Pediatric Foot Health and Development: Why Function Comes Before Form

Flat feet. Toe-walking. Collapsing arches. It’s easy to see why pediatric foot posture sparks concern — not just for parents, but for clinicians too. But when we view foot development through a Dynamic Neuromuscular Stabilisation (DNS) lens, we see a different story: one where motor control, not foot shape, takes centre stage.

If you’ve ever questioned when to intervene, or why so many pediatric interventions fail to produce long-term change, this is your reminder: It’s not about fixing the foot. It’s about restoring developmental sequencing and letting function emerge from the inside out.

DNS: The Missing Lens in Pediatric Foot Rehab

Dynamic Neuromuscular Stabilisation is grounded in developmental kinesiology — the idea that human motor control follows predictable, biologically hardwired patterns in early life. From rolling and crawling to squatting and walking, the nervous system “unfolds” postural and movement strategies that become the basis of long-term function [1].

In DNS, we don’t train muscles — we restore patterns. And the pediatric foot is a perfect example of this principle in action.

The medial arch of the foot is not a structure that needs to be “built” through external support. It is a byproduct of maturation, sensory input, and correctly sequenced load transfer through the body. In other words, when postural control is established centrally — through the diaphragm, trunk, and pelvis — the foot develops its stability naturally [2].

Flat Feet: A Normal Part of the Developmental Sequence

Most children are born with flexible flat feet due to the presence of a plantar fat pad and underdeveloped intrinsic foot musculature [3]. DNS teaches us that this isn’t a defect — it’s a developmental stage.

Research shows that approximately 97% of children under 18 months exhibit flat feet, and by age 10, that figure drops to just 4% [4]. This timeline mirrors key DNS milestones: crawling, kneeling, squatting, and standing — all of which contribute to progressive neuromuscular control and foot loading patterns.

The takeaway? Flat feet in early childhood are not dysfunctional. They are expected. And rushing to “correct” them with rigid orthotics or structured shoes may actually bypass or interfere with the developmental process [5].

The Role of Barefoot Time in Motor Patterning

DNS emphasises sensorimotor feedback as essential for motor development. And the sole of the foot — with its 200,000+ nerve endings — is one of the most information-rich surfaces in the body [6].

When children spend time barefoot, they’re not just strengthening foot muscles. They are:

• Enhancing proprioception

• Refining postural reflexes

• Engaging intrinsic muscles critical to arch formation

• Learning to adapt to different surfaces, textures, and loads

This barefoot exploration helps reinforce the correct sequencing of activation, from the foot upward — exactly what DNS promotes in its early developmental positions [7].

By contrast, stiff shoes reduce sensory input, limit motion, and can delay or distort normal foot function. One study showed that children who habitually go barefoot have higher arches and better balance than those raised in conventional footwear [8].

Understanding Compensation: When the Foot Does Too Much

When DNS patterns are disrupted — by injury, poor sensory input, or inefficient core stability — the body finds ways to compensate. And often, the foot takes the brunt of it.

Common signs of compensation include:

• Toe gripping during gait

• Excessive foot pronation  during propulsion and toe off or valgus collapse

• Rigid toe-walking beyond age 3

These aren’t just “foot problems.” From a DNS lens, they reflect a lack of proximal stability. The body recruits distal structures — like the foot — to make up for missing postural control in the trunk, pelvis, or diaphragm [2, 9].

That’s why relying on calf stretches or orthotics alone often fails. They may offload symptoms temporarily, but they don’t address the root cause: disrupted neuromuscular sequencing.

DNS-Based Intervention: Function Over Form

The DNS approach doesn’t chase the arch. It restores functional milestones:

• Foot loading in crawling and kneeling

• Transitions through deep squats

• Breathing and intra-abdominal pressure control

• Active barefoot play on varied terrain

• Integration of foot movement with trunk and pelvic stability

A 2024 study comparing intrinsic-first vs. extrinsic-first foot rehab found that starting with local stabilisers of the foot (DNS-style) led to greater improvements in arch height and foot function than traditional global muscle strengthening [10].

This reinforces the DNS hierarchy: stabilise first, then strengthen. The body needs the foot to feel and respond, not be braced into submission.

When to Intervene — and When to Let Development Unfold

In the absence of pain, dysfunction, or rigidity, most pediatric foot postures simply need time, load, and sensory feedback to self-correct [5].

That said, DNS-informed clinicians can add tremendous value by:

• Educating families that function precedes form

• Assessing gait and movement transitions (not just static foot posture)

• Recognising when foot compensation is really a sign of trunk or breath dysfunction

• Using DNS developmental positions as intervention tools — not just diagnostic models

Conclusion: The Foot is a Mirror, Not a Machine

The pediatric foot is not something we need to “fix.” It’s a reflection of how the child is sequencing, stabilising, and sensing the world.

By returning to the principles of developmental kinesiology, sensory-rich input, and postural control, DNS offers a clear path forward: build function from the ground up — and from the centre out.

Orthotics, rigid shoes, or outdated foot drills may appear helpful, but they often miss the bigger picture. DNS reminds us that the foot doesn’t function alone — and if we get the sequencing right, the structure will follow.

References (APA Style):

1. Kolar, P. (2014). Clinical Rehabilitation: Dynamic Neuromuscular Stabilization. Prague School of Rehabilitation.

2. Kobesova, A., & Kolar, P. (2014). Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system. Journal of Bodywork and Movement Therapies, 18(1), 23–33.

3. Wenger, D. R., Mauldin, D., Speck, G., & Morgan, D. (1989). Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. The Journal of Bone and Joint Surgery, 71(6), 800–810.

4. Uden, H., Scharfbillig, R., & Causby, R. (2017). The typically developing paediatric foot: How flat should it be? Journal of Foot and Ankle Research, 10(1), 37.

5. Evans, A. M., et al. (2022). Foot orthoses for treating paediatric flat feet. Cochrane Database of Systematic Reviews, (1), CD006311.

6. Kennedy, P. M., & Inglis, J. T. (2002). Distribution and behaviour of glabrous cutaneous receptors in the human foot sole. The Journal of Physiology, 538(3), 995–1002.

7. Bruggemann, G. P., Potthast, W., Braunstein, B., & Niehoff, A. (2005). Adaptation of children’s feet to barefoot and shoe conditions. Gait & Posture, 21, S69.

8. Hollander, K., et al. (2017). Growing-up (habitually) barefoot influences the development of foot and arch morphology in children and adolescents. Scientific Reports, 7(1), 8079.

9. Page, P., & Frank, C. (2010). Clinical application of the DNS approach. International Journal of Sports Physical Therapy, 5(3), 240–248.

10. Chen, Y., et al. (2024). Intrinsic- vs extrinsic-first exercises in pediatric flatfoot rehab: A comparative trial. Scientific Reports, 14, Article 11789.