If you’ve ever watched your child limp after sports, complain of heel pain, walk on their toes, or you’ve stared at “flat feet” and wondered if you’re missing something—this page is for you.
Most pediatric foot and ankle concerns fall into one of two categories: normal developmental variants that improve with time, or treatable overuse/sports injuries that improve with the right plan.
What parents need is a clear decision framework: Is this urgent? Is it normal for their age? What can we do at home right now? When should we get it checked?This is our cornerstone “start here” guide. When you want more depth, use the dedicated deep-dive articles for common topics.
Table of contents
1. Quick triage: when to worry
2. A fast symptom-to-likely-cause guide
4. The most common conditions (and what to do first)
6. Prevention: keeping kids active safely
8. How we evaluate kids at Bayshore Podiatry Center
1) Quick triage: when to worry
Seek same-day urgent care if your child has:
- Refusal to bear weight after an injury (they won’t take steps)
- A visible deformity or a foot/ankle that looks “out of place”
- Rapidly increasing swelling after a twist/fall
- A deep cut, puncture wound, or concern for an open fracture
- Fever plus a hot, red, very painful foot/ankle (infection concern)
- Severe pain at rest or pain that consistently wakes them at night
Schedule an evaluation soon (next few days) if:
- A limp lasts more than a few days
- Pain persists for more than 2–3 weeks despite rest and simple home care
- Pain is worsening rather than improving
- Recurrent ankle sprains or a sense the ankle “gives out”
- A foot looks stiff/rigid, especially if shape is changing over time
- One side looks very different from the other
- Your child is missing sports, PE, or play because of pain
Often reasonable to monitor at home (with a plan) if:
- Mild heel pain in a very active child that improves with rest
- Flat feet with no pain and normal activity
- Intoeing in a young child who is pain-free and not functionally limited
- Occasional toe walking in a toddler who can walk heel-to-toe when asked
If you’re unsure, the simplest rule is pain + limp + time. If pain causes a limp and doesn’t trend better over 10–14 days, it’s worth getting checked. You can book an appointment with us in Tampa here!
2) A fast symptom-to-likely-cause guide
Parents don’t search by diagnosis—you search by what you see. These common patterns can help you narrow down what may be happening.
Heel pain (back/bottom of heel)
Most often: overuse irritation at the heel growth center (a Sever’s pattern) in active kids.
Red flags: bruising, swelling after a single big jump/fall, inability to bear weight, pain at rest.
Pain on the inside of the arch with a “bump”
Often: accessory navicular irritation (an extra bone variant that can become painful).
Red flags: stiff painful flatfoot or progressive deformity.
Recurrent ankle sprains / “keeps rolling the ankle”
Often: incomplete rehab after the first sprain, leading to instability.
Red flags: persistent swelling, locking/catching, pain that never fully resolves.
Pain on the outside of the foot near the base of the little toe
Often: an overuse irritation where a tendon attaches (Iselin pattern) or a minor injury.
Red flags: significant point tenderness, swelling, or pain that doesn’t improve—some fractures here matter.
Toe walking
Often: a developmental habit early, or idiopathic toe walking.
Red flags: one-sided toe walking, inability to get heels down, weakness, coordination issues, or developmental concerns.
“Flat feet”
Often: normal flexible flatfoot.
Red flags: pain plus stiffness, one side much worse, or progressive symptoms in later childhood/teen years.
3) What’s normal as kids grow
The biggest mistake parents make is treating appearance instead of treating function.
Flat feet in toddlers
Many toddlers look flat-footed. Early on, the arch may be less visible when standing, and the foot often looks “puffy” through the arch area. In most cases, the important question is not “How flat is the foot?” It’s “Does it hurt, and does it limit what my child wants to do?”
Intoeing and out-toeing
Many gait patterns in kids are normal variants—especially when they’re painless, symmetric, and gradually improving. Intoeing often looks dramatic but improves with time.
Growth plates and overuse pain
Kids aren’t small adults. They have growth plates and apophyses (growth centers where tendons attach), and those areas can get irritated when activity load ramps up quickly. This is why heel pain and other overuse complaints often show up during sports seasons, growth spurts, camps, and tournament weekends.
A quick word on “growing pains”
True growing pains are typically:
- Achy discomfort (often calves/thighs), not sharp point pain
- Often in the evening or at night
- Not associated with swelling, redness, or limping
If your child is limping or has point tenderness in one spot, don’t write it off as growing pains.
4) The most common conditions (and what to do first)
This section is intentionally high-level. If your child fits one of these patterns, start with the home plan and watch the timeline. If they don’t improve as expected—or if red flags are present—get evaluated.
