Why Children’s Lower Limbs Matter

• Kids grow rapidly—and with that growth can come muscle imbalances, joint overload, and gait changes. Many conditions in growing feet and legs are common and treatable, especially when addressed early.

• At Toe-tal Podiatry, we help assess, treat, and guide families through concerns that may affect foot posture, walking patterns, joint development, or sports performance.

   

GAIT & POSTURE ISSUES IN CHILDREN

Toe Walking

What is it?

When a child consistently walks on the balls of their feet.

Can be normal under age 2, but persistent toe walking may indicate:

• Tight calf muscles

• Habitual gait pattern

• Neurological conditions (in rare cases)

 

Treatment:

• Stretching program

• Footwear modifications

• Possible referral for neurological screening if unresponsive to therapy

 

In-Toeing (Pigeon-Toeing)

What is it?

Feet turn inward during walking.

 

Common causes:

• Femoral anteversion (hips rotate in)

• Tibial torsion (shin bone rotation)

• Metatarsus adductus (foot bone curve)

 

Usually improves naturally by age 8, but referral is recommended if:

Tripping is frequent

One leg is affected more

Gait is painful or awkward

 

Out-Toeing

What is it?

• Feet point outward during standing or walking.

• Causes may include:

• External hip rotation

• Tibial torsion

• Flat feet

 

Treatment depends on:

• Child’s age

• Symptom severity

• Functional impact (pain, clumsiness)

 

Flat Feet (Pes Planus)

What is it?

Low or absent arch when standing.

Normal up to age 5 as foot arch develops.

 

Concerning signs:

• Pain or fatigue in feet/legs

• Uneven shoe wear

• Tripping or poor posture

• Family history of foot issues

 

Treatment:

• Supportive footwear

• Orthotics if symptomatic

• Strengthening and stretching

• Activity modification

 

Leg Length Differences (LLD)

What is it?

• One leg is longer than the other (structural or functional)

• Signs to look for:

• Limp or uneven walking

• Hip tilt or lower back pain

• One shoe wearing out faster

 

Treatment may include:

• Heel lifts

• Custom orthotics

• Stretching tight muscles (if functional)

• Referral for imaging if structural

 

 

GROWTH PLATE CONDITIONS (Apophysitis)

These conditions affect areas where tendons attach to growing bones—most common during growth spurts and high physical activity.

1. Sever’s Disease (Calcaneal Apophysitis)

• Age group: 8–14

• Area affected: Back of the heel

Symptoms:

• Heel pain during or after activity

• Limping, tiptoe walking

• Tenderness at the heel (especially with squeezing)

Treatment:

• Heel lifts or orthotics

• Activity modification

• Calf stretching

• Ice after sport

 

2. Osgood-Schlatter’s Disease

• Age group: 10–15

• Area affected: Bony bump just below the kneecap (tibial tuberosity)

Symptoms:

• Pain during running, jumping, kneeling

• Swelling or tenderness at the tibial tubercle

• Visible bump that may persist into adulthood

Treatment:

• Patellar straps

• Load management

• Stretching of quads and hamstrings

• Orthotics if biomechanics are contributing

 

3. Iselin’s Disease

• Age group: 9–13

• Area affected: Outside of foot at the base of the 5th metatarsal (pinky toe side)

Symptoms:

• Lateral foot pain with activity

• Tenderness to touch along the outside foot

• Worsened with jumping or side-to-side motion

Treatment:

• Supportive footwear

• Offloading with padding or orthotics

• Ice, gentle stretching

 

4. Freiberg’s Disease

• Age group: 11–17

• Area affected: Second metatarsal head (ball of foot, often under 2nd toe)

Symptoms:

• Forefoot pain, especially during toe-off phase of walking

• Stiffness or joint locking

• Swelling and reduced movement in the affected toe

Treatment:

• Offloading pressure (orthotics or padding)

• Reduced activity during flare-ups

• Referral to orthopaedics in advanced stages

 

Footwear & Activity Tips

• Fit shoes with 1cm toe room, firm heel counter, and flexible sole

• Avoid hand-me-downs—they’ve moulded to another child’s feet

• Rotate shoes to allow drying

• Encourage barefoot play (indoors or safe outdoors) for natural development

 

When to See a Podiatrist

• Book an assessment if your child:

• Complains of foot, leg, knee, or heel pain

• Walks with a limp or unusual pattern

• Trips frequently or fatigues easily

• Has flat feet with discomfort

• Has persistent toe walking

• You just want reassurance during their growth stages

 

Questions or Concerns?

We’re here to support your child’s journey from first steps to confident movement. Early intervention often means less invasive treatment and faster results.

 

Big care for little feet.

 From your team at Toe-tal Podiatry