I want to tell you a true story. I met a 3-year-old girl whose parents were concerned about the way she walked. The little girl indeed had a foot distortion. She put her body weight on the inside of the soles, while her toes pointed outward.
Although at this age it’s difficult to distinguish something we would call normal from something unnatural, I was immediately alarmed when I saw this little girl. It was not only her feet, but her whole posture and the way she moved told me that something was wrong.
I’m not a big fan of putting children through physical therapy if it’s not necessary, so I examined her thoroughly and confirmed my suspicions. Unfortunately, the parents’ concerns were justified.
The girl really did need physical therapy, not only due to her feet distortion, but also to improve the overall quality of her daily functioning.
BUT, TO THE POINT:
During one of our meetings, the girl’s mother asked me if she might have missed something earlier. Was there a chance of noticing the red flags before her daughter started walking? Maybe then detecting a possible abnormality and implementing appropriate treatment early would have changed something…
To tell the truth… yes and no.
On the one hand, as physiotherapists, we are indeed able to predict certain situations even before they become obvious, but… can we expect the same from parents? Can we really expect from them this kind of awareness if, for example, they became parents for the first time and absolutely everything is new to them? Sometimes we forget, but… the huge amount of challenges that a new parent has to face on a daily basis can be overwhelming. I know a thing or two about it as well… 😉
So, in my opinion, education is very important – and I would restrain from making judgments.
WHAT WAS THE CASE OF THIS LITTLE PATIENT?
When the girl’s mother thought back about her infancy, it turned out that her daughter always belonged to the less active group of children. Of course, she was interested in toys, but if something required more effort than what her abilities allowed her to achieve, she would often give up. She rarely raised her legs, she wasn’t really interested in playing with her feet and didn’t enjoy lying on the side. She didn’t stand upright until she was 12 months old and for a long time, she needed support. When she learned how to walk on her own, she walked at a quick pace and sometimes had trouble stopping.
DID ANY OF THIS MATTER?
For me — it did. If it was up to me, I would have taken a closer look at the activity of this baby, at least from the moment I noticed that she’s not interested in playing with her feet. But it’s hard to require such knowledge from parents who are not physiotherapists. After all, psychomotor development is not the only area which we have to keep an eye on. 😊
In this post, I want to focus on the things that I haven’t had the chance to write about so much yet.
I want to show you how little feet prepare for their future role and to make you realize that they are not just an adorable bonus to your baby, which we should pay attention to only when the child begins to use them for standing upright.
They’re cute of course, but… their activity can tell you much more than you think. 😉
WHAT IS NEEDED TO BE ABLE TO WALK?
Looking closely at the walking cycle, you see that in order to move efficiently, apart from obvious body control, keeping the weight above the ground and keeping balance, you also need:
- shoulder and hip dissociation (separation of their movements from each other),
- limb dissociation (alternate movements of the right and left leg, hip, knee, foot),
- shifting the body weight from side to side,
- pointing and flexing the foot,
- straightening and bending of the knee,
- straightening and bending of the hip.
It’s a lot, isn’t it? And… did you know that babies work on all of this from the very first days of their lives? Take a look:
NEWBORN:
Both when lying on the back as well as on the belly, a newborn engages in primal kicking movements. These movements take place in the Sagittal Plane (bending, straightening) and start from the heel — when the baby kicks, it’s the heel, not the toes, that leads the movement. The kicking movements can encourage babies to push their feet off the ground when lying on the tummy.
3RD/4TH MONTH:
By this time, babies reach the stage of strong symmetry, joining their hands in front of their chests, and raising bent legs. The bottoms of their feet touch and they can rub them against each other. This strengthens the muscles responsible for the arch of the feet, prepares them for their supporting function, and regulates their sensitivity to touch. Such activity is also beneficial in terms of babies building a sense of their body scheme.
In lying on the tummy, the baby’s legs are freely straightened. The knees are kept relatively close to each other, almost in line with the hips. The feet become more active — you can notice them pointing and flexing as well as the movement of rubbing the feet against each other.
AROUND THE 5TH MONTH:
Around the age of 5 months, babies start to do a lot more straightening movements. Up until now, they were mostly flexing, however… assuming an upright position and moving in it is, to a large extent, the same as straightening. That’s why, it would be useful to work on it a little. 😊
During this period, you can notice that babies lying on their backs will lift their legs up and when their hips start to bend, the knees straighten. Straightening of the knee while the hip joint is bent is evidence of progressive dissociation (the separation of movement) within the legs and it prepares the lower limbs for walking (the lunge phase).
*Up until now, the baby straightened the knees only when there was also the straightening movement within the hip joints… But if we followed such pattern, it would be very difficult for us to move in the future…
The child continues to rub the soles against each other, makes kicking movements, and stomps their feet.
“SWIMMING” is another activity thanks to which the baby has a chance to work on straightening, not only in the spine area, but also in the hips. Before, the hip joints were often bent, but from now on, “swimming” makes it possible for the baby to focus on ensuring that the length of the muscles allows them to fully straighten in the hip joint. Will this by any chance be what happens in the leg that performs the “reverse lunge” during walking?
