Paediatric flatfoot is a common but often misunderstood condition. On one hand, there is disagreement in the medical profession on whether flatfeet in children require treatment. On the other hand, many parents find themselves being enticed by retail shoe salesmen to put non-medical, supposedly “custom made” orthotic insoles into their children’s shoes without understanding if the device is really what the children need.
The opinion that children’s flat feet are normal and require no treatment is too generalized. It drew strength from an obsolete treatment philosophy, before the general recognition of the importance of preventative medicine.
Some children with untreated flat feet grow up to have normal feet. But many children with untreated flat feet also grow up to have musculoskeletal damage in the feet, legs, and spine. The difference between the two groups requires a lower limb specialist to determine. Only after being fully informed, can parents make proper decisions on whether to pursue early treatment for their children.
However, it is also wrong to pursue treatment of a child’s flat feet without proper specialist evaluation and advice. “Flat feet” is an umbrella term covering a variety of different foot alignment problems. Children’s flat feet are not all the same. Also, flat feet are not evaluated by simply measuring arch height or looking at a footprint. Lastly, shoe inserts sold in retail stores are not truly custom-made; a true “customized foot orthosis” is a medical device under the law.
Placing retail non-medical devices under the feet of a child will mould the feet shape, for better or for worse. Many parents take this fact lightly and buy such hard devices without understanding a clear aim for the device, or having a lower extremity specialist assess the need in the first place.
What is flatfoot?
Flatfoot is a term used to describe when a child’s arches lower or can no longer be seen. The child may have a slapping gait or feet pointing outwards. This is common in Asia due to an increased prevalence of hypermobile joints, footwear choices, and environmental differences.
Children may have flat feet with no pain, but that does not necessarily make it asymptomatic. The child may be expressing subtle signs such as laziness, asking to be carried, preference to be sedentary, or struggling during sports. Also, flat feet can arise from a variety of different biomechanical causes and can result in different types of pathology and damage. It is up to specialists to pick up on these subtle manifestations of the flat foot, and the long-term consequences of leaving it untreated.
Untreated flatfoot can negatively impact children’s appearance, activities, performance, and functional ability. Correcting the mal-alignment and dysfunction can result in immediate improvement; the child will be healthier and happier.
The paediatric flatfoot develops through stages:
2 years old, the toddler has physiologic (normal) flatfeet and is bow-legged.
2-4 years old, the foot bones are in the process of developing and ossifying.
4 years old, the child appears slightly knock-kneed, and foot arches continue to develop.
8 years old, the foot structure is fully developed and will simply grow in size.
Empowering parents with information on normal foot variance is an important aspect of a podiatry consultation. An easy (but incomplete) analogy is to imagine ‘footprints in the sand’. Footprints show a ‘C’ shaped curve where the arch is higher and the person is weight-bearing on the outside border of the foot. This is our normal way of walking. Everything from the bowing angle of the tibia bone to the landing angle of the foot is directed to a C shape; this is a normal foot arch. Many Singaporeans walk on the sand and notice a flat foot shape with no arch definition.
When to treat flat foot?
The medical scene is swiftly moving towards prevention rather than reactive treatment; children are being screened and treated for flatfoot before long-term damage is underway. Of course, a child in pain from flatfoot should be first diagnosed and then treated with the correct modality.
If you are worried about your child’s foot shape and lower limb development, then ease your worries and speak to a specialist.