An Article Written By Shaun Vu
Podiatrist – New Step Podiatry.
Children’s bones are fascinating. They grow, change, and develop at an astounding rate, ensuring that our little ones evolve from crawling infants to sprinting teenagers in what feels like the blink of an eye. As a podiatrist, I often get questions from concerned parents about the way their children walk, the shape of their feet, or the positioning of their legs. It’s essential to understand that many of these concerns can be attributed to the natural stages of bone development. Let’s take a closer look at this journey from the hip down to the toe.
The Wonders of Ossification
Bones don’t start as bones! At the earliest stages of foetal development, what will become bones are initially made up of cartilage. Through a process called ossification, this cartilage is gradually replaced by bone cells. This process begins before birth and continues well into adolescence.
Hip and pelvic bones – The Foundation
The journey begins in the hip and pelvic region, where a child’s skeletal structure is first established. These bones provide the foundation for the entire lower body, including the feet. In infancy, the femoral head and acetabulum (the socket of the hip bone) are mostly cartilage. Over time, they ossify, with the adult shape of the hip joint typically forming by adolescence. Proper posture, gait, and overall stability depend on the health and alignment of the hip and pelvic bones. Conditions like Developmental Dysplasia of the Hip (DDH) can cause the hip joint to develop improperly, affecting the child’s ability to walk.
Femur – The Mighty Thigh
The femur, or thigh bone, is the longest and strongest bone in the human body. It plays a significant role in mobility and balance. It develops through multiple ossification centres, with the primary centre forming before birth and secondary centres appearing during early childhood, which forms a candy cane twist-like appearance and corrects itself until skeletal maturity. It can vary per individual but can be similar to the parent’s age of skeletal maturity. 
Knee – More Than Just A Simple Hinge
The knee is another complex joint, consisting of the femur above, the tibia below, and the patella or kneecap in front. As with other bones, the knee has growth plates, and disturbances in this area can lead to conditions like Osgood-Schlatter disease, which affects growing adolescents, causing pain and swelling below the kneecap.
Many toddlers display a bow-legged stance, technically termed as genu varum. By age 3 or 4, this usually transitions into a knock-kneed (genu valgum) alignment. By adolescence, the alignment mostly straightens out. It’s essential to monitor these patterns but remember that mild variations are typically part of natural growth.
Tibia and Fibula – The Dynamic Duo/ Twin Pillars
Below the knee, the tibia and fibula run parallel to each other, with the tibia being the larger of the two. Both these bones play a crucial role in weight-bearing. The point where they meet the foot is the ankle joint.
These two bones of the lower leg undergo rapid growth, especially during growth spurts. Occasionally, you may notice rotational differences in some children, where their feet might turn inwards (in-toeing) or outwards (out-toeing). Such variations are usually due to the tibia’s rotation and often resolve without intervention. In-toeing in children over the age of 4 could originate further up the leg but would need to be assessed.
The Foot – A Complex Structure
The foot is a complex structure with 26 bones, and its development is vital for balance, support, and movement. In infants, the foot often appears flat due to a fat pad. However, as children grow, the arch of the foot starts to become more noticeable. Proper footwear during childhood is essential to support the natural development of the foot and its arch.
Common Concerns:
Flat Feet: It’s normal for children to have flat feet. The arch may not fully develop until age 10 or older. Only if flat feet cause pain or significant walking difficulties should you be concerned.
In-toeing: Often termed “pigeon-toed,” this is when a child’s feet point inwards when they walk. This can result from the shape of the femur, tibia, or foot. Many cases of in-toeing correct on their own as the child grows.
Out-toeing: Less common than in-toeing, out-toeing is when the feet point outwards. Like in-toeing, it’s often a result of bone positioning and can correct itself over time.
Toe walking: Some children walk on their toes. While this can be normal for kids learning to walk, persistent toe walking should be evaluated.
Why Understanding This Matters
Early Detection: Recognizing developmental discrepancies early can lead to more effective treatments. For instance, interventions for symptomatic flat feet, club foot or issues with tripping are often more successful when started at a younger age.
Footwear Importance: Properly fitting shoes can support the natural growth and development of the feet. Incorrect shoe sizes or types can hinder development and even cause foot deformities.
Injury Prevention: Understanding growth patterns can help parents recognize potential areas of weakness, reducing the risk of fractures or other injuries.
Final Thoughts
Remember, every child is unique, and so is their bone development journey. While some might fit the general patterns described above, others might deviate slightly. It’s essential to consult with a podiatrist or paediatric specialist if you have concerns about your child’s bone development. Regular check-ups will ensure that any issues are caught early and addressed appropriately.
In conclusion, the journey from hip to toe is filled with changes and growth. Understanding the stages of bone development can provide peace of mind and allow parents to appreciate the miraculous process that transforms their little ones into adults.
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