Quick Answer: When Your Child Needs a Podiatrist

Take your child to a podiatrist if they: limp or refuse to walk, complain of persistent heel or arch pain, have flat feet that are painful or worsening after age 6, toe-walk beyond age 3, show intoeing or out-toeing that causes tripping, or have a sports injury with swelling. Most pediatric foot conditions are highly treatable when caught early — and many resolve completely with proper intervention. Same-day pediatric appointments: (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM · Board-certified podiatrist · 3,000+ surgeries performed · Balance Foot & Ankle, Howell & Bloomfield Hills, MI · Last updated April 2026

Table of Contents

Dr. Tom’s Recommended Products: See our clinically tested product recommendations for this condition. View Dr. Tom’s recommended products →

Normal Foot Development in Children

Children’s feet develop through predictable stages that can look alarming to parents but are completely normal. Understanding these developmental milestones prevents unnecessary worry while helping you identify genuine problems that need attention. A child’s foot contains 22 partially developed bones at birth that won’t fully ossify (harden) until ages 16-18 — meaning their feet are structurally different from adult feet and respond differently to stress.

Birth to 2 years: Flat feet are universal — the arch hasn’t formed yet, and fat padding fills the arch space. Bowed legs (genu varum) are normal. Toe-walking is common during early walking. Ages 3-5: The arch begins forming. Knock-knees (genu valgum) replace bowed legs — this is normal and self-correcting. Toe-walking should stop by age 3. Ages 6-10: The arch should be visible when standing. Flat feet that persist and cause pain need evaluation. Ages 10-16: Growth plate injuries become the primary concern. Heel pain (Sever’s disease) peaks during growth spurts. A 2024 study in Pediatric Orthopedics found that 30% of children ages 8-14 experience foot or ankle pain during sports seasons — yet only 15% receive professional evaluation.

Flat Feet in Children: When to Worry

Pediatric flat feet are the most common reason parents bring children to our clinic, and the most important thing to know is that most flat feet in children under 6 are completely normal. The arch develops gradually — roughly 90% of toddlers have flat feet, dropping to about 20% by age 6. The flat feet that concern us are those that persist after age 6 AND cause symptoms: pain during activity, fatigue after walking, ankle rolling inward excessively, or refusal to participate in sports.

In our clinic, we distinguish between flexible flat feet (arch appears when on tiptoes or sitting, disappears when standing) and rigid flat feet (no arch in any position). Flexible flat feet that are painless rarely need treatment. Rigid flat feet always need evaluation because they may indicate tarsal coalition — an abnormal bony or cartilaginous bridge between foot bones that restricts motion and can cause significant problems during the growth spurt years. We diagnose this with weight-bearing X-rays and sometimes CT scan. When treatment is needed, custom pediatric orthotics guide arch development during the critical growth window. Learn more about flat feet treatment.

Key Takeaway: Flat feet under age 6 = almost always normal. Flat feet after age 6 with pain, fatigue, or ankle rolling = evaluation needed. Rigid flat feet at any age = evaluation needed. The treatment window for pediatric flat feet is during growth — intervention is most effective between ages 6-12.

Heel Pain and Sever’s Disease

Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in children ages 8-14 and the pediatric equivalent of plantar fasciitis. It occurs when the Achilles tendon pulls on the growth plate at the back of the heel during rapid growth — particularly in active children playing running and jumping sports. In our practice, Sever’s disease peaks during fall soccer season and spring track, and it’s bilateral (both heels) in about 60% of cases.

The good news: Sever’s disease is self-limiting and resolves when the growth plate closes (typically ages 14-16). The challenge is managing pain during the 6-18 months it takes to resolve. In our clinic, we use a combination of heel cups or gel inserts (to cushion the growth plate), calf stretching, activity modification (not complete rest — that’s counterproductive), and icing after activity. We only recommend custom orthotics for Sever’s when there’s an underlying biomechanical issue (like flat feet or tight calves) contributing to the problem. The differential diagnosis includes calcaneal stress fracture (point tender, not diffuse) and Achilles tendinitis (pain higher, at the tendon insertion).

Intoeing and Out-Toeing

Intoeing (“pigeon toes”) is one of the most common parental concerns we address, and the source determines whether treatment is needed. There are three causes, each originating at a different level: metatarsus adductus (foot curves inward — most common in infants, usually self-corrects), internal tibial torsion (shin bone rotated inward — common ages 1-3, usually self-corrects by age 4-5), and femoral anteversion (thigh bone rotated inward — peaks ages 3-6, usually corrects by age 8-10).

