Flatfoot is
one of the most common conditions seen in the pediatric and orthopedic
practice. Flat foot is defined by a partial or total collapse of the inner arch
of the foot.
Pediatric flatfoot can be divided into flexible and rigid
categories. Knowing which category your
child falls into will help your physician determine if your child needs
treatment, and if so, which kind of treatment.
Your doctor will typically ask about family history of flat feet as well as examine the arch of your child’s foot while sitting, standing and walking. He or she may also look for patterns of wear on you child’s shoes.
Your doctor will typically ask about family history of flat feet as well as examine the arch of your child’s foot while sitting, standing and walking. He or she may also look for patterns of wear on you child’s shoes.
Rigid flatfoot is the least common type of flatfoot. It is characterized by a stiff, flattened
arch seen in standing which does not disappear when the foot is taken off of
the ground. Most rigid flatfeet are associated with underlying bony deformities
that require special consideration that will be discussed in detail in one of
our upcoming newsletters.
Flexible flat foot is characterized by a normal arch that flattens in
standing, but re-appears in tip-toe standing. Flexible flatfoot may be
asymptomatic or symptomatic. It is considered a variation of a normal foot that
is estimated to occur in 80-90% of babies born in North America. Most children
often outgrow flexible flatfoot naturally.
As a child grows and begins to walk, the soft tissues along the bottom of
the foot tighten, causing the arch to form within in the first ten years of
life. It’s estimated that by the age of ten, only 20% of children will still
present with flexible flat foot.
Flexible flatfeet rarely cause pain or disability in infancy and
childhood. This is termed asymptomatic flexible flat foot. Parents are often
concerned about the potential of pain and dysfunction developing into adulthood. For many years, Physicians who have ordered
corrective shoes, inserts and other devices for the treatment of this condition
have reinforced this fear. However, the
newest research studies demonstrate that there is no evidence that an arch can
be created in a child’s foot by external forces or devices such as special arch
supports or shoe wear. Studies
additionally demonstrate that children who have not been treated with special
shoe wear and orthotic supports do not have an increased occurrence of pain and
disability as adults. Therefore, if your
child has a normal flexible flat foot that doesn’t hurt, treatment is not generally
recommended.
In contrast, flexible flat foot associated with a tight calf, is known to
cause pain and disability in some children and adults. In this case, your child should be treated
with conservative measures such as a home stretching program to help prevent
dysfunction later in life.
If your child has flexible flatfoot associated with a general aching pain
in the feet or legs after activities, simple and inexpensive arch supports or a
specialized running shoe may also be recommended. Although these supports will not impact the development
of the arch, they will serve to help manage your child’s pain symptoms and to
prevent uneven wear on your child’s tennis shoes.
To learn more about this condition and others, contact your local physician or physical therapist.
References:
1. Sullivan JA. Pediatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg. 1999;7:44-53.
To learn more about this condition and others, contact your local physician or physical therapist.
References:
1. Sullivan JA. Pediatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg. 1999;7:44-53.
2. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010; 4:107-121.
3. Edwin et al. Clinical Practice Guideline: Diagnosis and Treatment of Pediatric Flatfoot. J Foot and Ankle Surg. 2004; 43:341-368.
