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Flat Feet in Children
Link to flat feet in adults
“Flatfoot” (also known as pes planus) is a condition where the foot
lacks an arch on the inside. While the exact incidence of this condition
in children is unknown [1], we do know that it is very common. Given
that almost all children start out with little or no arch, do flat feet
pose a real problem? When, if ever, is it appropriate to intervene? Are
arch supports, special shoes, or in-shoe orthotics necessary?
Almost every child's foot initially has a large fat pad on the inside
arch which slowly decreases as they grow. Most kids eventually develop
a normal arch
It is important, however, to differentiate a normal, flexible flatfoot
from other more serious flatfoot deformities. These more serious
problems are often due to a bony deformity, such as an abnormal fusion
of one or more bones. Determining the existence of a rigid flatfoot can
be easily done in the podiatrists office.
Necessary intervention
When a child presents with flat feet who is between ages six and 10,
and a flexible flatfoot is confirmed, immediate intervention is
recommended to encourage normal development of the arch, and to prevent
pelvic and spinal postural deformities. [6] This is especially true when
one foot is flatter than the other.
Asymmetrical forces imposed during activities can eventually result
in significant cumulative trauma to the foot/ankle complex, knees, hips,
and low back. [6]
If the child is 10 or older, the flexible flatfoot can be considered
permanent, and long-term use of orthotics will be required to prevent
future problems in the feet, lower extremities, and spine. This is
especially true for overweight or athletically active youngsters.
Flexible flatfoot at-home care
- Strengthen the child's lower leg muscles with home exercises,
especially Tibialis Posterior, and Internal/External Rotation
exercises. Also, have the child perform the towel-gathering exercise
('scrunching' a towel lying on the floor with the toes) for 15
minutes daily.
- Insist the child wear supportive shoes with a stable heel (not
worn down on either side) and a strong counter (the shoe material
that fits around the heel of the foot).
- If excessive pronation and flatfoot are noted to persist as the
child matures, correction with custom-made orthotics is indicated.
Shoes
Proper footwear is important for the developing foot; but, whenever
safety and comfort allow, going barefoot stimulates proprioceptors and
encourages muscular coordination and strength. Children's shoes should
have flexible soles to allow for proper foot joint movement. Proper shoe
sizing and fit are critical, since the developing bones are soft and
malleable. Tight, constricting shoes interfere with normal growth and
may result in deformity. Frequent evaluation of size and fit (palpate
the child's foot for pressure points while standing with shoes on) is an
important concept for parents to understand and accept.
Orthotics
Orthotics are seldom needed in the early years of growth (see above). If
a supple flatfoot and/or excessive pronation is seen to persist beyond
ages six or seven, or is responding poorly to home care interventions,
custom-made, flexible orthotics are appropriate. Their additional
corrective support will encourage normal development while preventing
further deformity and reducing abnormal kinetic chain stresses on the
pelvis and spine during the formative years.
References
- Sullivan JA. "Pediatric flatfoot: evaluation and management." J
Am Acad Orthop Surg 1999; 7(1):44-53.
- Notari MA. "A study of the incidence of pedal pathology in
children." J Am Pod Med Assn 1988; 78:518-521.
- Wetton EA. "The Harris and Beath footprint: interpretation and
clinical value." Foot & Ankle 1992; 13:462-468.
- Hoppenfield S. "Physical Examination of the Spine and
Extremities." New York: Appleton-Century-Crofts, 1976:232.
- Luhmann SJ, Rich MM, Schoenecker PL. "Painful idiopathic rigid
flatfoot in children and adolescents." Foot Ankle Int 2000.
21(1):59-66.
- Kuhn DR, Shibley NJ, Austin WM, Yochum TR. "Radiographic
evaluation of weight-bearing orthotics and their effect on flexible
pes planus." J Manip Physiol Ther 1999; 22(4): 221-226.
All pages on this website © 2005-2010
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.
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