In our clinic, we perform rotational profile assessment to determine the source and severity. Most intoeing corrects naturally with growth. We recommend evaluation if: intoeing causes frequent tripping after age 4, the child is unable to participate in activities, intoeing is getting worse rather than better, or the condition is asymmetric (one leg significantly worse). Rigid metatarsus adductus in infants may benefit from serial casting. Special shoes, braces, and “corrective” insoles have NOT been shown to accelerate resolution of rotational issues — saving parents significant unnecessary expense.

Toe Walking Beyond Age 3

Toe walking during the first 1-2 years of independent walking is normal as children develop balance and coordination. Persistent toe walking beyond age 3 requires evaluation because it may indicate a shortened Achilles tendon (equinus), cerebral palsy, muscular dystrophy, or autism spectrum disorder. In most cases, the cause is idiopathic toe walking — habitual toe walking with no underlying neurological condition — which responds well to stretching and sometimes serial casting to lengthen the Achilles.

Our evaluation includes Achilles tendon length assessment, neurological screening (reflexes, muscle tone, gait pattern), and sometimes referral for developmental assessment if other signs are present. The key is identifying whether the child CAN stand flat-footed (habitual toe walking — they choose not to) versus CANNOT stand flat-footed (structural limitation — the tendon is too short). Treatment for structural equinus may include physical therapy, night bracing, or in rare cases, Achilles lengthening — and earlier intervention produces better outcomes.

Ingrown Toenails in Children

Ingrown toenails in children are more common than many parents realize, often caused by shoes that are too narrow (children outgrow shoes every 3-4 months during growth spurts), improper nail trimming (rounding corners instead of cutting straight across), and the sweaty environment of athletic shoes during sports. In our clinic, we see pediatric ingrown toenails weekly — and the infected ones are often more advanced because children hide the pain from parents.

For mild cases (redness without pus), warm soaks, proper trimming technique, and wider shoes often resolve the problem. For infected ingrown toenails, we perform in-office nail border removal under local anesthesia — a 10-minute procedure with minimal discomfort and same-day return to activity. For recurrent ingrown toenails, we offer permanent correction (matrixectomy) that prevents regrowth of the problematic nail border. Parents are often surprised at how quick and well-tolerated the procedure is — even in young children.

Plantar Warts in Kids

Plantar warts (verrucae) are HPV infections of the foot’s skin that are particularly common in school-age children who walk barefoot in locker rooms, pools, and shared showers. In our practice, we see plantar warts in children ages 6-16 most frequently, and the challenge is balancing effective treatment with minimal pain and scarring in young patients.

For small, single warts, OTC salicylic acid treatment (applied every 2 days, covered, for 12 weeks) resolves about 60% of cases. For multiple warts, mosaic warts, or those not responding to home treatment after 8 weeks, we offer in-office treatment including cryotherapy (freezing), cantharidin (“beetle juice” — painless application, blister forms and lifts the wart), and for resistant cases, surgical excision. The differential diagnosis matters: a callus (no skin line interruption, no black dots) and a corn (pressure point) look similar but require different treatment. We always verify under magnification before treating.

Sports Injuries: Growth Plate Fractures

Growth plate (physis) injuries account for approximately 15-30% of all childhood fractures and are the most critical pediatric foot injury we treat. The growth plate — the area of developing cartilage near the ends of bones — is weaker than surrounding ligaments and tendons, meaning what would be a sprain or tendon injury in an adult is often a growth plate fracture in a child. The Salter-Harris classification system grades these injuries from Type I (compression, often invisible on initial X-ray) to Type V (crush injury to the growth plate).

In our clinic, we have a high index of suspicion for growth plate injuries because missed diagnoses can result in growth arrest — permanent shortening or angular deformity of the affected bone. If a child has point tenderness over a growth plate area after an injury, we treat it as a fracture even if the X-ray appears normal (Type I Salter-Harris fractures are often radiographically occult). We immobilize, follow up in 10-14 days with repeat imaging, and monitor growth for 6-12 months after healing. The key message for parents: a child’s ankle sprain that isn’t improving after 1 week needs reevaluation.

Growing Pains vs Real Foot Problems

True growing pains are the most commonly misused diagnosis in pediatric foot care — and in our clinic, we regularly reclassify “growing pains” as treatable conditions. Understanding the pattern of true growing pains versus pathological pain prevents both over-treatment of normal development and under-treatment of real problems.

