Features that raise concern and warrant specialist referral:
Knocked knees in a child aged less than 2 years
Bowed knees in a child aged more than 3 years
Any asymmetrical findings
90% of concerns to GP’s are regarding flat feet. Toddlers and neonates have flat feet due to the presence of a fad pad under the arch, ligamentous laxity, lack of neuromuscular control and normal rotations of the one of the foot bones (talus). This typically resolves between the ages of 4-8 years of age. Treatment before this age can result in a premature arrest of the normal rotations of the foot bones. Treatment therefore is dependent on several factors predominately symptoms of pain and severity of deformity.
However a specialist podiatrist would be able to determine the difference between a flexible and rigid flat foot, i.e. one that would require further examination, x-rays and onward referral.
Intoeing (pigeon-toed gait), tripping and falling is another concern that often results in a podiatric referral. There are 4 main causes of intoeing 2 of which relate to rotational variants of the femur and tibia. 30% toddlers present with intoeing which continues in only 5-9% school age children and proceeds to only 1-3% adults. Treatment for intoeing therefore remains debatable. We as podiatrists treat when symptomatic with simple inserts that encourages the child to rotate the foot out.
Parents are also encouraged to monitor the child’s sleeping and sitting positions as they are both influential over the rotation of the femur. ‘W’ or ‘reversed tailor’ positions and sleeping on their tummy is discouraged.