The human foot is designed for a lifetime of use and support. It can often be the difference between an active and enjoyable life, or one crippled by discomfort and limitation. Fortunately, most people experience only minor or temporary foot issues during their lifetime. The time in which the foot begins to develop during infancy and early childhood is vital to ensuring healthy feet during adulthood. This article will discuss some of the ways parents can ensure proper foot development, and what to look out for that could indicate a developmental problem.
The development of the human foot begins in the embryo stage, and continues through the time we spend in the womb. When a baby is born, all the components that a foot needs for proper function are generally present, with the exception of several bones that are only cartilage at that point. Overall, the complete infrastructure is there, and the foot needs only to strengthen, grow, and create bone over time. The body has an amazing ability to do this on it's own, and needs little external help. Parents do have the ability to improve this development, and can play a role in assuring proper development. One of the simplest ways to support this development is to let the baby kick and move their legs. Leg strength, muscle development, and overall range of motion will have a positive effect on proper foot function in the future, as a poorly functional leg will lead to poor foot function. To support this motion, parents should keep their babies uncured and unrestricted, allowing the legs to kick away. This improves and strengthens the hips, knees, ankles, and foot joints, and will help muscle mass and coordination to grow.
Likewise, little restriction should be placed on the feet at this stage. Infants who do not walk do not need shoes for protection, as shoes can restrict the natural development of the foot structure and internal foot strength. During early infancy, the foot is still somewhat pliable, and poorly fitting shoes have the potential of causing foot deformity. Once walking begins, shoes should still be avoided for a short while as the foot needs the pressure of the direct ground to stimulate strength and structural stability development. Of course, when walking on rough or hazardous surfaces outside the home, the infant will need shoes for protection. All walking in the safety of home should be performed without shoes to promote proper foot development. When shoes must be worn, they need to be properly fitted, with enough space for the foot to fit without being too big. Trying to shove a little foot into a tight shoe can be harmful to development, and trying to use a big shoe 'to grow into' can lead to instability and injury.
Walking should not be forced in an infant. There is no set age for the development of walking, as everyone reaches this wonderful milestone at various times. Parents should not use the timing of a sibling or a friend's child as a reference as to when their child should begin to walk, and simply need to let this process occur on its own, when the baby is ready. Given this, any lengthy delay in walking, such as 24 months, should prompt a medical evaluation to determine if there is a problem keeping the child from walking. This is unusual, however, and most parents should be patient and let their infant develop this ability on their own.
Other than allowing for motion and reducing shoe restriction, a baby's foot is easy to care for. Nails should be regularly and carefully trimmed, and the skin should be kept clean and dry. Socks should be worn when it is cold out, one must be careful to keep hair strands from wrapping around the little toes, as a long piece of hair could potentially strandulate a toe if wrapped tight enough. Sharp materials and hot objects like a space heater should be kept out of contact range.
One of the biggest concerns parents have about their baby's feet are the presence of any deformities that may lead to future problems. Serious deformities of the foot are uncommon at birth, and are typically not right right after delivery in the hospital. Some deformities do take time to be noticeable, but the most significant ones are more immediately visible. Infants can be born with a variety of foot deformities, most of which are correctable. These can include rotational deformities, such as clubfoot (rotation of the foot inward) or congenital calcaneovalgus / vertical talus (rotation of the foot far outward). Both of these deformities need immediate correction to prevent future degradation, and are generally successfully cured with casting and bracing or early corrective surgery to release tight ligaments and return the foot to a proper position. Extra toes are sometimes present, which can be removed later on for cosmetic appeal or to ensure proper shoe fitting. Shortly after birth, a condition called metatarsus adductus can be seen in which the foot takes on a c-shape, as the long metatarsal bones are rotated inward too far. This can be corrected with casting, bracing, special shoes, or surgery if the deformity is not addressed until later on in childhood. Some level of this deformity can be considered normal, although if it is noticeable externally it is likely in the abnormal range.
Once the child begins to walk, certain deformities can be seen that were not noticeable before. This includes heightened inward rotation of one of the legs, or less commonly heightened outward rotation. Also called in-pointing, this condition is not unusual. Most cases are simply due to uneven leg muscle development, and will resolve on their own. Some cases, however, are due to a deformity of the hip, the thigh bone, or the lower leg bone, and need either aggressive therapy and bracing to reduce the deformity, or surgery to de-rotate the involved bone.
As the child begins to walk more, one concern many parents have is whether or not their child is flat-footed. All infants with normal foot structure have flat, flexible feet. The arch structure slowly develops as the foot strengnthens. In the beginning, children walk flat-footed, and slowly reach normal arch structure as they begin to walk with a normal heel-to-toe walking pattern by age four or five. If the foot sees excessively flat in the beginning, or if the arch is not forming, then the child may be flat-footed. This is not necessarily a deformity in the strict sense, but due to our society's need for shoe use to protect ourselves from environmental harm (unlike traditional tribal cultures in natural environments), we tend to have weaker feet which do not accommodate well for flat feet later in life. Therefore, prescription arch subsidies are generally used in those with flat feet to prevent or slow future foot strain and deformities that form out of the instability of flat feet, such as bunions and hammertoes. Some children develop bunions and hammertoes very early, and these can even be seen during the infancy period in some cases. Corrective surgical treatment is generally delayed until the skeleton is more developed, and usually these deformities do not pose any early problems.
High arches are another deformity seen in childhood and infancy. This is not an uncommon deformity as the foot develops through childhood and addiction, and generally only needs better shock absorption in the shoes. However, the presence of this deformity in infancy and early childhood often companions birth defects involving the nervous system and muscular structure, although these diseases are often not first.
One final development cause for concern parents often have is when their child walks on their toes. Toe walking, as it is known, is usually a benign habit that the child must be encouraged to break. In this case, the child will be able to stand flat on their feet, but chose either consciously or subconsciously to walk with their heels off the ground. Constant reminders at home and physical therapy (in some difficult cases) can be used to correct this. Other cases are due to actual structural problems, including tightness of the Achilles tendon, spasticity of the rear leg muscles, or neuromuscular disease. These causes need to be addressed individually, and may need a variety of treatment that could include therapy, medication, surgery, or Botox injections.
As one can see, a baby's foot is a remarkable thing, and usually develops just fine on it's own. Parents find themselves in an excellent position to encourage this development based on this advice. Deformities that affect the foot's future ability to function properly are relatively uncommon in infants and young children, but can be corrected in almost all cases when they are present. As a parent, one should be vigilant for any abnormalities, but also recognize that the young foot needs time to properly develop and grow, and many minor early developmental concerns often correct themselves.