Sore feet in active kids: when to see a podiatrist about orthotics

Your eight-year-old limps in from Saturday Little Athletics rubbing the back of her heel. She says it’s fine. By Monday’s sport lesson it isn’t, and she sits out the relay. Most aches in growing kids settle within a few days. Pain that keeps coming back after activity is a different matter, and a podiatrist can usually tell you why it’s happening. Sometimes the answer is a pair of custom orthotics. More often it’s a stretch routine or a better school shoe.

Growing pains or something more?

Growing pains usually come on in the evening and affect both legs. By breakfast they’ve gone, and your child runs around happily with nothing swollen or red.

Pain tied to activity behaves differently. A sore heel like that Little Athletics one, in a child aged roughly 8 to 14, is often Sever’s disease. The growth plate at the back of the heel gets irritated where the Achilles tendon pulls on it. It tends to flare during footy and netball season, and again over a Perth summer when school ovals dry out and turn hard underfoot. Kids grow out of it. Without the right management, though, it can keep them on the bench for months.

Foot shape worries parents more than it needs to. Toddlers’ feet look flat because of a fat pad under the arch, and most children have a visible arch by the early school years. If a flat foot is flexible and doesn’t hurt, it often needs no treatment at all.

Signs your child should see a podiatrist

Heel pain is the most common reason parents book. Other things to watch for:

• Heel pain that returns after sport, or stops your child joining in
• Tripping and falling well past the toddler stage
• Toe walking after about age three (on one side only is a stronger reason to book)
• Flat or high-arched feet that ache, or tire before the rest of the class does
• Shin or knee pain when running
• One leg that looks longer than the other

You don’t need a GP referral to see a podiatrist in WA. A referral only matters if you’re claiming a Medicare rebate through a GP care plan, so ask your GP about that first if it applies.

At the first visit the podiatrist will watch your child walk and run, and ask about their sport and shoes. They’ll also check for tight calf muscles and stiff joints. Bring the shoes your child wears most, the scuffed ones rather than a new pair. A heel worn down on one edge, or one shoe wearing faster than the other, tells the podiatrist a fair bit about how your child lands. Plenty of kids walk out with stretches and advice on shoes rather than an orthotic prescription.

What happens when a podiatrist prescribes orthotics

A podiatrist usually suggests orthotics once stretches and better shoes have had a fair go and the heel or shin is still sore, especially if the way the foot moves is adding load to that spot.

An off-the-shelf insole is shaped for an average foot. A prescribed orthotic is built from your child’s own foot structure and the way they walk. At Midland Podiatry, a clinic in Perth’s eastern suburbs, the podiatrists prescribe custom orthotics after a biomechanical and gait assessment. Plaster casts of the feet go to an orthotics lab with the prescription, and the finished pair can be swapped between school shoes and sneakers. Follow-up checks come once your child has got used to wearing them.

Children don’t usually wear new orthotics all day from the first morning. Most start with an hour or so and build up over a week or two while their feet and legs adjust. If a blister or a new sore spot shows up, ring the clinic instead of pushing through.

Custom orthotics cost more than a chemist insole, and a growth spurt can mean your child needs a new pair. Many private health extras policies include orthotics under podiatry, with yearly limits, so check your cover before the casting appointment. Before you agree to a pair, ask the podiatrist what the orthotic is meant to change and how you’ll both know it’s working. A good podiatrist will have a straight answer.

Choosing supportive school shoes

An orthotic can only do its job in a shoe that holds it. Take the inserts with you to the shoe shop and try them in each pair.

Squeeze the back of the shoe between your thumb and fingers. A good heel counter stays firm instead of folding. Then hold the toe and heel and bend it: the sole should flex where the toes bend and stay stiff through the middle. Laces or velcro stop the foot sliding forward, and a removable inner sole lets the orthotic sit flat.

Shop in the afternoon, when feet are a little bigger, and leave about a thumb’s width past the longest toe. Kids grow fast, but a shoe bought two sizes too big makes them grip with their toes and trip more.

Thongs and slides are a Perth summer staple, and they’re fine for the beach or the backyard. Most kids will argue the point, but for a full school day of running around, a supportive lace-up or velcro shoe is the better pick, especially for a child who already gets sore feet.

For the eight-year-old limping in from Little Athletics, a sensible first step is a few weeks in supportive shoes with a bit less running. If her heel still hurts after that, or her walk looks off to you, book her in.