Childhood Developmental Stages

Toddlers Runners

How does a child learn to walk? This is a skill we don’t need to teach; it will happen naturally and occurs in very distinct stages. Parents eagerly await those first few steps and often try to rush the process. However, it will take place once the neurological and musculoskeletal systems are mature and cohesive.

A child will begin to stand and cruise along furniture just before one year of age. However, walking independently can happen anywhere between 10-18 months. At this point they have a very wide stance and take many quick steps to maintain their balance. They also walk with their arms held up to protect during falls.

Within 6 months of beginning to walk the child will have developed a more natural walking pattern with their arms down and swinging. They also strike the ground with their heel first as oppose to the entire foot flat at once. However, their feet remain wider apart to help with balance.

As their neurological and musculoskeletal systems continue to develop and make connections they acquire skills such as running, walking on tippy toes, using stairs and standing on one leg. By 8 years old children have developed the gait and posture nearly identical to an adult.

Watching our children develop new skills is one of the joys of being a parent. These skills are inherent and will come with time but cannot be rushed. It is important to make sure your child is hitting the correct milestones but be careful not to wish this precious time away too quickly!

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Pediatric Flatfoot

Pediatric flatfoot is one of the most debated conditions when it comes to deciding whether treatment is necessary or beneficial to avoid. It is not uncommon for doctors to disagree on when to avoid or prescribe treatment, which can be confusing for the parent. What we do know is that children are almost universally flatfooted when they start walking due to a large fat pad underneath their arch. However, as children begin to grow this fat pad decreases and some of the arch structure becomes apparent. At this stage there are two different styles of flatfoot with one being flexible and the other being rigid. Flexible flatfoot can further be divided in to symptomatic (with pain) and asymptomatic (without pain) flexible flatfoot. At this stage, generally in the age range of 5-8, a Pedorthic assessment can help establish which style of pediatric flatfoot your child presents with.

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Shin Splints

My shins are burning! If you’ve even gone for a run or even a brisk walk and felt like your lower leg muscles were on fire you were likely experiencing shin splints. Shin splints are the common term for pain along the shin bone caused by micro-tearing in the muscle and connective tissue that attach muscle to bone. The location of the shin splints depends on the muscle that is affected.

Medial shin splints are commonly felt along the lower, inner portion of the shin bone. These are generally caused by biomechanical issues such as over pronation. The tibialis posterior muscle is responsible for supporting the arch and in cases of overpronation during running it isn’t strong enough to do its job and begins hurting. This type of shin splints are better treated with addressing running mechanics, switching to a more supportive shoe and wearing a custom orthotic to prevent overpronation.

Lateral shin splints are typically painful along the outer upper half of the leg. This type is caused by increased demand on the tibialis anterior muscle. If you have begun a new exercise regime, increased your kilometers, increased your pace or increased your incline you are likely to develop this pain for a short period. Luckily once the muscle adapts to its new demands the shin splints should diminish. You can help this process along by stretching before and after activity, icing, getting a massage and wearing compression socks.

Shin splint recovery can take time; however you don’t have to stop activity completely. Cut back on distance or intensity and try a new sport that has less impact like cycling, swimming and weight training. If in doubt about your type of shin splints, the cause or how to heal them, consult a Certified Pedorthist!

Stretches/Exercises for Shin Splints

Foam Rolling

Comprehensive Exercises


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Tip Toe Walking

photo credit: FotoGrazio Family of 3 via photopin (license)

As a child I can recall walking down the street with my mom, my older brother a few meters ahead of us. As we walked my mom instructed “heel, toe, heel, toe”. She was concerned because although he was nearing his teen years my brother was still a frequent tiptoe walker. This was a practice he’d retained from childhood and I was starting to model his behaviour.

Tip Toe walking is commonplace until approximately the age of three years old. After such time a normal heel to toe gait pattern typically emerges. Toe walking that continues past this age can lead to tight Achilles tendons, which perpetuates the toe walking. Young children can also be distracted while walking and, in addition to tripping and veering; toe walking can be a hazard of this behaviour. However, it can also be a symptom of a more serious condition such as cerebral palsy and muscular dystrophy. Typically these cases also present with additional symptoms and milestone delays. If there is ever a concern about a more serious cause seek the advice of your pediatrician or family physician.

