Caring for your child's feet

How do my child's feet grow?

Babies are born with only 22 bones in each foot, but by the age of five, this increases to 26 bones (SCP nd).

The first few years are crucial, as the bones in your baby's feet are made of soft, flexible cartilage that gradually converts to bone over time (SCP 2009). Your baby's feet are particularly vulnerable to injury if they're not cared for properly (SCP nd).

By the time your child is two years old, her foot shape has become clear. There are three main shapes, and she'll have inherited one of these from you:

• tapered: her big toe is the biggest of all her toes
• rounded: her second or third toe is longer than her big toe
• square: all her toes are roughly of equal length
  (SCP nd)

How can I take care of my child's feet?

Looking after your toddler's feet now will help prevent foot problems later on in her life.

Make sure that socks, soft booties and bedclothes allow your baby or toddler's toes plenty of room to straighten out and move around easily.

Check her feet regularly. This will help you to notice any problems, such as blisters. Wash your toddler's feet and dry them well between the toes. Cut her toenails straight across to prevent them from becoming ingrown (DH 2009).

Let your baby have some time every day with bare feet so she can exercise her feet and toes. Make a game of it by tickling your baby's feet and legs to encourage her to flex and stretch her foot muscles.

Don't be in a rush to buy shoes. Socks or tights made from cotton or a cotton and wool mix are best and will keep her feet warm. Check the size of your child's socks regularly, especially if you tumble dry them. Socks can shrink, and if they are too tight, this can restrict how your toddler's feet grow (SCP 2009).

When can my toddler have her first shoes?

A baby who's just started walking takes about 176 steps a minute. The longer your toddler walks without shoes, the more it will allow her feet to develop naturally.

When your toddler starts learning to walk, let her walk barefoot indoors, but make sure the floor is clean and safe. Walking barefoot allows her feet to develop and strengthen without restriction.

Once your child can take a few steps confidently and perhaps walk outdoors on rough surfaces, protect her feet outdoors with early first shoes.

Choose shoes made from soft leather, with lightweight flexible soles, padded ankles and non-slip bottoms. The shoes should come in whole and half sizes, and in a choice of widths, so that they fit properly (SCP ndb).

Make sure that her shoes are fitted by a professional shoe-fitter. Aim for plenty of room and width in the toe area, and a secure fastening such as Velcro, a buckle or laces. They'll hold the heel in place and stop your toddler's feet slipping forward and damaging her toes (DH 2009).

Your toddler's feet should be measured every six to eight weeks. Children's feet grow, on average, two full sizes a year until they're four years old.

Allow at least 1cm (0.4in) of growing room between the end of your child's longest toe and the end of her shoe. The shoe also needs to be wide enough for all of her toes to lie flat (DH 2009). Children's feet grow faster in the spring and summer, and sometimes hardly at all in the winter.

What foot development problems can happen?

If you suspect a developmental problem with your child's feet, talk to your child health nurse or GP. He can refer your child to a paediatric podiatrist, if she needs it.

These are some of the developmental conditions that can affect a child's feet:

Talipes (club foot) is a congenital condition that affects one or two babies in 1,000. The shape of one or both feet bends inwards and downwards. Experts are unsure of the cause, but it's more common in boys, and sometimes runs in families (NHS 2011).

Treatment begins soon after birth and usually involves physiotherapy to manipulate your baby's foot gently back into the right shape. She'll also wear a cast and special boots (Jowett et al 2011).

Flat feet is something that all babies are born with, along with a waddle, when they first start walking.This is partly due to posture, and partly due to deposits of fat on your toddler's feet that make her feet look flat (SCP 2009). It can be difficult to tell if your child has flat feet, as the arches may not fully develop until she's 10 years old (SCP nd).

Most children don't take adult-like heel-toe steps until they're about three years old. If an arch forms when your child stands on her tiptoes, don't worry (DH 2009, PATNT 2012). But if your child still seems to have flat feet when she's five years or six years, and is in pain, see a podiatrist. Gentle inserts (orthoses) to support the arch may be prescribed (PAHNT 2012, Rome et al 2010).

Intoe-ing and outtoe-ing is when toddlers walk with their feet turning inwards ("pigeon-toed") or outwards. It usually corrects itself as your child becomes more confident on her feet (DH 2009). Talk to your child health nurse or GP if the problem persists beyond toddlerhood, or worsens, especially if it only seems to affect one foot.

Toe walking is when a child walks on her toes without putting much weight on her heels. Persistant toe walking can be a sign of abnormally short achilles tendons, and may need treatment by a physiotherapist (NHS UHS 2011).

What minor foot problems should I watch out for?

Check your child's feet regularly, as it's unlikely that she'll tell you, or even be able to tell you, that her feet hurt.

Blisters are often caused by new or ill-fitting shoes. These can be quite bad, as your baby or toddler can't necessarily tell you that something is rubbing, or that her foot hurts.

Check your child's shoe-size in case her width-fitting or size has changed. Remove socks and shoes for a while to allow the blister to dry up. If the skin is broken, apply an antiseptic protective dressing (SCP 2009). Don't burst her blisters, as it may cause infection.

Hand, foot and mouth disease is a common childhood, mild viral infection that causes blisters on your child's mouth, hands and feet. It's also sometimes accompanied by a slight fever. It usually resolves itself within a few days.

But the rash can extend up the arms and legs, and often causes small blisters or spots around the nappy area.

Ingrowing toenails will cause the skin at side of your child's toenails to appear red or swollen. This is usually caused by her toenails not being cut correctly.

Cut your child's toenails, and her fingernails, straight across, rather than in a curve. Use nail clippers and file any sharp edges if necessary.

Never cut down the side of your child's toenails or cut them too short. Just follow the line of the nail at the tip of the toe, and leave the corner of nail just clear of the fleshy part of the toe (SCP 2009). If your child complains of sore toenails, ask your GP or child health nurse to take a look.

Athlete's foot is a fungal infection that causes a red, itchy, moist rash, usually in the area between your child's toes. It's rare in babies and toddlers (PRODIGY 2009), but it may be more likely to happen if you take your child swimming often. This is because the fungus thrives in warm, damp areas.

Help prevent athlete's foot by dressing your toddler in cotton socks, and drying between her toes properly after baths and swimming (PRODIGY 2009a). See your GP if you think your toddler has athlete's foot, as some over-the-counter treatments aren't suitable for young children (PRODIGY 2009a).

Verrucas are small warts on your toddler's feet that have a black speck in the centre. They are most often picked up at swimming pools, and usually disappear within two years of appearing.

Verrucas are usually left to run their course, unless they're particularly troublesome (SCP 2009). If they're painful, they can be treated with salicylic acid, as long as your child is over a year old. You can buy it over-the counter or get it on prescription from your GP (PRODIGY 2009b).

Where can I learn more?

The Australian Podiatry Association offers advice about caring for your child's feet. You can also use its online search to find a podiatristOpens a new window near you.