East Coast Podiatry
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Last Updated: 06 Jan 2021

Paediatric Flat Feet

Flat Foot Child
Footage of a paediatric patient with flat foot walking

A common complaint from parents is their child’s foot arches being flat. There are two types of flat feet in children: congenital and acquired. Non-specialists would rarely know the difference between the two, nor would they know when further investigation is warranted.

  • Congenital: present at birth.
  • Acquired: develops after birth.

At birth, all children should have soft chubby feet.  The feet continue to appear relatively flat as the baby grows.  If a child has congenital flatfoot, then investigations are needed to rule out deformities such as tarsal coalition and vertical talus within the first few months of birth.  Treatment must be started promptly to reduce long-term foot and ankle deformity and disability.

Generally, feet are soft and flexible from birth until around 8 years old when bone ossification starts in earnest.  Most flatfoot conditions in children are acquired, influenced by genetics and subsequent growth and development, as well as what is done (or neglected) during that period.

Assessment and treatment should be taken especially seriously if a child is displaying the following signs and symptoms:

  • Complaining of leg pain during activities or at night-time
  • Requesting massage for relieving aches and pains
  • Inability to participate in, or avoidance of, typical play and activities
  • Excessively wearing out their footwear
  • Instability or alignment concerns, e.g. falling over regularly or asymmetrical posture
  • Both parents have high arches but child has flat feet
  • Foot pain during activities or long periods of walking

Paediatric flatfoot should not be taken lightly as subtle signs in children can lead to more severe problems later in adult life. One foot flattening compared to the other foot can sometimes be a sign of another lower limb abnormality such as leg length difference or angular torsion, which in turn can be caused by a variety of conditions.

Simply looking at a toddler’s standing foot arches on a scanner or as a footprint on a piece of paper, means almost nothing in terms of true assessment of the foot and lower extremity. A wide footprint is not an adequate description of flat feet, and tells you nothing about the specific type of paediatric flat feet or what range of treatment is necessary.

Changing footwear often does not correct the foot shape much, as the shoes fundamentally are flat inside.  Adding any form of arch contour to the shoe also does not guarantee that the flatfoot is being correctly addressed. Only individually designed orthotics are meant to guide paediatric feet development accurately. Again, the designer must know what is normal versus abnormal, specifically in terms of your child’s feet and skeletal development.

Specific treatments for congenital flatfoot:

  • Detailed consultation of child’s current status and development from birth
  • Serial x-rays
  • Serial casting – removable and non-removable depending on condition
  • Customised orthotics, footwear and braces if needed
  • Surgical referral if deemed necessary

Specific treatments for acquired flatfoot:

  • Detailed consultation of child’s current status and development from birth
  • X-rays and imaging if required
  • Customised foot orthotics and ankle-foot orthotics with dedicated follow-up to ensure the feet are developing optimally
  • In-clinic treatment for reducing tightness and hypertonicity in the lower limbs, where applicable
  • Regular focused exercises and at-home instructions to influence soft tissue development
  • Surgical referral if deemed necessary

When it comes to paediatric cases, timing is key. Young children are growing quickly, and require close monitoring to ensure up-to-date diagnosis and timely adjustments to ongoing treatment. Many lower limb alignment concerns can be easily managed and even resolved, if initiated at the earliest stages. After the age of 8, the foot is harder to mould or change, but prompt intervention can still make a world of difference for a child’s well-being.

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