A) Flexible flatfoot (common “flat feet”)
What parents see: the arch looks low or absent when standing.
What matters most: pain and stiffness.
Most kids with flexible flat feet do not need treatment. If the foot is flexible (an arch appears when the child stands on tiptoe) and the child is pain-free, reassurance and normal activity are usually the right move.
Home plan
If painless:
- Supportive, comfortable shoes
- Normal play and physical activity
If painful:
- Temporarily reduce high-impact activity for 1–2 weeks
- Supportive shoes; consider a simple over-the-counter insert for comfort
- Gentle calf stretching if the heel cord is tight
When to get it checked
- Pain that limits activity
- Frequent ankle rolling with pain
- A foot that is stiff/rigid (arch never appears, even on tiptoe)
- One foot is changing shape or looks very different than the other
Myth vs truth: Inserts can be reasonable for comfort in symptomatic kids, but they don’t “build” an arch.
Read more: Flat Feet in Kids: What’s Normal vs What Needs Treatment (supporting article)
B) Painful flatfoot that is stiff (possible tarsal coalition)
When a flat foot is painful and stiff—especially in older kids and teens—it deserves a different workup. One important cause is tarsal coalition, where two bones in the foot are connected and don’t move normally.
What parents often notice:
- Activity-related pain and fatigue
- Recurrent “sprains”
- Stiffness (the foot doesn’t move like the other side)
- Symptoms that show up later (late childhood/teen years)
First steps: reduce impact temporarily and use supportive shoes. If symptoms persist, evaluation and imaging are often needed to clarify the cause and best plan.
C) Intoeing (pigeon-toed)
Intoeing is common and often self-corrects.
Most reassuring pattern:
- Pain-free
- Symmetric
- Child is otherwise thriving
- Gradual improvement over time
Common causes by age:
- Infants: metatarsus adductus (forefoot curves inward)
- Toddlers: internal tibial torsion (shin bone rotation)
- Ages 3–6: femoral anteversion (hip rotation)
What to do first:
- Usually observe and reassure
- Focus on function, not “perfect-looking” gait
- Avoid “magic shoes” or braces unless directed for a specific, rigid condition
When to get it checked:
- Pain, limping, or significant functional limitation
- Progressive worsening over time
- Marked asymmetry
- Persistent severe intoeing in an older child
Read more: Intoeing and Out-toeing: What Parents Should Know (supporting article)
D) Toe walking
Many toddlers toe walk at times. Persistent toe walking is worth discussing with a clinician because it can be idiopathic (no underlying cause) or related to tightness, habit, or less commonly neurologic/developmental conditions.
More reassuring:
- Symmetric
- Child can walk with heels down when asked
- No concerning neurologic signs
More concerning:
- One-sided toe walking
- Child cannot get heels down
- Weakness, coordination issues, or developmental concerns
What to do first:
- If mild and early: monitor and encourage heel-to-toe walking during play
- If persistent: a structured plan focused on calf flexibility, strength, and gait retraining may help
- Some cases benefit from casting or bracing when tightness is developing
Read more: Toe Walking in Kids: When to Watch vs When to Treat (supporting article)
E) Heel pain in active kids (often a Sever’s pattern)
This is one of the most common reasons active kids limp. It is typically an overuse irritation where the Achilles tendon pulls on the heel growth center.
Typical pattern:
- Heel pain during/after running or jumping
- Worse in cleats or very stiff shoes
- Better with rest
- Can flare during growth spurts
Home plan (first 10–14 days):
- Reduce impact: swap running/jumping for biking or swimming if possible
- Supportive shoes; avoid barefoot and flip-flops during a flare
- Heel cushion or heel cup
- Ice after activity
- Gentle calf stretching (consistency beats intensity)
When to get it checked:
- Pain that does not improve after a couple weeks of load reduction
- Significant swelling, bruising, or pain at rest
- Inability to bear weight
Read more: Sever’s Disease: The Common Cause of Heel Pain in Active Kids (supporting article)
F) Outer-foot pain near the base of the little toe
Active kids can get pain at the outside of the foot near the base of the 5th metatarsal. Often it’s an overuse irritation where a tendon attaches. Sometimes it’s a minor injury.
Home plan:
- Reduce impact for 1–2 weeks
- Supportive shoes (avoid flimsy sandals)
- Ice after activity
- If pain is significant, persistent, or very focal, evaluation is appropriate
G) Ankle sprains (and why rehab matters)
The sprain label can be misleading. The main risk is not the first sprain—it’s the second and third sprain that happen because rehab was skipped.
