All About Feet

"It's a girl!" one of my patients enthusiastically called to tell me soon after she gave birth. But what I really wanted to know was how were the baby's feet. Her other children, Ilyssa and Matthew, had both suffered from intoeing, or turned-in feet, so I wanted to make sure that the new baby didn't have the same problem.

Fortunately, Jocelyn was born with healthy, straight feet, and everything looked fine when her mother brought her in for a checkup after she started walking. My patient understood the potential problems that could arise with a baby's feet and legs because of her experience with her older children. But most first-time parents probably don't give much thought to their newborn's feet, other than how cute they are.

According to the American Podiatric Medical Association (APMA), by the time your child reaches 65, she will have walked more than 100,000 miles. That's why it's important not to take your child's feet for granted. Start her off on the right foot by taking proper care of her little soles and understanding the possible problems that can affect them.

Newborn Feet

Your baby's new feet may be blue, wrinkled, and peeling like much of the rest of his body after nine months in a cocoon of protective fluid. Be assured, however, that his feet will pinken up and fill out as soon as he gets warm.

Baby's feet normally appear flat because children are born with a pad of fat in the arch area. Also, their foot and leg muscles aren't developed enough to support their arches when they first begin to stand. In fact, the arch doesn't usually become apparent until about age 2 1/2.

At the time of delivery, your ob-gyn, and then later your pediatrician, will look for obvious abnormalities of your baby's feet and legs. She will check his hips to make sure they are not dislocated, tickle the bottom of his foot to check for the appropriate neurological response (the toes should fan out), and will actually count to make sure there are ten toes. Occasionally, an infant is born with an 11th (or even 12th) toe, called polydactyly.

Though alarming to parents, this condition simply requires surgical removal of the additional toe to avoid problems with wearing shoes and walking, as well as for cosmetic reasons. The procedure is usually done before your child begins to walk, but can be performed at almost any time from infancy. Once the toe is removed, your child's foot will develop normally, and he will run, jump, and play just like every other kid his age.

Webbed toes are much more common than multiple toes but often go unnoticed by parents because webbing can occur to varying degrees. Webbed toes result because the skin failed to separate between two toes during fetal development, making the area look webbed, similar to a duck's foot. The toes can be surgically separated for cosmetic appearances or if the webbing interferes with the normal toe movement essential for walking.

Genetics, uterine positioning, and prolonged breech positioning can contribute to various congenital foot deformities. Clubfoot, a common disorder, leaves the foot slightly smaller than a normal foot, with the toes pointing toward one another and down. The APMA says clubfoot occurs in 1 of every 1,000 live births and may be present in both feet. If you've already had a child with clubfoot, there's a 10 percent chance that a subsequent child will be born with it, too.

Foot x-rays confirm that a child has the condition, and additional x-rays of the limbs and spine are typically taken to rule out any other associated bone problems. Treatment can begin at birth -- the earlier the better -- while the foot and legs are still pliable. The skeleton of an infant is still very flexible as it hasn't yet solidified into the hard bones of older children and adults. Because of this flexibility, the abnormal position of the foot can be corrected with plaster casts. It takes several weeks to months, and the casts are typically changed every one to two weeks. Your baby should quickly catch up on achieving motor skills, such as rolling or crawling, once the casts are removed.

Special shoes or braces are usually required after the casting to hold the foot in its new position. Surgery may be needed if the initial treatment wasn't successful.

Metatarsus adductus is another foot problem present at birth. It is just as common as clubfoot but sometimes overlooked. The foot is often shaped like the letter "C" with the big toe pointing in and facing the other foot. To treat it, a podiatrist will stretch the foot and reshape it with plaster casts as well.

Look Who's Walking

Before she takes her first step, your baby needs to develop adequate strength in her legs to carry her body weight, as well as the confidence to stand on her own two feet. While many parents look to the first birthday as the target date for this major milestone, the average age when children begin walking is closer to 15 months.

A lot of babies "cruise" -- walk by holding on to furniture -- for many months before taking those first real steps. When children do walk on their own, their feet tend to spread out farther than adults' feet to give them more stability. You may also find that your child walks on his toes. This is normal at the beginning, but persistent toe-walking is not.

If your child is still walking on his toes after a few months, make an appointment with a podiatrist, who will test for a tight Achilles tendon or a contracted muscle. (The APMA Web site, apma.org, can recommend a podiatrist in your area who treats children.) If that's not the problem, your podiatrist may refer you to a neurologist because, in rarer cases, toe-walking can be a symptom of a neurological problem.

Besides toe-walking, many other foot and leg problems that might not have been apparent at birth are often noticed by parents and doctors when a child starts to walk. This is a good time to visit a podiatrist if you have any concerns, especially if there's a family history of foot problems.

One such problem, intoeing or pigeon toes, is when one or both feet point inward. It can be caused by uncorrected metatarsus adductus or an abnormal rotation in the foot, leg, thigh, or hip. Some children outgrow the condition, but unfortunately many do not, especially if foot and leg abnormalities run in the family. These cases may require surgery to correct. It's also a good idea to have children sit with their legs crossed in front of them rather than on their knees or with their legs behind them, which can aggravate intoeing.

Your toddler may also appear to have knock-knees (knees that are turned in) or to be bowlegged (turned out at the knee), but typically as she walks, her legs will straighten out. If you're concerned, your pediatrician can evaluate your child's knees to determine if they are in proper position for your little one's age.

If your baby's feet still appear to be flat by the time he's 2 1/2 to 3, he may truly be flat-footed due to a bone deformity or a tight Achilles tendon. Have a podiatrist evaluate him, particularly if there is a family history of flat feet. The condition can lead to leg cramps, bunions, and hammertoes as early as the teenage years. Flat feet can be treated with shoe inserts once your child begins to walk. In some cases surgery may be recommended.

The earlier foot and leg problems are diagnosed and treated, the better off your baby will be.

What to Wear?

It's difficult to resist the temptation to put cute little shoes on your baby, but they can be an obstruction to growing feet. Shoes that are too restrictive don't allow for normal toe and foot motion.

Stick to nonrestrictive socks (make sure the sock and elastic around the top aren't too tight) and crib shoes -- those soft, flexible leather booties. Save sturdy, adult-like shoes -- such as Mary Janes or loafers -- for special dress-up photos. Even when children are learning to walk, shoes are only necessary for protection from slippery floors, a splintery deck, or the ground outside. Otherwise, let your child walk barefoot or with nonskid booties. This will allow her toes to grip the floor and her feet to balance better.

When purchasing shoes for your new walker, again look for ones that are lightweight and flexible, and that bend easily. Make sure that the shape of the shoe is straight; shoe designs sometimes flare in or out at the toe. Your child's shoe size will change every few months in the beginning. Get him properly fitted for width as well as size at a shoe store.

Marlene Reid, DPM, is in private practice in Westmont, Illinois, and the mother of two. Dr. Reid is also president of the American Association for Women Podiatrists.

Originally published in American Baby magazine, August 2004.