1 Does your child have a painful or tender foot?

2 Has your child injured his or her foot recently?

3 Is your child able to walk on the foot?

4 Does the pain only occur when your child is wearing shoes?

5 Does your child have one or more painful lumps of hard, roughened skin on the sole of a foot?

6 Does your child have a red, tender area on the sole of the foot?

7 Does your child have itchy, tender, peeling skin between the toes?

8 Are you concerned about the appearance of your child's feet?

9 Does one or both of your child's feet turn inwards?

10 Does the whole foot including the heel turn inwards, and has it been like this since birth?

11 Are you concerned that your child may have flat feet?

12 Is your child under 3 years old?

13 Are your child's toes bent or curled under?

14 Does your child have a red, tender swelling around the big toenail?

15

Possible cause A minor sprain or strain of the ligaments or muscles in the foot is likely.

Action Follow the advice for treating sprains and strains in a child, and encourage your child to rest with the foot raised for a few hours. See your doctor within 24 hours if the pain is severe or is no better the next day.

16 Emergency! Call an ambulance

Possible causes Your child may have a fracture or a serious injury to the muscles or ligaments of the foot.

Action Your child will need an X-ray to determine the type and extent of the damage. A procedure may be needed to reposition the bones. Depending on the nature of the injury, your child may need to wear a plaster cast or a firm bandage.

17

Possible causes and action Check your child's shoes for stones or thorns, which could be the cause of the problem. Also check inside his or her socks. As children's feet can grow very rapidly, make sure your child's shoes still fit comfortably, even if they are relatively new.

18

Possible cause Your child may have one or more plantar warts, that grow into the sole of the foot as a result of pressure from the weight of the body. They are caused by a viral infection of the skin.

Action Most plantar warts will disappear naturally in time; however, this may take months or even years. Over-the-counter preparations can be used to treat them effectively. If a plantar wart persists after treatment, consult your doctor. He or she may remove it by freezing, burning, or scraping it off.

19

Possible causes Your child may have an infection from a cut or a foreign body, such as a splinter, embedded in the skin.

Action If you can see a splinter or other foreign body in your child's skin, remove it using a pair of tweezers. Once it is removed, the wound should heal quickly. If the foreign body is too deep for you to remove or if the cause is not obvious and the sore is no better the next day, you should see your doctor within 24 hours.

20

Possible cause Athlete's foot, a fungal infection, is the likeliest cause.

Action Regularly wash and dry your child's feet carefully, particularly between the toes, and apply an over-the-counter antifungal cream. When indoors, your child should wear open-toed sandals or go barefooted whenever possible. If your child's symptoms persist for longer than 2 weeks, consult your doctor. If redness and swelling develop in the foot, see your doctor within 24 hours.

21

Possible causes The shape of your child's foot may be due to an abnormality in the structure of the bones in the foot or to the position of the baby's foot when it was in the uterus. It is usually noticed by a doctor when the child is born. Consult your doctor.

Action If the shape of the foot has resulted from its position in the uterus, it should correct itself within a few weeks of birth. If the shape of the foot is due to a structural abnormality, treatment will consist of manipulation and the use of a splint. If this has not corrected the problem by 3 years of age, an operation may be needed.

22

Possible cause and action Your child may have a condition called "intoeing". This is usually noticed when a child begins to walk and is often caused by the inward rotation of the whole leg from the hip or by bow legs, both of which are normal in some children. Consult your doctor so that the diagnosis can be confirmed. This condition rarely needs treatment. Bow legs usually correct themselves by the age of 3 years, while hip rotation usually corrects itself by the age of 8 years. In rare cases, an operation is needed to correct the problem.

23

Possible cause and action Children under 3 years of age usually have flat feet because the muscles, ligaments, and bones in their feet are not yet fully developed. The fat pad in the feet of young children also adds to this appearance. There is no cause for concern at this age because a normal arch will probably develop as your child grows.

24

Possible cause and action Flat feet are often inherited. In this condition, ligaments in the foot are lax and only form an arch when the child stands on tiptoes. Flat feet are rarely a cause for concern and do not prevent a child from doing well in sports or cause problems in the future. Special exercises and shoe inserts are almost always ineffective and unnecessary. If your child's feet are painful or if you are worried, consult your doctor.

25

Possible causes and action If your child was born with bent toes, there is probably no cause for concern. If they lead to pain or embarrassment, however, an operation to straighten the toes may be recommended when your child is older. If the condition has developed recently, your child's shoes and/or socks may be too small. Make sure your child always wears well-fitting shoes and socks.

26

Possible cause An infected, ingrowing toenail is a likely cause. This may be the result of cutting the toenails incorrectly or wearing shoes that are too tight. Consult your doctor.

Action Your doctor may prescribe antibiotics and drain any pus under a local anaesthetic. Surgery is sometimes recommended to remove part or all of the toenail (see Removal of an ingrowing toenail). To prevent ingrowing toenails, your child should always wear correctly fitting shoes or, if practical, open-toed sandals. Keep the affected area clean and dry, and always cut the toenails straight across rather than in a curve.

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Consult your doctor if you are unable to make a diagnosis from this chart.

28

Consult your doctor if you are unable to make a diagnosis from this chart.

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Consult your doctor if you are unable to make a diagnosis from this chart.