Infant foot deformities are one of the most common deformities in babies and are found in almost five per cent of all newborns. Many foot deformities improve without treatment, however, some may require further intervention.
--What problems occur with infants’ feet?
A ‘foot deformity’ refers to a change in the usual shape of the foot. ‘Talipes’ is another term used to describe the different foot deformities that can occur in babies. Talipes is a common condition and is thought to be caused by the position of the baby in the mother’s womb.
The foot is generally positioned either pointing down and inwards (’equino-varus’ deformity) or pointing up and outwards (‘calcaneo-valgus’ deformity). The foot position is usually flexible, meaning that the foot can be gently moved back into a normal position. Sometimes the outside border of the foot curves inwards, resulting in a bean-shaped appearance of the foot (this foot deformity is called ‘metatarsus adductus’.)
Many parents become concerned about the position of their baby’s feet when they stand and start to walk. It can sometimes appear that the ankles ‘roll over’ or that the feet are pointing inward when walking. Many of these foot deformities that are present at birth correct as the child grows, but some may need further treatment. It is important that the foot is carefully assessed and monitored by the child’s doctor and health nurse, and a referral made to a paediatric physiotherapist if the foot position is not improving.
--What’s the difference between ‘normal feet’ and infants’ feet?
Infant feet look different to adult feet. Their feet have a greater amount of fat tissue than adult feet and can often appear ‘pudgy’. An infant’s joints are more flexible than adults and their ankles often appear to ‘roll over’ in standing. Infants and young children have flexible flat feet. This means that the sole of the foot is in full contact with the floor, and there is no inner arch visible when they are standing and taking weight through the foot.
--How do I know if my condition requires physiotherapy or other medical attention?
If an infant’s foot deformity is not correcting within 6–12 weeks, a referral should be made to a paediatric physiotherapist. It is recommended that a baby with a foot deformity should also have a careful hip examination. They may require a hip ultrasound to screen for developmental dysplasia of the hip (DDH). This condition can be associated with foot deformities.
The normal walking age is between 8–18 months. If the position of the foot appears to be making it difficult for a toddler to balance and is causing delays in their walking, it is recommended to see a paediatric physiotherapist. If the foot is causing tripping and functional difficulties when a child is walking and running, it is also recommended that they see a paediatric physiotherapist.
--Should I be concerned?
No. Most infant foot deformities at birth correct and improve with movement and growth. ‘Flat feet’ in toddlers and young children in not a concern. The arch in foot usually develops in standing by the age of 4–5 years old. Orthotics in shoes are not necessary—they will not help in the arch in the foot to develop any faster than what will happen naturally.
Parents sometimes notice that their baby or toddler has ‘bow legs’ (‘genu varum’). This is a normal shape in an infant or toddler’s legs. Genu varum is present from birth but is often more apparent when a baby starts to stand. Although it may look unusual and awkward, it is not painful and usually corrects without treatment by three years old.
--How can physiotherapy help with infants’ feet?
Physiotherapists can show parents how to gently stretch, massage and play with their baby’s feet to improve the position of the feet; use splinting or casting with plaster to improve and/or maintain the position of an infant’s foot; and also give advice about appropriate shoe wear and activities to encourage an infant’s gross motor development.
--What can I do at home?
Encourage your child to be active and to have time to walk and play barefoot both indoors and outdoors. Provide good-quality, supportive shoes for your child. It is recommended that children are fitted for shoes after they have been walking independently for 8–12 weeks. Shoes with stiffness in the heel cup, and that are not able to be twisted or bent easily, are good options. Shoes with laces give more support than Velcro. Some shoes are cute and pretty but give little support to growing feet.
--How long until my child feels better?
Flexible flat feet and infant foot deformities are not painful conditions.