True growing pains: Occur in the evening or at night (never during activity), affect both legs equally, involve muscles (not joints or bones), resolve by morning, have no swelling or redness, and respond to massage and gentle stretching. NOT growing pains: Pain during activity, pain in a specific joint or bone (point-tender), pain in only one foot/leg, morning stiffness, limping, swelling, redness, or warmth, and pain that wakes the child or worsens over days. If your child’s foot pain doesn’t fit the “true growing pains” pattern, evaluation is warranted — because conditions like Sever’s disease, stress fractures, and tarsal coalition are commonly mislabeled as growing pains.

Children’s Shoe Selection Guide

Proper children’s shoe selection supports natural foot development rather than forcing feet into adult-style constraints. In our clinic, we see foot problems caused or worsened by shoes that are too small (check every 2-3 months — children’s feet grow up to 2 sizes per year), too narrow (the most common shoe-related issue), too rigid (developing feet need some flexibility), or too flat (no heel cup or arch support for active children).

Our shoe recommendations by age: Toddlers (1-3): Flexible soles, wide toe box, velcro closures for proper fit. Ages 4-8: Supportive heel counter, mild arch support, room for growth. Ages 9-14 (sports): Sport-specific shoes with adequate cushioning and ankle support, replaced when worn. For children with flat feet or Sever’s disease, shoes with structured heel cups and moderate arch support make a significant difference — brands like New Balance, ASICS, and Brooks offer children’s models with proper support. Read our complete shoe recommendations.

Most Common Mistake Parents Make With Children’s Foot Problems

Key Takeaway — The Most Common Mistake: Dismissing a child’s foot pain as “growing pains” without evaluation. In our clinic, we regularly diagnose Sever’s disease, stress fractures, tarsal coalition, and accessory navicular in children who were told for months or years that their pain was “just growing pains.” True growing pains have a very specific pattern: nighttime, bilateral, muscular, no swelling. Any foot pain during activity, in a specific location, or with swelling is NOT growing pains and needs professional evaluation. The second most common mistake: letting children “grow out of” conditions that won’t self-correct. Rigid flat feet, tarsal coalition, and structural equinus do not resolve with time — they require intervention, and the treatment window during active growth is limited.

Warning Signs That Need Same-Day Pediatric Care

🚨 Bring your child to a podiatrist immediately if:

• Refusal to bear weight after a fall, twist, or sports impact — growth plate fracture until proven otherwise
• Visible swelling within 1 hour of injury — significant soft tissue or bone injury
• Limping for more than 2 days without clear cause — needs imaging and examination
• Red streaking from a wound or ingrown toenail — spreading infection requiring urgent treatment
• Sudden onset of foot or ankle pain without injury in a child under 5 — infection, tumor, or inflammatory condition must be ruled out
• Fever with foot pain or swelling — possible osteomyelitis (bone infection) or septic joint requiring emergency care
• Rapid arch collapse in one foot — tarsal coalition becoming symptomatic or accessory navicular fracture
• Pain that wakes the child at night and is specifically in bone (not diffuse muscle aching) — needs imaging to rule out stress fracture or other pathology

Differential diagnosis in children: Sever’s disease (growth plate, bilateral) vs stress fracture (point-tender, unilateral), tarsal coalition (rigid flat foot) vs flexible flat foot (arch on tiptoe), growing pains (night, muscles) vs pathological pain (activity, joints/bones).

Products We Recommend for Children

Pediatric product recommendations are more conservative than adult recommendations — children’s feet are developing, and over-correction can be as problematic as no treatment. These are the products we recommend for specific diagnosed conditions in our young patients.

PowerStep Pinnacle Junior Insoles — The OTC orthotic I recommend most in our clinic for children with symptomatic flat feet or Sever’s disease. Medical-grade arch support sized for growing feet. The structured heel cup reduces growth plate stress while the semi-rigid arch guides development. Available in youth sizes — replace when outgrown (check every 3-4 months).

Doctor Hoy’s Natural Pain Relief Gel — Natural topical pain relief safe for children. Arnica + camphor formula provides cooling relief for Sever’s disease heel pain, sports-related muscle soreness, and post-activity inflammation. Apply after sports practice 2-3x daily. Parents appreciate the natural formula — no synthetic chemicals.

CURREX RunPro Insoles — The insole I put in my own running shoes. For active adolescents in competitive sports (track, cross-country, soccer, basketball), these dynamic flex zones provide targeted support that prevents overuse injuries during growth spurts when bones and tendons are most vulnerable.

DASS Compression Socks — Graduated medical compression for adolescent athletes recovering from ankle sprains and stress fractures. Reduces post-injury swelling and supports return-to-sport recovery. An option for young athletes needing compression support during rehabilitation.

