Flat Feet in Children
The sole lacks its upward arch and looks flat.
Even with normal bones and arches, children's ligaments that hold the arch are looser than adults', so the arch flattens under weight. The arch starts to form at 5 to 6 and is complete after 6 to 8, so most young children look flat-footed. Parents should keep watching as the child grows, and if there is flat foot or bone deformity, non-surgical support for the arch is needed.
Flexible flat foot
No arch, except when standing on tiptoe. Usually seen with a short Achilles tendon.
Rigid flat foot
Caused by bone deformity. Squatting is hard and overall movement ability is lower.
Signs to watch for
- Often rolls the ankle, walks with toes out or waddles
- Says their feet hurt after running for a while
- Inner side of shoes wears down; spine curves to one side
How we diagnose
History and examination
We check symptoms, medical history and lifestyle, then perform a physical exam.
X-ray
The basic first test. Further tests may be added for a definite diagnosis.
Gait and foot pressure analysis
Equipment that objectively compares before and after treatment analyzes body shape, posture, feet, gait and balance.
How we treat it
Most flexible flat feet in children need no treatment. Braces or special shoes help only in special cases: when a child is overweight with severe flat feet causing calluses and peeling skin on the inner foot, or frequent sprains from tarsal coalition.
Insoles
When flat feet are severe and the inner foot hurts, shoes, insoles or arch pads that create an arch can ease the pain.
Stretching
If the Achilles tendon is tight, it needs stretching. Exercises to strengthen the arch muscles, such as picking up a towel with the toes, toe raises and walking on tiptoe, are repeated.
Surgery
Options include shortening the tendon on the inner foot, lengthening the heel bone, or placing an implant between the ankle and heel bones or fusing the joint. Surgery for underlying causes of rigid flat foot is also possible.
When surgery is consideredSurgery is considered when long conservative care fails and pain limits daily life, or when severe deformity distorts the shape of shoes.