• Rebecca 'Bec' Bacusmo

Paediatric Lower Limbs: Flat Feet, Curly Toes or Toes Walking

Are you concerned that your child has flat feet, curly toes or has developed some toe walking?


These are all common concerns that are presented to health professionals. However it is important to note that for most of these are considered "normal" and are part of development in a growing child!


Your paediatric physiotherapist can help you see if your child needs treatment, exercises or supports, or a referral to a doctor.


FLAT FEET


You might notice your child has a flat foot, without an arch, when they stand.


Flat feet is common in nearly all infants under 4 years due to the fat pad in the infant foot.

An arch is still observed when the child takes their foot off the ground or when they go on their tippy-toes, this is known as a "flexible flat foot".

By age 6, most children will have developed an arch in standing. However this is not always the case and children can have flat feet through to adulthood.


Image description: Infant standing on concrete floor, lower legs exposed illustrating flat foot during standing.


The Royal Children's Hospital reports that flexible flat feet do not require treatment, unless:

  • Child complains of pain

  • Limits the ability for child to participate in daily activities

  • Affects only one side

  • Arches does not re-form during standing or on tip-toes

Your paediatric physiotherapist can help with this assessment and will refer on to a medical team if needed.


Image Description: Illustration demonstrating a) flexible flat foot b) arch reformation on tippy toes c) arch reformation when foot off ground



CURLY TOES

Curly Toes is when some of a child's toes curl inwards during standing.

The most commonly affected toes are the 3rd and 4th toe and occurs at the early stages of walking. The toes are usually able to be fully straightened and improves without the need of treatment.

The Royal Children's Hospital advises to seek medical advice if:

  • Affects ability of child to participate in activities

  • Child complains of pain

  • Toes are unable to be straightened out

  • Changes to the nail bed (flattening or thickening)

  • Unable to tolerate shoes

  • Persistent blisters on toes

Image Description: Infant in mid-step, exposed ankles and feet on floor boards. Infants toes curled inwards.


TOE WALKING

Toe walking is commonly seen in beginner walkers, it occurs intermittently and is usually also seen with a flat foot during standing.


Toe walking is normally seen in both feet and often resolves as the child grows, however this can range between 4 to 10 years of age.


Image Description: Infant standing on high toes on floor with red lego block to left and blue lego block to right


Seek paediatric physiotherapy advice if:

  • Toe walking is persistent (child ALWAYS on toes)

  • Affects one side only

  • You notice changes in foot posture

  • Your child start toe walking AFTER they have already learnt to walk

Your paediatric physiotherapist can help with this assessment and will refer on to a medical team if needed.

There are multiple body systems involved in an assessment of toe walking, including sensory, neuromotor and musculoskeletal. Identifying the source(s) of toe walking is important to develop an effective treatment plan.


At Splash Physiotherapy:

We regularly assess and monitor the lower limbs of all the children we work with, educate and discuss findings with our families.


We observe how you child walks, runs and moves, assess their position in standing and laying and measure range of movement of each joint of the lower limbs. These measurements are then compared against "normative" values and checked if they fall within expected age range. We provide referrals to GP's and other health care professionals if required and work together with your team to deliver the best possible outcome for your child.



References:

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/FLAT-FEET.pdf

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/CURLY-TOES-RCH.pdf

Jones, Stanley & Knadehar, Sumukh. (2013). Normal Variants of the Lower Limbs in Paediatric Orthopaedics. International Journal of Clinical Medicine

Graham HK. In Broughton Ed's. Paediatric Orthopaedics 1997 Chapter 14 Normal Variants

Staheli L., 2006 Practice of paediatric orthopaedics 2nd ed. Lippincott Williams & Wilkins. Philadelphia


Image References:

https://surestep.net/blog/flat-feet-kids-problems-causes-treatment/

http://www.yourpodiatrist.com.au/condition/curly-toes/

https://epidemicanswers.org/symptoms_and_diagnoses/toe-walking/


This advice is general in nature. Please consider if it is right for you, and speak to your physiotherapist or paediatrician if you have any concerns.


Rebecca Bacusmo is a Splash physiotherapist working with children and young adults in aquatic, land and telehealth physiotherapy. She is passionate about helping children learn and develop functional skills to assist them in participating in meaningful activities in everyday daily life at home, school and their communities. Rebecca has daily aquatic sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne, combined with daily home, school and Telehealth sessions and sports and recreation intensives over the school holidays.



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