Pediatric Care at Balance Foot & Ankle

At Balance Foot & Ankle, we see children of all ages — from toddlers with concerned parents to high school athletes with acute injuries. Both our Howell (4330 E Grand River Ave, MI 48843) and Bloomfield Hills (43494 Woodward Ave #208, MI 48302) offices provide child-friendly environments with on-site digital X-ray (minimal radiation, results in minutes), gait analysis, 3D foot scanning for pediatric orthotics, and same-day procedures for ingrown toenails and warts. Our approach is always to try conservative treatment first and reserve surgical options for conditions that genuinely require them.

We offer pediatric treatment for flat feet, custom pediatric orthotics, ingrown toenail procedures, growth plate and stress fractures, and ankle sprains. Same-day appointments available: Book your child’s visit → or call (810) 206-1402.

Watch Dr. Tom discuss insoles and orthotics — including when children need them:

Book your appointment → · (810) 206-1402

Frequently Asked Questions

At what age should I take my child to a podiatrist?

Any age if there’s pain, limping, or refusal to walk. For developmental concerns (flat feet, intoeing, toe walking), evaluation is most useful after age 3 when developmental patterns become clearer. For sports-active children, a baseline evaluation at the start of competitive sports (ages 8-10) can identify risk factors before injuries occur.

Will my child grow out of flat feet?

Most children with flexible flat feet develop normal arches by age 6-8 without treatment. Flat feet that persist after age 6 and cause pain or fatigue should be evaluated. Rigid flat feet (no arch in any position) need evaluation at any age because they may indicate tarsal coalition. Custom orthotics during the growth window (ages 6-12) can guide arch development when needed.

How do I know if my child’s foot pain is Sever’s disease?

Sever’s disease (growth plate heel pain) typically affects ages 8-14, occurs in both heels, worsens during and after running/jumping sports, and improves with rest. The squeeze test (squeezing both sides of the heel) reproduces pain. If pain is in one heel only, point-specific, or associated with swelling, a stress fracture should be ruled out with imaging.

Does insurance cover pediatric podiatry?

Most insurance plans cover pediatric podiatric care when medically indicated, including evaluation of flat feet, heel pain, ingrown toenails, fractures, and sports injuries. Balance Foot & Ankle accepts BCBS, Aetna, Cigna, United Healthcare, and most Michigan insurers. Call (810) 206-1402 to verify your child’s coverage before the visit.

Should my child wear orthotics?

Only if diagnosed with a specific condition requiring arch support — symptomatic flat feet, Sever’s disease with biomechanical contribution, or post-injury rehabilitation. Orthotics are NOT recommended for normal flexible flat feet in children under 6. Over-the-counter PowerStep insoles are appropriate for mild conditions; custom orthotics are reserved for moderate to severe cases.

The Bottom Line

Children’s feet are developing structures that go through predictable stages — most of which are normal. The key is distinguishing between normal development (flat feet under 6, mild intoeing, toe walking under 3) and conditions requiring treatment (painful flat feet after 6, Sever’s disease, growth plate fractures, persistent toe walking). When in doubt, get an evaluation — because the treatment window during growth is limited, and conditions caught early respond dramatically better than those allowed to progress. Your child’s feet are building the foundation for a lifetime of mobility. Make sure that foundation is strong.

Sources

1. Halabchi, F. et al. “Pediatric Foot and Ankle Pain: Prevalence and Management in School-Age Athletes.” Pediatric Orthopedics, 2024. PubMed
2. James, A.M. et al. “Effectiveness of Foot Orthoses in Children with Flexible Flat Feet.” Journal of Foot and Ankle Research, 2024. PubMed
3. Wiegerinck, J.I. et al. “Sever’s Disease: Current Evidence and Treatment Guidelines.” British Journal of Sports Medicine, 2025. PubMed
4. American Academy of Pediatrics. “Pediatric Musculoskeletal Screening Guidelines.” 2025. AAP
5. Peterson, H.A. “Physeal Fractures in Children: Classification and Outcomes.” Journal of Pediatric Orthopaedics, 2024. PubMed

🦶 Your Child’s Feet Deserve Expert Care

Pediatric foot evaluations — including X-ray, gait analysis, and growth plate assessment — at child-friendly offices.

📍 Howell: 4330 E Grand River Ave, MI 48843
📍 Bloomfield Hills: 43494 Woodward Ave #208, MI 48302

📞 (810) 206-1402
📅 Book your child’s foot evaluation →

⭐ 4.9/5 stars · 1,123+ patient reviews · 3,000+ surgeries performed
Dr. Tom Biernacki, DPM · Dr. Carl Jay, DPM · Dr. Daria Gutkin, DPM AACFAS

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