It is important for parents to outfit children in supportive footwear that fits correctly and sometimes a helpful “heel, toe” reminder can aid their normal gait development. If you are concerned about your child’s toe walking ask one of our Canadian Certified Pedorthist for their guidance.

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Legg-Calve-Perthes Disease

hipdysfunction1I’m willing to bet the majority of the public has never heard of Legg-Calve-Perthes disease and that’s exactly what this little blog is hoping to remedy.  Commonly known as Perthes disease this condition typically affects boys age 4-8.  It begins with the blood supply to the femoral head inexplicably stopping.  Once the blood supply ends the femoral head begins to slowly die and misshapen.

As the contact between the femoral head and the acetabulum decreases, pain, limping and range restrictions increase.  This is when parents will typically notice children complaining of pain with activity and seek medical attention.

hipdysfunction2After proper diagnostic imaging and orthopaedic assessment the normal course of treatment includes: physical therapy to maintain range of motion, activity restriction and bracing.  All of these methods are in an effort to maintain mobility until proper blood supply does return.  Understandably children who have suffered from Perthese disease are more likely to have arthritis later in life, at which point additional treatment may be necessary.

If you have any concerns regarding your child’s hip development and walking please call us to book an assessment with a Certified Pedorthist.

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I tore my lateral meniscus this year because I play like I think I’m 21 ( I’m not- I’m 42!) Yes, it hurt, it was swollen and I felt like an idiot for pushing myself so hard. I did a lot of physio and therapy and everything I was supposed to. The Canadian long drive championships were 4 weeks away, and I did not have enough time to repair it and recover in time. Thankfully I found the Bauerfeind Genutrain S brace. The brace gave me enough compression and knee joint stability with its compression knit technology and dual plastic hinges, which decreased my tracking issues in half! Be fully aware that bracing is a band aid solution, and the best option is always to strengthen and fix the underlying issue. Given that I had to continue to compete at an elite level, I needed something to give me the confidence to keep swinging out of my shoes and not hurt myself more.

-Fareen Samji

Meniscal tears are a common injury of the knee. The meniscus are c-shaped discs that are designed to add a cushioning layer inside the knee joint. A torn meniscus can alter the way the knee joint functions, and can be painful.

meniscausSigns and symptoms of a torn meniscus:

  • Instability or sensation of giving way
  • swelling
  • pain with range of motion
  • decreased range of motion
  • any clicking or catching inside the joint


Diagnostic imaging is usually needed in order to properly diagnose any meniscal tear. Depending on the severity of the tear, rest may be all you need. If there is any clicking or decreased range of motion at the joint or pain with movement, then an orthopedic surgeon will arthroscopically scope the knee and repair or remove any damaged portion of the meniscus. In which case the healing process is that much longer of a timeline.


Depending on the severity of the tear, the Bauerfeind Genutrain S and the custom Bledsoe Z12 brace are great. The genutrain S will act on minor meniscus tears and the Z12 will act on more severe tears.

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Haglund’s Deformity

Haglund’s is a fancy name for the bump at the back of the heel that forms in some people. It is also called pump bump because it is quite common in women who wear dress shoes. The action of the shoe rubbing up and down on the back of the heel could be a contributing factor. There is a hereditary factor that may contribute to Haglund’s and people with high arches may be predisposed. When you have a high arch it causes the uppermost portion of the back of the heel bone to rub against the Achilles tendon, which in combination with certain styles of footwear can lead to the formation of the bony protrusion seen in Haglund’s deformity. Once this protrusion has formed, the bursa in the area tends to become inflamed leading to painful bursitis.

The majority of children I have seen with a Haglund’s deformity have been competitive hockey players playing 5-6 times per week. This is thought to be due to how rigid hockey skates are and at times they have pressure points at the back of the heel where the Haglund’s deformity is formed. Once the deformity has formed, it is common for the continuous irritation between the bony growth and back of the skate to lead to rbursitis. This is typically when children begin having symptoms.

A Pedorthic assessment can determine if custom foot orthotics would help reduce the discomfort or if accommodation pads can be implemented in footwear to reduce the irritation between the deformity and the shoe. Heel lifts can be added to custom foot orthotics or placed separately in footwear to slightly raise the heel to help relieve some tension in a tight Achilles tendon. This should be accompanied with a stretching program for the calf muscles to help lengthen the tendon.

