent flat feet, in-toeing or other problems past six years of age, it’s time to bring them in for a checkup.