THE day your child takes his first step is always memorable, but it's usually this period of early childhood when parents may also notice something odd or unnatural about their child's gait.
Some of the common foot problems in children include flat feet, in and out-toeing and tiptoe walking.
Gleneagles Hospital Kuala Lumpur consultant in orthopaedics, trauma surgery and paediatric orthopaedics, Dr Abd Razak Muhamad says most babies are born with flat feet because of baby fat obscuring the arch on the inner part of the feet.
"However, as they grow older, the arch gradually develops as baby fat starts to disappear and the muscles of the feet become stronger."
As flat feet are part of normal dynamic changes and disappear by the age of 4, most do not require treatment, even in some children who retain the flatness of feet as they grow older, he explains.
In a small percentage of children though, who have painful, severe and stiff flat feet, further assessment needs to be done by a doctor to exclude structural or bone problems and this includes X-rays of the feet. A surgical approach may even be recommended depending on the underlying cause.
In-toeing, meanwhile, is when both feet turn inwards when the child walks while the opposite happens in out-toeing.
Dr Abd Razak says in-toeing is more common in boys aged 1 to 4 and the usual cause is internal tibial torsion (the leg bone is twisted internally).
In girls, in-toeing is commonly seen in those aged 4 to 7 and is caused by excessive femoral anteversion (where the hip has excessive internal rotation).
Children will outgrow both these conditions but those with in-toeing from excessive internal hip rotation are advised not to sit in the "W" position while on the floor as it could delay the physiological correction as they grow. Instead, these children are encouraged to sit cross legged.
LEG AND FOOT COMPLAINTS
Heel pain is also common in children and one of the causes is inflammation around the insertion of the heel cord tendon.
Dr Abd Razak says this condition is called Sever's disease, where a repetitive traction injury during physical activity triggers inflammation at some part of the bone (apophysis).
Treatment usually involves rest from the activity that triggers it, placing ice on the affected area and using anti-inflammatory medication.
Ingrown toenails, meanwhile, are common among older children and adolescents. Among the risk factors are tight shoes so parents need to be mindful of buying well-fitting footwear for their kids.
While most common foot problems in children are part of dynamic changes in the feet and leg alignment and position and will improve naturally, some may get progressively worse with time and age.
"It is important to observe closely and if the deformity does not resolve as expected, the child needs further evaluation to rule out any underlying causes."
Any further need for correction or intervention would depend on the underlying cause of the condition and its severity.