A flat foot is one which doesn’t have an arch on the inner part of the foot. This inner arch of the foot is called the medial arch. Flat feet are also medically called pes planus.
Flat feet in children are normal because they have not yet formed the inner arch of the foot which is attributed to how stretchy the ligaments are in children.
When a child has a flat foot, the whole sole of the foot touches the ground.
Causes of flat feet in children
- Age; children less than 7yrs often have flat feet.
- Unknown causes. This is called an idiopathic flat foot.
- Neurological causes like cerebral palsy. Feet can become flat because of neurological disorders which cause muscle imbalances in the foot.
Do you need to see a paediatric orthopaedic surgeon?
Differential diagnoses for flat feet
- Congenital vertical talus.
Congenital vertical talus is a condition where the child is born with one of the bones in the foot called talus in a standing position causing a dislocation at the talonavicular joint.
The feet will have a rocket bottom appearance.
- Calcaneovalgus deformity
Calcaneovalgus deformity is one where a child is born with the front of the foot plastered to the front of the leg. It is common in children with spina bifida.
What comprises a flatfoot in children?
- Flexible feet
Even though the feet are flat when the child is standing, the inner arch forms when the child is not standing.
- Pronation of the foot.
This means the outer part of the foot lifts off the ground when the child is standing.
Will my child’s flat feet correct?
The answer to this question is Yes and No.
Yes, feet in most children do seize to be flat as the children grow. Most children’s feet have changed by about 8yr to 10 years.
Some children stay with flat feet all their lives and have perfectly normal lives.
Conditions associated with flat feet
- Accessory navicular; even though this can happen in any foot, it is very common in children with flatfeet.
- Tarsal coalition. This is where the bones of the foot are fused at areas where it would normally be a joint. This condition can cause pain in the foot.
Treatment for flat feet.
- Observation; this is the mainstay of treatment for flexible flat feet in young children.
- Bracing
Braces like shoe insoles or medial arch supports are used if there are pressure symptoms on the inner side of the foot. Therefore the brace relieves the inner side of the foot to improve the proper distribution of weight across the foot.
- Surgery.
When is surgery indicated for flat feet?
– In the presence of an associated deformity in the foot and ankle joint.
-If there is an abnormal fusion of the joints of the foot like in the Tarsal coalition.
-For the removal of an extra bone in the foot like in the accessory navicular.
Types of surgery for flat foot
- Calcaneal lengthening osteotomy.
This is a surgery done to increase the length of the outer side of the foot by inserting a small wedge of bone into the heel bone.
In conclusion
Flat feet are very common and normal in children. They often develop a medial arch as they grow.
Treatment is typically observation, other treatment options which include bracing and surgery can be done if the child is experiencing pain in their feet.
