Children’s feet and Paediatric Biomechanics
What is normal?
Because standing and walking are things that we learn rather than things we do instinctively, and because all children and families are different; every child develops in their own, individual way. Some children walk very early, some quite late and there is a very wide range of what can be considered ‘normal’ as this takes place. When we are born our feet are not yet complete and still have a long way to go before they are finished. We are born with more bones then we end up with because as we grow, small bones fuse into single larger bones. In the foot, this process is on-going until we are around eight years old. Because of this, very young feet are incapable of form a true ‘arch’ and so can often appear to be flat, which can be perfectly normal. When problems do occur they are usually fairly easy to spot if you know what to look for.
What should I look for?
Usually, your child will let you know if something is wrong because it will hurt and they will tell you about it. A single episode of pain is usually nothing to worry about but if a pain becomes regular or consistent then there may be something wrong. Watch out for patterns; do they always complain when they have been walking for a certain distance, do they complain if you walk a certain route, do stairs seem to aggravate the pain, is there a time of day when they seem to complain more often? Pain patterns can tell us a lot about what might be going on.
If, for example, your child is fine when they are walking on a pavement but seem to have trouble or complain when walking over rough ground, it could mean their feet are a little weak and find it difficult to make constant adjustments to the changing shape and texture of the ground (this sometimes happens if they don’t spend enough time without shoes on as this can delay the development of strength in the foot muscles).
Sometimes a problem might not be painful but might cause a change in the way your child moves or behaves. If, for example, they seem to be falling over more than usual or seem to having trouble balancing during play. Often this is perfectly normal but sometimes it can be a sign that they are favouring a certain way of walking and therefore not generating an all-round fitness in their feet and legs (it is not uncommon for children to get into the habit of walking up on their toes which means they are not using all of their foot and thus not ‘gathering enough information’ about the ground, in this situation the body can’t make quick adjustments to the foot and therefore balance can appear to be a problem).
At other times it can look like there is a problem, but everything seems to be normal and nothing hurts. Often shoe-shops are the first people to raise concerns about potential problems or relatives that don’t see your child very regularly can see something that may have happened quite gradually and therefore gone unnoticed. Usually this involves one side behaving differently from the other side (as in a very mild left sided limp) or looking different compared to the other side (one foot might appear slightly flat and the other side normal). This too can be very common and is often perfectly normal, it is when the difference seems to be causing a problem that it might need addressing.
Why do things go wrong?
The study of children’s medicine is a huge field both in general practice and in Podiatry. There are as many reasons for problems as problems themselves but some things can be talked about in general terms:
Developmental Problems
These are probably the most common set of problems and most of them are transient. Because each child develops at a different speed and in different ways, sometimes if your child stands out from their piers it can be quite a worry but often it is just because they are taking their time. Some people, for example, can never hop on one leg; some can from a very young age, some not until they are ten. Some people can hop on either foot, some people on only one. It is just one of those individual things.
Other types of developmental problems relate to the different type of tissues our body is made from. Bone, for example, can grow up to three times more quickly then muscle does; so if you have a growth spurt and your leg bones shoot out, it will take time for your muscle to catch-up and where the muscle attaches to the bone (usually near a joint) it can become sore due to the extra tension. This is probably the most common cause of ‘growing pains.’ Children that have growth spurts can be particularly prone to these sorts of problems.
Depending on how old your child is, this is also important. During adolescence, for example, bones become denser and heavier as well as longer. If this happens quickly over a relatively short period of time, it is a difficult thing to live with. Teenagers that ‘gangle’ or bounce on their toes with their arms hanging limply at their sides are often going through such a phase.
These sorts of issues are not usually a problem until they start to cause other problems. If the pain from muscle tightness becomes too uncomfortable then treatment is indicated in order to make them more comfortable. The only way to know for sure whether this is required is to have them checked by your GP or a specialist Podiatrist or Physiotherapist.
Activity Problems
These days, problems caused by activities can broadly be split into two groups. Children that do too much and those that don’t do enough; which type you have is usually fairly obvious.
