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Ballerina Feet Or Fred Flintstone’s Feet? – Common Foot Problems in Children

From the moment our children are born, we expect them to be perfect and beautiful. We count their toes, fingers and love through them. As most of us realize, however, perfection doesn’t always happen. Some children have problems with their feet from birth, while others may develop problems in the early years.

Toe Walking “Ballerina feet” or toe walking is one such problem. Causes of toe walking include tension in the heel cords at birth, habitual toe walking or neurological conditions such as Cerebral Palsy or Duchenne Muscular Dystrophy. Although many children who are learning to walk tend to go up on their toes, if this continues past the age of 18 months, a doctor’s consultation is necessary to determine causes and treatment options. You may think that the child looks cute walking on his/her toes, but that ballerina will be the focus of ridicule when that child becomes school age. Treatment options can be as simple as stretching the tight calf muscles. Other options include serial casting, orthotics, or surgery. If a child only has the habit of walking on their toes but can change this behavior on command, it may still be necessary to intervene with serial casting or orthotics. The child may change this habit when repeatedly told, “Don’t walk on your toes… don’t walk on your toes,” but soon both the parent and the child will tire of this necessary annoyance.

Although serial casting or bracing may seem extreme, don’t let the title scare you; it is only a short-term treatment to provide a slow continuous stretch to the tight muscles. Serial casting applies a cast on the lower leg to allow prolonged stretching on the tight calf and Achilles tendon. The cast is removed weekly and reapplied in a more optimal stretched position until it is adequate for the child to walk with heel strike at initial contact during the walking phase. After the casts are removed, it may be necessary to place some type of orthotic in the shoes to strengthen the heel strike and continue the child’s progress. Other orthotic options can be discussed with a certified orthotist. Some might include orthotic inserts that go into the shoes. These can help support the arch as well as provide some stiffness to prevent toe walking or plantar flexion/equinus and ensure correct foot position. For a more supportive option, a brace called an AFO (ankle-foot orthosis) can be customized and used as long as needed to prevent the recurrence of toe-walking. If no neurological conditions are present, this period of time is approximately 3 to 6 months. Flat Feet Another foot problem is flat feet (pes planus) or “Fred Flintstone feet”. This is something that can be and often is normal for young children. Arches evolve over time. The foot muscles are actually exercised and strengthened best when walking barefoot. Flat feet can be considered a problem when the child complains of pain in the feet or lower legs after walking. Children may not always give you a clear picture of what they are feeling. So as a parent, one must be alert to the way a child’s shoes wear out over time; paying special attention to the heel position.

If the wear of the shoe is more on the inside edge and it looks like the heel is positioned more outside, then you may have a child who has flat feet. Another basic test is to see what a wet footprint looks like. If you think Fred Flintstone, you may have a child who has flat feet! The most important thing is to pay attention to their complaints of pain after walking. Flat feet without pain do not necessarily indicate a need for treatment. Just like toe walking, there can be many reasons for flat feet other than an arch not developing normally, such as Down syndrome, hypotonicity (low tone) or developmental delay. If your child has any of these diagnoses, you may also need to discuss it with your doctor and decide if orthotics are necessary as additional treatment. Orthotics for flat feet are used to support the arches and provide a better mechanical advantage so that the foot can walk properly. The feet are the structural foundation of the body, therefore, keeping the feet in their optimal alignment allows the muscles in the legs to be activated at their best. If you have any questions about orthotics, please consult your doctor and then look for a Certified Orthotist who specializes in children.

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