Flatfoot in children
It brings great joy when parents see the fat, cuddly feet of their children and watch them waddle down the hallway making their first steps. Those cute, flat, cuddly feet are one of the hallmarks of childhood that can become a vexing foot problem later in life – flatfeet.
Flatfoot, common in both children and adults, is the partial or total collapse of the arch in the foot. Flexible flatfoot is where the arch of the foot collapses or disappears, gets very low or is absent when standing. Upon sitting or when the child is on their tiptoes, the arch reappears. Most children eventually outgrow flexible flatfoot without any problems.
Flatfeet is normal in infants and small children, partly due to “baby fat” which sits in the developing arch. The arch develops during infancy and early childhood and appears by the age of four to six years. Training and stretching exercises of the feet and walking barefoot on various surfaces can facilitate the formation of the arches during childhood. The arches continue to develop during adolescence and adulthood. It is estimated that 20 percent to 30 percent of the general population has flat arches in one foot or both feet. It is felt that the condition is even more common in Black people. Several studies of military recruits with asymptomatic flatfeet have shown no evidence of later increased injury, or foot problems, due to the flatfeet.
Most children with flatfoot have no symptoms as it is painless and does not interfere with walking or sports. If the child has normal muscle function and good joint mobility the flatfoot is often considered a normal variant. Flexible flatfoot normally continues until the child is at least age five-to-six-years-old. If flexible flatfoot continues into adolescence, the child may experience aching pain along the bottom of the foot. Some children may exhibit other symptoms such as pain, tenderness, or cramping in the foot, leg, and knee; turning the heels outward, changes in walking pattern, difficulty with shoes, reduced energy when participating or withdrawal from physical activities. Bunions and hammertoes may develop as a result of a flatfoot. If the child’s flatfeet cause pain a podiatrist should be consulted.
In diagnosing flatfoot, the podiatrist examines the feet and observes how they look when the child stands and sits. The podiatrist observes how the child walks, looks for wear patterns on the child’s shoes and evaluates the range of motion of the foot joints. Because flatfoot can sometimes cause problems in the leg as well, the podiatrist may also examine the leg, knee and hip. X-rays are often taken to look at the bones and determine the severity of the deformity.
If a child has no symptoms, treatment for flat feet is often not needed. Instead, the podiatrist will observe and re-evaluate the condition periodically. Custom orthotic devices may be considered even for some cases of asymptomatic flatfoot, because of the severity and the potential future complications seen in that foot type.
When the child is experiencing symptoms, treatment is required and may include:
Activity modifications: If the child has activity-related pain or tiredness in the foot/ankle or leg, the podiatrist may recommend stretching exercises for the heel cord. The child may need to temporarily decrease activities like sports that bring pain as well as avoid prolonged walking or standing.
Orthotic devices: If the pain and discomfort continue, the doctor may recommend shoe inserts. In many cases, a soft, firm, or hard arch support may relieve the child’s foot pain and fatigue. They can also extend the life of their shoes, which may otherwise wear unevenly. The podiatrist can provide custom orthotic devices that fit inside the shoes to provide support to the structure of the foot and improve its function.
Physical therapy: Sometimes the podiatrist may prescribe physical therapy or casting if your child has flexible flatfeet with tight heel cords. Stretching exercises and other therapy by the physical therapist can provide relief in some cases of flatfoot.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be needed at times to help reduce pain and inflammation.
Shoes: The type of shoes a child wears, is important to arch support. The podiatrist will advise the child to wear well structured, supportive shoes with built-in arch support rather than very flat, flexible shoes that do not support the foot. Sneakers are a good choice for supportive footwear.
As the child grows, a small number of flexible flatfeet become rigid, making it worse instead of correcting itself. In these cases, further medical evaluation and even surgical treatment will be necessary for children with persistent foot pain. Surgery is necessary to relieve the symptoms as well as improve the foot structure and function. The surgical procedure or procedures are selected depending on the severity of the symptoms, the type of flatfoot and the degree of deformity.
If you suspect your child may have flat feet or if they have foot pain, you need to have them see a podiatrist.
• For more information visit www.apma.org or email email@example.com. To see a podiatrist visit Bahamas Surgical Associates Centre at Hilltop Medical Centre, Centreville or call 603-1814/15/16 for an appointment. In Grand Bahama, visit Lucayan Medical Center call 373-7400 for an appointment.