Home plan (first week):
- Relative rest, ice, compression, elevation
- A lace-up brace can help comfort and stability
- Early gentle range of motion as tolerated
The most important step:
- Rehabilitation: balance, strength, and movement control.
When to get it checked:
- Inability to bear weight
- Significant swelling or pain over bone
- Pain that lingers or instability that persists
- Recurrent sprains
Read more: Kids’ Ankle Sprains: What to Do Now and How to Prevent the Next One (supporting article)
H) “Sprain or growth plate injury?” when X-rays are normal
Parents are often told “It’s probably a growth plate fracture” even if X-rays are normal. Many of these injuries behave like sprains. The practical takeaway is the same: protect it, control pain, and follow a guided return to activity. If your child is not improving on the expected timeline, reassessment matters.
I) Fractures and growth plate injuries
If a child cannot bear weight, has point tenderness on bone, or has deformity, evaluation is important. Some ankle fractures in adolescents involve the growth plate and the joint surface. Those are not “walk it off” injuries.
If you’re ever unsure after a significant injury, it’s reasonable to be evaluated. A short delay in proper care can turn a straightforward injury into a longer recovery.
J) Stress fractures and overuse injuries
Think of stress fractures when pain is:
- Localized to a specific spot on a bone
- Worse with impact and better with rest
- Associated with a recent jump in training, camps, tournaments, or new mileage
Home plan:
- Stop impact activity
- If symptoms persist or your child is limping, evaluation is appropriate
Read more: Stress Fractures in Kids: Warning Signs and Safe Return to Sport (supporting article)
K) Accessory bones and “extra bone pain”
Some kids have extra bones that are normal variants. They only matter when they become symptomatic.
Accessory navicular (inner arch pain):
- Pain and prominence on the inside of the arch
- Often irritated by shoes or activity
- Home plan: wider shoes, padding, activity modification
- Persistent pain should be evaluated
Os trigonum / posterior ankle impingement (back of ankle pain):
- Pain in the back of the ankle with pointing the toes down
- More common in sports with repeated plantarflexion (dance, soccer, gymnastics)
- Persistent symptoms should be evaluated
L) Warts and ingrown toenails
Warts (verrucae)
Warts can be stubborn, especially on the sole. Many resolve over time, but treatment can speed clearance and reduce spread.
Home plan:
- Don’t pick at them
- Consider over-the-counter treatments as directed
- Keep feet dry and avoid sharing footwear
Ingrown toenails
Home plan (mild cases):
- Warm soaks
- Keep the area clean and dry
- Avoid tight toe-box shoes
- Don’t dig aggressively into the corner
Get it checked if:
- Drainage or pus
- Worsening redness/swelling
- Significant pain
- Recurrent episodes
M) Teen bunions and forefoot pain
Bunions in adolescents can be structural and sometimes symptomatic. The first line is shoe fit and symptom management. Surgical decisions are more nuanced in growing patients and should be individualized.
N) Less common, but important patterns
High arches with recurrent sprains
A very high-arched foot pattern with frequent ankle rolling can sometimes reflect mechanics or (less commonly) a neuromuscular condition. Persistent instability deserves evaluation.
Inflammatory arthritis patterns
Persistent swelling, morning stiffness, and multi-joint pain patterns are not typical “growing pains.” If you see this pattern, evaluation is important.
5) Myths and misconceptions
Myth: Flat feet always need to be corrected.
Truth: Painless, flexible flat feet are often normal. Pain and stiffness are what change the plan.
Myth: Orthotics build arches.
Truth: Inserts may improve comfort in some kids, but they don’t “create” an arch.
Myth: Toe walking always means autism.
Truth: There are many causes. Some kids toe walk idiopathically. Persistent toe walking should be evaluated so you don’t miss less common causes.
Myth: Heel pain in kids is a heel spur.
Truth: In children and adolescents, heel pain is commonly an overuse/growth-plate pattern.
Myth: An ankle sprain is no big deal.
Truth: The problem is recurrence. Rehab (balance and strength) helps prevent repeat sprains.
Myth: A normal X-ray means “nothing is wrong.”
Truth: Some injuries don’t show on early X-ray. Timeline and function matter.
Myth: Pain is always “just growing pains.”
Truth: Limping, swelling, redness, or persistent point tenderness should be taken seriously.
6) Prevention: keeping kids active safely
Avoid sudden spikes in load
The most common trigger for overuse pain is “too much, too soon.” Tournament weekends, camps, sudden mileage changes, and new sports seasons are classic setups. If you can control one variable, control this.
