Expert Advice



Kate Carter is an experienced podiatrist with a special interest in children's feet (podopaediatrics). Kate studied at the London Foot Hospital and School of Podiatric Medicine and gained a first class degree in podiatric medicine. Kate has since gained an MSc in Clinical Biomechanics and a Post Graduate Certificate in Musculoskeletal Diagnosis.

Since qualifying, Kate has worked both within the NHS and private sector and is currently employed as a podopaediatric podiatrist for an NHS trust in south London.

Kate feeds back on some recent foot health queries

[+] My 15 month old daughter has flat feet. Does she need insoles?

My daughter is 15 months old, she is not yet walking independently but she is standing on her feet a lot (cruising around, pushing toys etc.). When she started bearing weight and standing up about 2 months ago, we were really worried about her feet: she had totally inverted ankles and her feet were going outward (at almost a 45 degree angle). Most of her weight was born on the inside the foot and ankles. Things have improved a bit since then but she still has inverted ankles (esp. on one foot) and her foot isn't flat on the floor: it looks as though only the inside of the foot is touching the floor.

My questions are: Do I need to consult a specialist or will this get better naturally as she starts walking? And what kind of shoes does need? A soft shoe with flat insole or something a bit more supportive of the ankle with perhaps a built-in arch?

Kate reply's -

At first all babies' feet look flat. A baby's foot contains no fully formed bones and the shape of your child's foot is mapped out in soft, pliable cartilage with no discernible arch. Arches should form by the time your child is 6 years old, even older sometimes.

Flexible flat feet do turn outward and also at this age their hips turn outwards too which allows for greater stability when walking. As the child walks more, becomes more confident and muscles strengthen, the legs will start to rotate in. As this is a part of normal development most flat feet cause no trouble and do not need treatment.

Encourage your baby to walk barefoot indoors as this allows the foot to develop and strengthen. Only once walking is established should a child have their first shoes. An ideal shoe should be soft and flexible with a fully adjustable fastening, and go to a shop with trained staff who will measure your child's feet for length and width.

I would suggest getting an assessment by a Podiatrist if only for reassurance. It is difficult to assess via email but if the asymmetry continues, with one foot flatter than the other, I would definitely seek advice.



[+] Help! Our 5 year old son and 2 year old daughter have curly toes

Please can you help us, our son who is now 5 and a half has curly toes (4th /5th) both feet, which are quite severe and our local hospital has recently offered the 'Tenotomy' operation.

After reading articles on the internet most of them say the best age for this operation is 2-3 years, why our hospital hasn't offered the op sooner we are not sure, other articles have said that after 5 it becomes a soft tissue tendon transfer.

We have also seen a local Chiropodist and he has said not to have the operation but to have orthotics which will make a 70% difference to our sons toes. Our little girl of 2 and a half now appears to have the same problem (4th/5th toes on both feet).

Please can you shed some light on this. All we want is the best for our children and not to have unnecessary surgery.

Kate reply's -

Overlapping toes or mobile curly toes in children rarely persist into adult life. In many cases, the exact cause of curly toes is unexplained although it may run in the family. Since these toe conditions commonly resolve on their own most curly toes cause no pain or trouble and do not need treatment. A wider fitting shoe with a fully adjustable fastening is often all that is necessary to accommodate the toe position. Go to a shop with trained staff who will measure your child's feet for length and width. The small muscles inside the foot that control toe function may be weak. Encourage your child to walk barefoot indoors as this allows the foot muscles to strengthen. Specific exercises that involve gripping the floor can help further strengthen these foot muscles.

In the early stages of noticing a curly toe (in the case of your 2 year old daughter), strapping the toe into a straighter corrected position and soft tissue manipulation / massage can sometimes be helpful. Ask your Podiatrist for the guidance on the most appropriate technique for your child.

Surgical correction of a mild to moderate non-painful overlapping toe in children is rarely justifiable and is often purely cosmetic. However, when it is 'severe' then congenital digital deformities need surgery and insoles and splints will not correct them, please refer to a paper by A. McCulloch in the British Journal of Podiatry about 8 years ago. In young kids soft tissue rebalancing is appropriate if surgery is really needed and ensure you see a Paediatric surgeon who knows about feet. Although if it is not that bad than wait until the child stops growing.



[+] I have difficulty finding shoes to fit my 8 and 11 year old sons

I have had increasing difficulty getting shoes to fit my 2 boys, aged 11 and 8 years. They are both slim, but have wide feet, and we never seem to be able to get shoes which fit around the ankle, providing adequate grip. At our last attempt, the shop assistant pointed out that both of the boy's ankle 'rolled' inwards quite badly and they were very flat footed and may need orthotic insoles. We have tried extra insoles, but without effect. Both boys' shoes wear out rapidly and excessively on one side.

My eldest has recently been complaining of knee pain, but I'm not sure if this is connected or just 'growing pains'.

Kate reply's -

It is good you are aware of the importance of having your children's shoes fitted correctly, as permanent problems can be caused by wearing shoes that are inadequate in length and width.

A shoe with an adjustable fastening across the front of the ankle will ensure a good fit around the ankle even when the front of the shoe is wide fitting. Laces or Velcro allow the shoe to be fastened to the foot allowing enough space for the toes to function properly.

When the front of the shoe curves inwards compared to the heel this can reduce the space available at the toes. Look at the bottom of the shoe and imagine a line or hold a pencil in the centre of the heel. Many shoes are made like this, so look for a straighter shoe shape to help avoid squashing the little toes.

Many shoes also have a narrow sole that your foot overlaps. Good trainers are usually wider underneath. The Children's Foot Health Register is a register of retailers who guarantee to be 'centres of excellence for children's shoe fitting' and 'provide comprehensive training for staff and offer children's shoes in whole and half sizes and in up to 4 width fittings. See the website at: www.shoe-shop.org.uk

It is normal for feet to roll inwards to a certain extent because this movement is required to absorb ground forces when walking. Therefore, a low-arch foot type can be normal when there are no other problems. However, when feet roll in excessively and/or there is pain associated with the feet or legs, treatment is often indicated. Knee pain could be connected with a low-arch foot type and so I would advice you see your local Podiatrist.

Footwear advice and muscle strengthening exercises may be the only treatment needed to help improve foot function. Insoles are used to alter the position of the foot but again I advise you see your local Podiatrist to see if treatment is required and if so which is most appropriate.

When walking the heel strikes the floor on the outside of the heel first and so the outside sole at the heel of the shoe tends to wear down more obviously, which is normal. However, if this wear is excessive it could indicate a problem with foot function and may be used by the Podiatrist to build up a picture of what is happening in the foot during walking.



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Podopaediatrics is the area of podiatry concerned with children's feet. It is focused on the treatment and correction of early foot deformities and improvement of child foot health.

Many deformities that show up in adult life can often be traced back to early foot growth and development in children. Podiatrists focus on preventative foot care and the early detection of foot deformities. It is often possible to prevent the lasting effects of abnormal foot growth and development in children by early diagnosis.

Early diagnosis is essential and many paediatric foot deformities can be treated before they progress into adult foot complications that occur later in life.