Paediatric podiatry

From the very first years of life, as a sensory-motor organ the foot works in synergy with the rest of the body to guarantee stability and movement; it is therefore necessary to give it the right degree of attention to avoid or limit the onset of problems in adulthood.

Podologia pediatrica

In this regard, consulting a podologist as early as infancy is highly recommended, as the doctor can assess the child’s growth and postural changes to avoid having any problems with this important structure that could cause defects in walking.

For children, feet are above all an instrument for understanding terrain and a source of information for the ability to balance and walk; it is essential that the child independently chooses when and how he or she will walk after crawling, especially to be able to identify any walking defects.

It is also advisable to allow children to walk barefoot at home or, even better, on grassy or sandy ground as an exercise to strengthen the sole of the foot, train the muscles of the legs and learn balance.

In fact, children’s feet are constantly evolving structures; often the defects that appear are simple behaviours that will correct themselves without any aid. However, in order to distinguish natural and physiological behaviours, it is advisable to consult a paediatric podologist from 3-4 years of age, at which time children pass from hyperlaxity to the formation of the plantar arch as a stable structure.

Indeed, all children have a hyperlaxity that their parents can easily confuse for flat feet; this is usually the first question parents ask podologists at their first appointment. The parents must remember that at birth a child has only 50% of their ossified skeleton and, consequently, the feet are constantly evolving.

Already from the first year of age, after learning to crawl children move on to find their unstable balance, despite the apparent absence of an arch. It is therefore necessary to stimulate the child for correct placement.

After 3-4 years of age, regardless of whether a child demonstrates incorrect behaviours regarding the feet, a podologist appointment is advisable to together evaluate the most suitable shoes for the child (bringing the footwear worn to assess deformity and wear) and any orthotic insoles to combine with functional recovery exercises such as walking on uneven ground, walking on toes or on heels, walking on the outer edge of the foot or picking up items with toes. Periodic check-ups are also recommended.

Another pathology after flat feet or the assumption of the same that is often referred to during a first appointment is pes cavus, to be distinguished however from any pathological forms diagnosed at birth. This is a malformation of the arch that causes the foot to rest mainly on the heel and forefoot, contracting the muscles of the leg and foot. These children often wear down their shoes on the outer edges and report pain in the forefoot or leg or fatigue during motor activities. The podologist can achieve a functional improvement with custom orthotics and stretching, with relative periodic check-ups.

It is essential for parents to observe the wear and tear of shoes from their children’s very first steps, to keep the postural behaviours of the child under control to avoid postural and podological problems deriving from sitting incorrectly, as well as any diseases caused by incorrect or precocious crawling or scoliosis, examine the children’s feet when their legs are dangling, let them carry out regular motor activity and consult a specialist for advice on any doubts.

The choice of shoe is also fundamental, as it must allow the right movements, have a flexible sole, adequate length (there should be about a finger’s width of space in front of the big toe to allow the foot to slide forward while walking) and a solid and resistant counter which does not exceed the height of the malleoli. A separate chapter could be dedicated to other motives for a podologist appointment such as ingrown nails, plantar warts and onychomycosis, which often afflict children as much as adults and can be avoided with correct footwear and daily attention.

Why then go to the podologist?

The podologist teaches children about toenails and possible diseases that may arise (warts, ingrown toenails, flat feet, pes cavus or congenital clubfeet). Periodic check-ups with the podologist and collaboration with the parents can highlight defects and conditions to act on with immediate treatments or appointments in collaboration with other specialists… and always remember that the best exercise is always walking!

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