Flat Feet in Children

Link to flat feet in adults

Does your child have feet that are flatter than normal? Although sometimes this is nothing to worry about, in other situations flat feet can lead to pain and long-term damage to the feet. We specialize in the foot problems of children and can help you determine if your child’s flat feet are something to worry about. Make an appointment for your child in our Seattle clinic if you are concerned.

What is Flat Foot?
“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 our Seattle office. For a complete evaluation of your child, make an appointment for your child today.

Is Treatment of Flat Feet Necessary?
When a child presents with flat feet, our first goal is to determine if your child is currently having, or is likely to have, any problems related to their flat feet. Remember, sometimes flat feet can cause serious problems, but sometimes a person is meant to have flatter feet and that’s just normal for them.

Immediate problems from flat feet can include pain, lack of coordination or a desire not to participate in sports. Long term problems can be the development of deformities such as bunions, arthritis or unstable ankles. By evaluating your child’s feet, gait and family history we can usually determine what kind of problems, if any, your child is likely to suffer as a consequence of their flat feet.

If your child is (or is likely to) suffering any problems caused by their flat feet, then treatment will be started.

Treatment of Flat Feet
Treatment usually includes the use of either prefabricated or custom orthotics designed to do the following:

• Support the foot
• Eliminate pain
• Encourage normal development of the arch,
• Prevent pelvic and spinal postural deformities. [6]

We will also provide you with information about proper shoes for your child and discuss exercises that can prevent problems.

There is some evidence that early use of orthotics can help encourage normal arch development. If your child is 8 or older, the flexible flatfoot can be considered permanent, and long-term use of orthotics will often be required to prevent future problems in the feet, lower extremities, and spine. This is especially true for overweight or athletically active youngsters.

What if One Foot is Flatter than the Other?
Having one foot latter than the other is a more serious problem as these asymmetrical forces imposed during activities can eventually result in significant cumulative trauma to the foot/ankle complex, knees, hips, and low back. [6]

Flexible flatfoot at-home care

1. 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.
    
2. 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).
    
3. You can try some prefabricated arch supports.
    
4. If excessive pronation and flatfoot are noted to persist as the child matures, correction with custom-made orthotics is indicated.

Shoes
Proper shoes are important for the developing foot; but, the proper type of shoe is dependent on what type of foot your child has. Details on shoes for children is available here. Link to kids shoe page Kids with flat feet often require a more stable shoe. Be sure to bring a selection of your child’s shoes in when you bring them in to see us for an evaluation.

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 or prefabricated orthotics are appropriate. Their additional corrective support will encourage normal development while preventing further deformity and reducing abnormal forces on the feet, ankle, knees, hips, 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.

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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.
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