Development of the child's arch.

The purposes of the project were to monitor the development of the lower extremities and the longitudinal arch of the foot and to determine whether or not arch support footwear (three types) affected development of a neutral arch in toddlers 11 to 14 months of age until age 5 years. A total of 125 beginner walkers were recruited through the pediatrics department during a period of 1 1/2 years and divided by lot into four different footwear groups (one nonarch supportive). The group was studied for 4 years by physical examinations, x-ray films, and pedotopography (a Moire fringe technique of photography). At initial examination all of the apparently normal toddlers had pes planus by all clinical, roentgenographic, and photographic measurements. There were no cavus feet at that time or at 5 years of age. Arches developed regardless of the footwear worn but development was faster during the first 2 years (until age 3 years) with arch support footwear. The rapidity of arch development until 5 years of age continued in those children who wore longitudinal arch cookies. Ossification of the sustentaculum tali begins at approximately 5 years of age but is not complete for at least another 1 to 2 years. Hyperpronation was present in 77.9% and genu valgum in 92.3% of the 5-year-old children. These conditions are apparently the norm at this age in both boys and girls.