Pediatric podiatry

The development of children's feet begins in-utero, being mainly derived from basic embryological tissue called mesenchyme.

In simple terms, the mesenchyme differentiates to form a cartilage foot template, which is largely complete by the end of the embryonic period (8 weeks after conception).

The feet were bound tightly and forced into increasingly small shoes so that the front part of the foot was bent back and the toes touched the heel.

[3] [4] The early gait of young new-walking children is distinguished from that of an older child or adult by many features: shortened stride, feet held widely apart, arms held up (‘high guard’ assisting balance), apparent sway (coronal plane), and rapid steps (high cadence).

More mature gait includes body rotations (transverse plane), longer stride, and lowered arm swing, all of which increase both speed and energy efficiency.

Laboratory based gait analysis can be very useful for planning treatment regimes, especially surgical management, but also the effects of ankle-foot-orthoses (AFO's) and footwear.

During running, shoes were found to reduce swing (non-weight-bearing) phase leg speed, attenuate some shock, and encourage a rearfoot strike pattern.

[6] Children's feet are a frequent presentation to a range of health professionals and represent a common parental concern.

Congenital foot appearance may also be indicative of a genetic condition; a wider space between the first and second toes with associated skin creasing may be found with Down's syndrome (trisomy 21).

Whilst some cavus foot types are familial and normally inherited, others are indicative of genetic neurological conditions, e.g. Charcot–Marie–Tooth disease[10] or Friedrich's ataxia.

[12] Contemporary management of the paediatric flat foot is directed according to pain, age, and flexibility, considering gender, weight, and joint hypermobility.