Children’s foot care

Common concerns we see

Heel pain in young athletes (Sever’s disease). The growth plate at the back of the heel bone is pulled by the Achilles tendon and loaded by running and jumping. In growing, active kids it can become irritated, causing heel pain during and after sport. It is the most common cause of heel pain in children and is linked to sports like soccer and basketball.^[2] Limited ankle flexibility and foot alignment are among the factors associated with it.^[3] See our article on Sever’s disease.

Flat feet. Most young children have flat-looking feet, and flexible flat feet usually cause no problems. A Cochrane review found limited evidence for orthoses in children without symptoms.^[4] We look more closely at flat feet that hurt, are stiff, or are different on each side. See flat feet.

In-toeing and out-toeing. Walking with the toes turned in or out is common in young children and usually comes from normal rotation of the foot, shin or thigh that improves with growth. A careful history and examination tell normal variation from a true deformity.^[1]

Plantar warts, common in school-age children. See plantar warts.

Sports injuries: ankle sprains, fractures (including growth-plate fractures) and overuse injuries. See ankle sprains and fractures and trauma.

How we evaluate a child’s foot

We ask about when the problem started, whether it is changing, and how it affects play and sport; examine the feet, legs and walking; compare both sides; and use X-rays at the practice when bone or growth plates need a look. Most visits end with reassurance and simple advice.^[1]

Treatment for Sever’s disease

Conservative treatment works for most children. Trials have used heel inserts or cups, stretching and strengthening exercises, taping and orthoses, and a period of reduced high-impact activity.^[2] In one comparison, orthoses gave more short-term pain relief than heel raises.^[5] The condition resolves once the growth plate matures.

Common questions

Does my child need inserts for flat feet?

Not if the feet don’t hurt. In a Cochrane review, custom inserts made little or no difference to pain at one year in children whose flat feet caused no symptoms.^[4] Flat feet that hurt, are stiff, or look different on each side are another matter, and we examine them closely.

My toddler’s legs look bowed, or knock-kneed. Is that normal?

Usually, yes. Bowed legs in toddlers and knock knees in young children are common stages of growth, and they don’t need tests or treatment when the child’s measurements are in the normal range for their age and nothing hurts.^[1] Have it checked if only one side is affected, it is getting worse, or your child limps or has pain.

Should my child stop sport because of Sever’s disease?

Usually not completely. Cutting back on the running and jumping that bring on the pain, along with heel cups and stretching, is enough for most children, and they build back up as the pain settles.^[2] We give you a plan for how much to play and when.

What should I look for in my child’s shoes?

A shoe that fits the longer foot with about a thumb’s width in front of the longest toe, a firm back around the heel, and a sole that bends where the toes bend, not in the middle. Feet grow quickly, so check the fit every few months, and don’t hand down shoes that have molded to another child’s foot.

When to seek care