Stages of A Child’s Foot Development

People say, “children grow so fast,” and for a good reason: They do!

During our youth, humans go through a variety of different stages and reach a variety of milestones in the journey to adulthood.

When you think about child milestones, there are probably several that come to mind, such as first steps, first word, and the first day of school. Child development experts consider rolling, crawling, walking, and talking to each be important milestones for motor functions.

From a cognitive perspective—and extending a bit further into childhood than beyond the first couple of years psychologists consider there to be four key stages (sensorimotor, preoperational, concrete operational, and formal operational).

Another set of milestones many parents are interested in knowing about are ones based on how a child’s lower limbs grow. With that in mind, here is a guideline of when you can see various points of lower limb development and newfound abilities:

• At two months, the leg movements will be less jerky and instinctive and become smoother.
• Around four months, your baby may start pressing his or her legs against a chair or your lap when you hold him or her up straight.
• At six months, your child will start to put weight on the legs and may bounce up and down. Some crawling motions in the legs may begin at this stage as well.
• Most nine-month-old babies will be crawling around, sitting without support, and standing while holding on to something.
• Around your baby’s first birthday, he or she will likely be able to pull up to stand by furniture and start cruising around it.

At this point, they are ready to stand alone and take those first few unaided steps that make parents so proud.

The next few months can be rather heart-in-throat times for parents as their toddler careens around from one thing to the next, falling frequently. They will also start climbing on things, take running steps, and pull things behind them (not looking where they are going!). It’s an important stage in becoming independent, and a fun one, too.

Your two-year-old will soon be able to run, kick a ball, stand on tiptoes, climb on and off furniture, and walk up and down stairs holding on.

That’s a long way from that little helpless newborn with the thin little legs and floppy feet you welcomed into your home two years ago!

One area of foot development we’re asked about frequently is a matter of foot arches, and we need to start by saying that they aren’t typically present when a child is born.

For the parents who expect to see foot arches right away, the explanation is simply that infantile arches are obscured under normal pads of fat in the area. Additionally, arches don’t even really begin development until as late as three years of age.

Once a child is in the age range of 3 to 8 years, arches still might not be seen when a child is standing or otherwise placing body weight on his or her feet. This is also not usually a cause for concern because arches do not completely develop until around age 8.

During this time, arches that only become visible when a child stands on tiptoe or is sitting with his or her legs dangling is a condition we call “flexible flatfoot.”

With regards to foot growth, this is what you can likely expect:

• Feet can be expected to grow as much as 1.5mm in length every month between ages 1-3. (This adds up to roughly 18mm—three-quarters of an inch—per year.)
• On average, children’s feet grow 1mm in length per month between ages 3-6. (Approximately 12mm—half an inch—per year.)
• On average, children’s feet start to grow just a little less than 1mm in length monthly between ages 6-10.
• From ages 12-17, a girl’s foot will usually only grow an additional 2% in length, whereas a boy’s foot grows about an additional 10% (which can be attributed to the fact females mature at an earlier age than do males).

Of course, it’s important to keep in mind that all of these child development stages are somewhat flexible, as each child is different and grows in their own way.

Now, when it comes to child foot development and structure, there are a couple of conditions and situations often seen in young feet. Frequently, these matters can be worrisome or concerning for parents, and they include things such as:

• In-toeing/out-toeing. In these conditions, feet either point inward or outward (respectively). Feet that are pointed in an abnormal manner (either way) may seem like a big problem, but the majority of cases resolve on their own—without causing long-term issues.
• Flatfoot. As we’ve discussed, sometimes pediatric flatfoot is simply a matter of normal foot development. This isn’t usually a problem to be worried about until around the age of 8. At this time (and beyond), flat feet should be treated if they are causing pain and contributing to overpronation (excessive foot rotation with every step).
• Sever’s disease. As the leading cause of heel pain for teens and adolescents, we have plenty of experience in providing treatment for this condition. When we do, the techniques used are applied to resolve symptoms—not to “fix the problem.” The reason for this is that Sever’s is a type of growing pain and will usually resolve over time—without long-term issues—as the lower limbs develop into physical maturity.

Depending on the nature of the case, sometimes it’s simply best to monitor the situation. In the event you are unable to help your child find relief from painful symptoms with at-home care (rest, ice, OTC medications, etc.) or there is severe pain, contact our office at the earliest possible opportunity.

We have professional treatment options that can help your child find relief and get back to favorite activities at the earliest opportunity.

Some other common problems we see in children’s lower limbs—ones that are not caused by structural or developmental issues—include:

• Sports injuries. Many children are active and participate in sports. This is fantastic in a variety of ways—but sports always have at least a certain degree of injury risk. That’s especially true for feet and ankles (given the role they usually play in athletic activities). Fortunately, first aid and plenty of rest can help with many common sports injuries. Ones that are more severe, however, may require professional care.
• Plantar warts. Warts are caused by a fairly common virus—HPV (human papillomavirus). The viral strands are found in many places and are easily transmitted from person to person. Not all HPV strands—there are hundreds of them—cause warts, but some do, and children can be quick to contract them. Wart removal kits bought off the shelf are typically ineffective (and potentially dangerous). A better idea is to bring your son or daughter in for professional wart removal services at our office!
• Ingrown toenails. As with these other issues, ingrown toenails are not exclusive to children. When a child does have a toenail become ingrown, the root cause is frequently related to either footwear that doesn’t fit correctly or improper nail trimming practices. If you aren’t sure what is entailed with correct shoe fit or how to trim toenails the right way, we’d be happy to help answer any questions you might have.

While these various conditions and their respective treatments are different, they do share some common signs that show parents there’s a problem to be resolved. These include things like:

• Pain, swelling, and redness that does not subside, especially if these symptoms worsen with activity
• Development of thick calluses in one area of the foot, as this can indicate a biomechanical problem causing too much force to be placed in that area
• Problems with your child’s gait pattern (how he or she walks)
• Ankles that are weak or easily give out
• Shins or thighbones that appear to turn inward

Checking with your child—and observing his or her feet, ankles, and legs—goes a long way towards catching problems at their earliest, most treatable stages. And this means it’s important you do your best to stay vigilant in this area.

For more information on child foot care, or to request an appointment with our Gilbert, AZ office (in case your son or daughter is suffering from a lower limb problem), simply contact Pediatric Foot & Ankle today by calling (480) 497-3946, or contact us.