Flat Foot in Children

Introduction
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet [1]. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA. The good news is that the vast majority of cases, especially in children, require only conservative (non-surgical) treatment, if any at all.

What Causes Flat Feet?
There are many different causes of flat feet, which can be separated into two main categories. The first category, congenital flat foot, is a condition that one is born with or is predisposed to at birth. This type includes the completely asymptomatic, pediatric flexible flat foot-by far the most common form of congenital flat foot [2]. Flexible means that an arch is present until weight is put on the foot, at which time the arch disappears. This foot type is a result of the fact that all people are born with different physical features. Some people have bigger noses than others, just as some people have flatter feet (of course, there is no known correlation between the two). Any alteration in the many building blocks of the foot can influence its shape.
 

At the other end of the spectrum, exist several rare, more severe forms of flat foot. These severe conditions include conditions  which are more rigid (no arch with or without weight on the foot) and definitely symptomatic. Luckily, these are much less common, but can usually be identified by specialists at the time of presentation and treated appropriately.

The second category, acquired flat foot, develops over time, rather than at birth. Many different factors can contribute to the development of flat feet. These include the types of shoes a child wears, a child's sitting or sleeping positions, compensation for other abnormalities further up the leg, or more severe factors such as rupture of ligaments or tendons in the foot. Very commonly, the reason for flat feet is that the foot is compensating for a tight Achilles tendon. If the Achilles tendon is tight, then it causes the foot to point down, or to plantarflex (as occurs when stepping on the accelerator of your car). The body tries to compensate by pronating, or flattening out the arch, thereby making up for the perceived extra length on the affected side.

The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction [3]. This develops with repetitive stress on the main supporting tendon of the arch over a long period of time. As the body ages, ligaments and muscles can weaken, leaving the job of supporting the arch all to this tendon. The tendon cannot hold all the weight for long, and it gradually gives out, leading to a progressively lower arch. This form of flat foot is often accompanied by pain radiating behind the ankle, consistent with the course of the posterior tibial tendon.

Compounding matters is the fact that the human foot was not originally designed to withstand the types of terrain and forces it is subjected to today. Nowhere in nature do you see the flat hard surfaces that we so commonly walk on in present times. Walking on this type of surface continuously puts unnatural stress on the arch. The fact that the average American is overweight does not help the arch much either-obesity is a leading cause of flat feet as the arch collapses under the excessive bodyweight. Furthermore, the average life span has increased dramatically in the last century, meaning that not only does the arch deal with heavy weight on hard flat ground, but also must now do so for longer periods of time. These are all reasons to take extra care of our feet now in order to prevent problems later.

Treatment Options
Just as there are many different causes of flat feet, there are also many different treatment options. The most important aspect of treatment is determining the exact type or underlying cause of flat feet that you have. Foot and ankle specialists can determine this through thorough clinical examination and special imaging studies (e.g., x-rays, computed tomography, and/or magnetic resonance imaging). Conservative treatment is effective in the vast majority of flat foot cases, and consists of things such as insoles, splints, manipulation, or casting. Surgery is required much less frequently, and is reserved only for some of the severe types of flat foot that do not respond to conservative therapy.

Adult Acquired Flat Foot Treatment: Acquired flat foot is an entirely different entity in itself. The best way to treat acquired flat foot is to never acquire it in the first place. This is where proper, well-made and well-fitting shoes come into play.   Arch supports – either over-the-counter or custom can also help prevent the onset of the adult flatfoot.  

If you have already acquired flat feet, again the treatment is based on the exact type of problem that you have. If we determines a tight Achilles tendon to be the cause, then we may prescribe some combination of stretching and strengthening exercises or possibly physical therapy and orthotic devices. If Posterior Tibial Tendon Dysfunction causes your flat foot, conservative measures may include rest, immobilization, shoe gear modifications, orthotics, bracing, and anti-inflammatory medications [6]. Depending on the severity, we  may deem it necessary to cast your foot while the tendon repairs itself. Because Posterior Tibial Tendon Dysfunction is progressive (worsening over time), it is essential to seek medical attention early, as conservative measures tend to fail in the later stages of dysfunction.

Wonderful World of Orthoses: You may have noticed that one common element in the conservative treatment of all types of flat feet is orthotics.  Depending on your problem we may recommend OTC orthotics or custom functional orthotics.   In some more severe cases, an ankle-foot orthotics may be necessary. 
 
Surgery: Flat feet that do not respond to conservative therapies, remain painful, and/or continue to cause other problems, may require surgery. Again, the surgical procedure selected is entirely dependant on the type and severity of  flat foot, as well as the age of the patient. Again, before surgery, conservative.

Don't live with the pain caused by flat feet. Call us today for an appointment at our convenient Seattle office.

All pages on this website © 2008
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.