Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists

Why Pediatric Foot Care Matters

A child’s feet are not just smaller versions of adult feet. They are still developing — with growth plates, soft cartilage, and bones that do not fully ossify until the late teens. Problems that go unaddressed during these critical growth years can become permanent structural issues that affect mobility, posture, and quality of life well into adulthood.

The good news is that most pediatric foot conditions respond exceptionally well to early intervention. What might require surgery in an adult can often be corrected with orthotics, stretching, or simple shoe changes in a child whose bones and joints are still malleable.

Common Pediatric Foot Conditions We Treat

Flat Feet (Pes Planus)

All babies are born with flat feet — the arch develops gradually between ages 3 and 6. If a child’s arches have not developed by age 6, or if flat feet are causing pain, fatigue, or difficulty keeping up with peers during play, evaluation is warranted.

Flexible flat feet (the arch appears when the child stands on tiptoes) are very common and often asymptomatic. Rigid flat feet (no arch in any position) are less common but more likely to need treatment. Treatment options include supportive shoes, custom orthotics, stretching exercises, and in rare cases, surgical correction for severe rigid flat feet that do not respond to conservative care.

In-Toeing and Out-Toeing

In-toeing (pigeon toes) and out-toeing (duck feet) are among the most common concerns parents bring to a pediatric podiatrist. In most cases, these gait patterns are developmental and self-correct by age 8. However, evaluation is important to rule out underlying causes like metatarsus adductus (curved foot), tibial torsion (twisted shinbone), or femoral anteversion (inward-rotated thighbone).

If the condition causes tripping, difficulty running, asymmetry between the two feet, or pain, treatment may include stretching, special shoes, or night splints depending on the cause and severity.

Toe Walking

Many toddlers walk on their toes as they learn to walk, and this typically resolves by age 2 to 3. Persistent toe walking beyond age 3 should be evaluated to determine whether it is habitual (idiopathic) or caused by a tight Achilles tendon, sensory processing differences, or neurological conditions. Treatment ranges from stretching exercises and physical therapy to serial casting or Achilles tendon lengthening in severe cases.

Sever’s Disease (Calcaneal Apophysitis)

Sever’s disease is the most common cause of heel pain in children ages 8–14, particularly those who are active in sports. It occurs when the growth plate at the back of the heel becomes inflamed from repetitive stress — often during growth spurts when the bones grow faster than the tendons can stretch.

Despite its name, Sever’s disease is not a disease — it is an overuse injury that resolves once the growth plate closes (typically by age 15). Treatment focuses on managing symptoms through activity modification, heel cups or orthotics, stretching the calf muscles, and icing after activity. Most children can continue sports with appropriate modifications.

Plantar Warts

Plantar warts are caused by the human papillomavirus (HPV) and are extremely common in children, especially those who walk barefoot in locker rooms, pools, and gyms. They appear as hard, grainy bumps on the bottom of the foot and can be painful when walking.

While some warts resolve on their own, stubborn or painful warts may require professional treatment. At Balance Foot & Ankle, we offer several treatment options for pediatric warts including cryotherapy, topical acids, and Swift microwave therapy — choosing the approach based on the child’s age, pain tolerance, and wart severity.

Ingrown Toenails in Children

Ingrown toenails are common in children and adolescents, often caused by improper nail trimming, tight shoes, or toe trauma from sports. Children may resist showing parents their painful toe until it becomes infected. Signs to watch for include redness, swelling, or tenderness along the nail border, limping, or reluctance to wear shoes.

Treatment is similar to adults but tailored for younger patients. For mild cases, warm soaks and proper nail care may resolve the issue. For recurrent or infected ingrown toenails, a quick in-office procedure under local anesthetic can provide permanent relief.

Growing Pains vs. Something More Serious

True growing pains typically occur at night, affect both legs equally, and involve muscles (not joints). They are not associated with limping, swelling, or morning stiffness. If your child’s leg or foot pain is one-sided, occurs during activity, involves a specific joint, or is accompanied by swelling, redness, or fever, see a podiatrist to rule out stress fractures, juvenile arthritis, bone tumors, or infections.

How to Choose the Right Shoes for Your Child

Proper footwear is one of the most impactful things parents can do for their child’s foot health. Here is what to look for at each stage:

Babies and early walkers (0–18 months): Barefoot is best for indoor walking. When shoes are needed outdoors, choose soft-soled, flexible shoes that allow natural foot movement. Avoid rigid soles and stiff ankle support — these can actually hinder normal muscle and arch development.

Toddlers and preschoolers (18 months–5 years): Look for lightweight shoes with flexible soles, a wide toe box, and a secure fastening system (Velcro or laces — not slip-ons that cause toe gripping). The shoe should bend at the ball of the foot, not the middle of the sole.

School-age children (6–12 years): Athletic shoes should be activity-specific (running shoes for running, cleats for soccer). Replace shoes every 3–4 months during rapid growth periods. Check fit monthly — there should be about a thumb’s width between the longest toe and the shoe tip.

Adolescents (13+): Fashion choices may conflict with foot health. Encourage supportive shoes for daily wear and reserve fashion shoes for short occasions. This is the age when flat feet, bunions, and stress fractures often become symptomatic if footwear is inadequate.

Frequently Asked Questions About Pediatric Foot Care

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

There is no mandatory age for a first visit, but we recommend an evaluation around age 5–6 if you have any concerns about your child’s gait, arch development, or frequent foot pain. Earlier visits are appropriate if specific problems (toe walking, visible deformity, pain) arise at any age.

Are flat feet in children normal?

Yes, flat feet are completely normal in babies and toddlers. The arch develops gradually between ages 3 and 6. If your child still has flat feet after age 6, an evaluation can determine whether treatment is needed. Many children with flexible flat feet never need treatment unless they develop symptoms.

Do children need arch support in their shoes?

Not necessarily. Healthy children with normal arches do not need extra arch support. In fact, overly supportive shoes can prevent the foot muscles from developing properly. Children with flat feet, pronation, or foot pain may benefit from custom orthotics prescribed by a podiatrist — but over-the-counter arch supports are rarely appropriate for children without a professional evaluation.

My child walks on their toes. Should I be worried?

Occasional toe walking is normal in toddlers learning to walk and usually resolves by age 2–3. Persistent toe walking beyond age 3, especially if the child cannot stand flat-footed when asked, should be evaluated. It may be habitual, or it could indicate a tight Achilles tendon or other condition that benefits from early treatment.

Will my child outgrow their foot problem?

Many pediatric foot conditions do improve with growth — in-toeing, out-toeing, and flexible flat feet often self-correct. However, assuming a child will “outgrow it” without evaluation can delay treatment for conditions that do not resolve on their own, like Sever’s disease, rigid flat feet, or structural abnormalities. A brief evaluation gives parents peace of mind and catches the small percentage of problems that need intervention.

Does insurance cover pediatric podiatry visits?

Yes, most insurance plans — including BCBS, United Healthcare, Aetna, Cigna, and Medicare (for qualifying conditions) — cover podiatric care for children. At Balance Foot & Ankle, our team verifies your child’s insurance coverage before the appointment so you know what to expect. Visit our insurance page for details on accepted plans.

Related Articles

• Heel Pain in Children: Causes and Treatment
• Custom Orthotics: Complete Guide
• Plantar Warts: Causes and Treatment
• Ingrown Toenail Treatment
• Flat Feet: Complete Guide