"Flexible Flatfeet"-Issue 15

          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.

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.

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.