At any age, the body will become conditioned, or ‘best at,’ whatever it does most often. Just like a musician practicing their instrument, the more hours they spend at it, the better and stronger a performer they become. In the same way, if a child spend several hours a week playing football and only a few minutes a day walking; their body will be ‘best at’ running an therefore walking can become problematic. When we run we don’t use as many muscles as when we walk, so when ‘runny children’ try to walk it can quickly become uncomfortable as their running muscles can’t balance out with their walking muscle. This usually manifests in them running around whilst you are walking or moaning that they are tired much sooner than you might expect (it doesn’t always seem to make sense why a child that can run for several hours gets tired after walking around just a few shops; boredom aside, it is sometimes because of this).
At the other end of the scale are those children that don’t do enough. What ‘enough’ actually is, is an impossible question to answer; but all children should perform some level of continuous walking activity during the day. Those that spend too long sitting in front of computer screens or televisions become ‘best at’ sitting still and their fitness quickly deteriorates. This can manifest in many ways including weight-gain, poor fitness, difficulty keeping-up with their piers and generally being uncomfortable within themselves. When trying to help an unfit child to get healthier, it can sometimes be useful to have a Biomechanical assessment in order to see if there are any ways to make exercise more comfortable and therefore more appealing.
Then there are the activities of the people around them. This, again, is a broad point but children as part of a family respond to the ways in which their parents and siblings move. For example, some parents walk quite quickly and in order for their child to keep up they might have to take three steps for every one of their parents’ steps. This will mean they have to run. In other instances they may have grown up as the youngest of three children and sometimes this means that they will achieve their growth ‘milestones’ much more quickly as they are stimulated by people closer to their own age and size.
Development is about balance and as long as a good range of regular, steady activity is undertaken, problems are easy to avoid. If a problem is already there, however, a short course of treatment can often put things right.
Structural or Hereditary Problems
These are problems caused by the way an individual’s body can develop, when there is an issue that is handed down through the generations. These problems are very common but quite often what the family will think of as the problem is actually the final stages of the problem. Because people don’t tend to be screened, or checked for problems, nothing is seen in it’s early stages. It might be known, for example, that in a family everyone develops a bad hip when they get older; but we don’t always think about when these things start.
A common cause of hip pain is because one leg might me longer than the other and because of the way this causes the hip of the loner leg to work, it get worn out more quickly than the other side. The process of wearing away is quite normal but the fact it happens on one side more quickly is actually quite unusual; it’s very common so we don’t tend to question it, but if the musculoskeletal system is well balanced then all the joints to wear at the same rate. It is therefore a biomechanical problem.
Leg length differences are extremely common and nothing within themselves to worry about; but the way in which the body comes to cope with a leg length difference is important and settles in, sometimes, at quite a young age.
What can be done to help? click here
The only way to know for sure whether or not a problem exists is for your child to be assessed, often a worry you have may turn out to be nothing too serious but occasionally we find things that need correcting. In this situation, The Mackenzie Practice Specialist in Biomechanics, Steven Lassetter, is very well experienced in this field and ready to advise you on your treatment options.
Steven Lassetter - Professional Biography
After graduating in 1998, Steven remained at University as a lecturer for a year where he both taught and specialised in clinical biomechanics and sports podiatry. Keen to pursue a career in the NHS, he left the university and moved to Kent where he continued to specialise and developed an interest in Podopaediatric care. Within two years he was recognised clinical lead in this area and helped to establish and maintain a dedicated children’s and young persons gait clinic.
Having risen through the ranks of the NHS, Steven now works as a Principle Podiatrist in Musculoskeletal Therapies in London and we are delighted that he has joined the Mackenzie Practise as a part time associate. Steven brings with him a wealth of specialist experience in several fields of biomechanics including sports, children and young adults.
Unusually in Podiatry, Steven has been a specialist since the very start and thus has had the chance to ‘road test’ most of the modern theories on Podiatric biomechanics from the traditional methods known as ‘Rootian Biomechanics,’ to the lesser known disciplines of ‘Kinetic Chain’ and’ Sagital Plane Biomechanics.’ Given this experience, Steven has a huge toolbox to help you with any problems or pains you may experience in your feet or legs. A firm believer in patient autonomy, no treatment will be under-taken until all options have been discussed and all your questions are answered.
Whether it’s an ankle pain when you run, a worry about how your child is developing or a nasty corn that just won’t go away; no case is too big or too small. Why not find out for yourself, if nothing else you’ll learn about things you never knew existed.