Footwear that are backless or have a soft back would help limit irritation to the area associated with this condition. Accommodation pads can also be added to the interior portion of the back inside footwear to help create a pocket for any bony growth at the heel. These pads are intended to reduce any rubbing between the bony growth and interior portion of the shoe.

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Does Your Child In Toe?

intoe-2Childhood developmental milestones are a huge concern for parents. Everyone wants to make sure their little one is hitting the landmarks they should be. Crawling, walking, and running; these are all things we assess to ensure our child is where they should be. So it comes as no surprise that when something appears amiss we are quick to look for confirmation of normalcy.


intoe-1As Certified Pedorthists we assess gait patterns in people of all ages and young children are no exception. One of the most common reasons for a pediatric assessment is worry regarding in-toeing. It is important to remember that in-toeing is very common in young children due to the structural position of their hips and legs at a young age. In the majority of children these structural positions resolve by eight years old.


intoe-3It is possible to aid in correcting childhood in-toe. A specialized orthotic called a “gait plate” is used to gently guide the child toward a more straight foot position. In addition it is important to use well-structured footwear, verbally encourage pointing the toes forward with walking and reinforce sitting with legs crossed in front of them. The commonly seen “W” position, when sitting can encourage the continued internal rotation that perpetuates in-toeing.

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Elbow Tendonitis- Golfers elbow or Tennis elbow?

fareenI have been an avid tennis player and golfer my whole life and I consider myself in pretty decent shape. When I developed elbow tendonitis, it was debilitating! I was so sore after a round of golf, I couldn’t even lift a cold drink can to my mouth! I would take the can and place it on my elbow for some relief instead. I didn’t think much about it, but then it started to affect every aspect of my life. I couldn’t carry grocery bags, my briefcase, anything. More importantly, it hurt a lot when I was trying to hit a forehand or swing a golf club. Icing and some active release and massage certainly made a big difference and it was a “good pain” during treatments! But I needed something to make sure that I could still play – yes, I know I’m supposed to rest it, but if it flared up in the middle of a competition I needed something more than Advil to help me get through. Cue the Epitrain elbow brace from Bauerfiend. Don’t know what it is about German engineering, but this brace saved my round many times! It’s an easy to wear, simple pull on piece that works for either golf or tennis elbow , and it breathes so you can wear it in the heat and it will not smell too much ! The gel pads go right over the points of nerve entrapment on your elbow and provide instant relief. As soon as I pulled it on and started swinging I felt better right away. Not only did the pain diminish but it also gave me the confidence to swing hard which is something that I really enjoy doing when it comes to driving the golf ball!

Fareen Samji, 4 Time ILDC Canadian Women’s Long Drive Champion

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The Best Over-The-Counter Knee Brace

genutrainineeThere are so many over the counter knee braces that sometimes it’s hard to decide which one is better for you. The concept of all them are the same. Compress the area around the knee and keep the swelling down. My personal favourite is the Genutrain by Bauerfeind, for several reasons, the first being that it is very comfortable to wear. The knit fabric that is integral to all Bauerfeind products is breathable and washable. No more sweaty, stinky, black neoprene sleeves that feel disgusting after one use! The silicone omega pad surrounds the knee cap keeping the patella in place so that it tracks efficiently and provides a great feeling of stability around the knee. The fact that the knee cap is closed means that any swelling in the knee is dissipated nicely in conjunction with the compressive actions of the fabric. The sense of instant relief is second to none when you have the Genutrain on. It’s lightweight, fits under most pants discreetly and is very comfortable to wear. I play a fair amount of golf and badminton and my kids keep me pretty active playing with them or hiking the Bruce Trail. My knee doesn’t always hurt but when I push it too hard or am on uneven surfaces, it starts to bother me. I immediately go to my Genutrain and feel instant relief. Theoretically, the best cure for knee pain is to strengthen the muscles around the knee. My feeling is that if your knee hurts and you can’t do the exercises you need to do to stay healthy then please wear the brace. It’s lightweight, easy to slide on and it works, and did I mention it was breathable and washable!

Fareen Samji, Certified Pedorthist, C.Ped. ( c )

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