Prioritize fit and comfort in shoes
Ignore marketing labels. Choose shoes that:
- Fit well (roomy toe box, not cramped)
- Feel comfortable immediately
- Match the activity (running shoes for running; court shoes for court sports)
Build ankle resilience
Simple balance and strength work reduces recurrent ankle problems:
- Single-leg balance progressions (make it a game)
- Calf strength and hip strength
- Controlled jumping/landing mechanics when age-appropriate
Respect limping
A limp is a protective signal. If the child is limping, the load is too high. Rest and adjust before it becomes a longer injury.
Treat skin and nail issues early
Warts spread more easily when ignored. Ingrown toenails are easier to manage early than once they’re infected.
7) Frequently asked questions
Will my child outgrow flat feet?
Many do. If the feet are painless and flexible, observation is often reasonable.
Do inserts or orthotics weaken feet?
Not inherently. The key is not using inserts as a substitute for strength and capacity building.
Is toe walking harmful?
Sometimes it’s benign. Persistent toe walking can lead to tightness over time and should be evaluated.
When does intoeing need treatment?
Rarely. Observation is common unless it’s painful, worsening, very asymmetric, or severely limiting.
How long does heel pain last?
It often improves with load management, but it can flare during growth spurts or heavy sports periods.
Does my child need an X-ray?
Not always. It depends on the injury story, exam, ability to bear weight, and timeline.
How soon can my child return to sports?
A good rule: when they can walk and run without limping and without pain the next day. For sprains, rehab is key before full return.
Are warts contagious?
Yes. They spread through contact and shared surfaces, especially in damp environments.
When do ingrown toenails need a procedure?
When they are recurrent, persistently painful, or repeatedly infected.
Should my child “push through” pain?
No. Pain that changes how they walk is a stop sign.
Do I need special shoes for flat feet or intoeing?
Usually no. Fit and comfort matter more than labels.
Why does pain keep coming back during sports seasons?
Often because the overall load (practice + games + growth spurt) keeps exceeding tissue capacity. A plan has to address load, not just symptoms.
What if my child’s pain is only in one foot?
One-sided pain isn’t automatically dangerous, but it’s a reason to be more cautious—especially if it persists.
What if my child has morning stiffness and swelling?
That is not typical for simple overuse injuries and deserves evaluation.
Can “extra bones” be normal?
Yes. They only become a problem when they become painful.
8) How we evaluate kids at Bayshore Podiatry Center
We start with the basics and we stay practical:
- A careful history: when it started, what activities trigger it, and what has helped
- A focused exam: alignment, flexibility, strength, gait, and where it hurts
- Imaging only when it changes decisions: X-ray is common for injury and bony pain; advanced imaging is considered when needed
- A conservative-first plan: reduce tissue stress, restore mobility and strength, and get the child back to safe activity
- Clear expectations: what should improve and on what timeline
If a condition needs specialty coordination, we help guide that pathway clearly. If you’re in the Tampa / South Tampa / Hyde Park area and you want a clear diagnosis and plan, we’re happy to help. Book here!
9) Sources
- Mosca VS. Flexible flatfoot in children and adolescents. Journal of Children’s Orthopaedics. 2010.
- Evans AM, Rome K. Foot orthoses for treating paediatric flat feet. Cochrane Database of Systematic Reviews. 2022.
- Cady R, Hennessey TA, Schwend RM. Diagnosis and Treatment of Idiopathic Congenital Clubfoot. Pediatrics. 2022.
- Bauer JP, et al. Idiopathic Toe Walking: An Update on Natural History, Diagnosis, and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2022.
- Martin RL, et al. Lateral Ankle Ligament Sprains: Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2021.
- Boutis K, et al. Radiograph-Negative Lateral Ankle Injuries in Children. JAMA Pediatrics. 2016.
- Venkatadass K, et al. Paediatric Ankle Fractures: Guidelines to Management. 2020.
- Olgun ZD, et al. Management of Pediatric Ankle Fractures. 2018.
- Vincent KA. Tarsal Coalition and Painful Flatfoot. Journal of the American Academy of Orthopaedic Surgeons. 1998.
- Houghton KM. Evaluation of pediatric foot and ankle pain. 2008.
- Shelat NH, et al. Pediatric stress fractures: a pictorial essay. 2016.
- Bristow I. Paediatric cutaneous warts and verrucae: an update. 2022.
- Mitchell S, et al. Surgical treatment of ingrown toenails in children. 2010.
- Harb Z, et al. Adolescent hallux valgus: a systematic review of outcomes. 2015.
Medical disclaimer
This page is educational and does not replace individualized medical advice. If your child has severe pain, fever, significant swelling, deformity, or cannot bear weight, seek urgent evaluation.