It is worth remembering that the right lengthening of the deep muscles in the pelvic area affects the position of babies’ hips, and thus will be significant for the future posture of their body.
5TH, 6TH, 7TH MONTH
When lying on the back, babies reach for their thighs, knees, shins and feet. Oftentimes, at the end of the 6th month of life, babies put their toes in their mouths, work on the full range of external hip rotations, and stretch their feet.
During this time, children can also grasp objects with their feet, which then shapes the functional length, width, and height of the foot.
When children grasp objects in this way, they put pressure on the soles of their feet.
Could this be in preparation for putting more pressure and weight on the feet when they start walking??? 😊
ROTATIONS:
Is it possible to prepare little feet for their later function by… rotating?
Yes, of course! Looking at the baby’s activity, you can notice the so-called limb dissociation (the separation of work of both legs). The leg that is placed higher during rolling over works in the pattern of flexion, abduction, external rotation (forward lunge) and the other, lower-lying leg, is more straightened (reverse lunge).
PLAYING IN A SIDE POSITION:
When you look at your child playing in a side position, keep in mind that in this way, he or she not only satisfies their curiosity about the world, but also works very hard on… the future function of their little feet.
In this position, the baby for the first time experiences WEIGHTING DOWN of the feet (so far, he or she has been grabbing objects with the feet and working on stretching them, but now… it’s time to go one step further).
If you look closely at this photo, you will notice that:
- the lower-lying foot is in supination, meaning that its bottom is turned towards the ceiling,
- the upper-lying foot takes on part of the body’s weight,
- the gripping function of the feet gradually disappears,
- although it’s not visible, the head of the thighbone centralizes in the joint socket,
- the inside edge of the foot is raised and the heel is set in the desired intermediate position.
Quite a few important things are happening there, right? 😊
OTHER ACTIVITIES:
Preparing the feet for their future function also happens during other activities, such as:
- Pivots, in which the weight of the body is located in the pelvic area, and both sides of the body are dissociated (the right leg is bent when the left leg is straight and vice versa).
- Crawling, during which the body’s weight shifts from side to side, the feet roll forward, and the baby pushes off the ground with the bottom of the big toe. And don’t we actually push off the ground with our big toe when walking?
- Moving on all fours — when children master shifting the body’s weight to the sides and dissociation (separating the work of the right and left side), they also practice placing the knees in line with the hips and the feet in the same line as the shins.
- Kneeling — while kneeling, the foot is in slight supination, is aligned with the shin as the toes are pointed, which helps to form its shape.
Kneeling also involves straightening of the hips.
Do you remember the deep pelvic muscles mentioned during “swimming”? The straightening of the hip while kneeling encourages the child to constantly work on their length, so that achieving a range of motion in the joint that makes the baby’s walk smooth, elegant and qualitative is possible.
…
Of course, if you were to dive even deeper into the subject, you would discover that the feet really have a lot of functions in many other activities and… that they cannot be separated from that bundle of joy that is the baby.
If you want to support the development of those small feet, bear in mind all the previously mentioned elements, because thanks to them, the feet — when they finally take on the weight of the body, are properly prepared for the task.
That’s why, give your child freedom, provide them with a variety of experience, play with them in a way that supports the achievement of different skills important for individual stages of development – the first 6 months of life. Be observant, avoid forcing the child to do activities for which he or she is not ready, make sure that the baby feels safe and doesn’t feel pressured to tense the body in incorrect patterns . Also, avoid using equipment that could negatively affect the work of small feet — you really can do without them! -> bouncer.
CAN THE ABSENCE OF ANY OF THESE ELEMENTS INDICATE A PROBLEM?
As you probably know very well, there’s no such thing as two identical babies, as every single child develops differently. There is no one ideal developmental path from which a deviation would indicate that the baby doesn’t develop well. What you see in one child may occur almost imperceptibly in another. And it’s not possible to predict anything based on the lack of only one activity.
As for the feet, you should remember that they are not a separate entity, but part of the whole. You should always look at your child holistically, because how the feet work largely depends on postural tension. You never evaluate only the QUANTITY of what the baby can do, but you also take into account the QUALITY of particular activities. Only then can you get the whole picture of the baby’s process of development. 😊
So, shower your baby’s feet with kisses but also… keep in mind that they are not there just because they are cute, but that they work really hard to eventually take your baby on the journey of their life. 😊
If you still wonder what you can do to help your baby prepare for walking, my suggestion is to take a look at the developmental games in all of the above mentioned positions. Check out my propositions for fun playtime activities that focus on preparing the baby to one day take on the world on their two own feet! 👶👣
Sources:
- Bly, Lois (1995), “Motor Skills Acquisition in the First Year:” Therapy Skill Builders.
- Zukunft- Huber, B. (2013), “Three-plane Manual Therapy of Foot Defects in Children”.
- Gogola, Anna; Matyja, Malgorzata (2011), “Sensomotor Education of Infants:” Katowice.
