Paediatric Flat Foot

Paediatric Flat Foot
 

‘Flat foot’ constitutes approximately 90% of clinical visits for paediatric foot problems.1 It refers to when the foot presses flat on the ground, also known as ‘fallen arches’, due to the loss of the medial longitudinal arch. Flat feet can be divided into two types, either rigid or flexible2 - the difference between these being that a flexible flat foot has the ability to form an arch when the patient stands on their toes, and rigid remains the same regardless of position and weight bearing.

Causes

The majority of flat feet cases are not obviously caused by anything, it is simply something you are born with. However on rare occasions they can be caused by:

 
  • A condition which affects muscles, nerves or joints
  • Bones in the feet not growing correctly in the womb
  • Stretching of the tissues in your feet due to issues such as an injury or becoming overweight
  • Syndromes such as Downs Syndrome and collagen disorders

Symptoms

A child presenting with flat feet may exhibit one or more of the following characteristics:

 
  • Reduced arch height when bearing weight on their foot
  • Heel position is turned outwards
  • Lower navicular height (a bone situated on the inner side of the foot)
  • Deformation of their footwear
It is important to bear in mind that all children are born with flat feet as it is a normal phase of development, however in some cases if not naturally corrected can lead to problems. 

A child suffering from flat foot may exhibit secondary symptoms such as:
 
  • Pain in their lower limbs after prolonged activityor intermittent back pain
  • Unable to endure long periods of walking due to pain, or increased fatigue in lower limbs4
  • Night cramps
  • Poor balance or coordination5
Not all children presenting with flat feet need treatment, particularly if they do not display any of these symptoms.

Treatment options

It is important for your orthotist to determine whether your child's presentation or symptoms warrant treatment.

There are two types of flat foot: 'Physiological' / 'Normal' flat foot, and 'Non-Physiological' / 'Abnormal' flat foot.

Non-Physiological / Abnormal Flat Foot
This is when deformation of the foot cannot be easily corrected. This may be due to tightness in the muscles of the ankle or instability of joints. This can be seen with excessive wear and/or distortion to the child’s shoes.

Children often present with aches and pain in their legs, either during the day during activities, or at night. They may struggle to keep up with their friends and peers, and have issues with their balance and coordination.

In these cases a child will be monitored regularly and suggestions on implementing a stretching and strengthening regime may be discussed.

Insoles with or without supportive footwear may help in these cases to reduce the secondary symptoms of flat foot. 


Physiological / Normal Flat Foot
This foot type will usually be monitored to ensure that the foot develops as expected for the age of the child. In the majority of these cases an arch is present on sitting but not standing and there are no symptoms such as pain, falling or tiredness. 

Insoles may help the foot assume and arch quicker, however this will not influence the normal development stages of the foot and are often not indicated.


If you are concerned about your child's feet, or would like more information on flat foot treatment at Steeper Clinic, contact us using the enquiry form below.
 

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References
1. Fabry G., (2010). Clinical Practice. Static, axial and rotational deformities of the lower extremities in children. European Journal of Pediatrics, Vol.169(5), p529-534.

2. Yagerman et al., (2011). Evaluation and treatment of symptomatic pes planus. Current Opinion in Pediatrics, Vol.23, p.60-67.

3. Clinical guideline panel (2004). Diagnosis and treatment of the flat foot. J of foot and ankle surgery, Vol.43(6).

4. Harris et al., (2004). Diagnosis and treatment of pediatric flat foot. J Foot Ankle Surg, Vol.43(6), p.341-73.

5. Selby-Silverstein et al., (2001). The effect of foot orthoses on standing foot posture and gait of young children with Downes syndrome. NeuroRehabilitation, Vol.16, p.51-59.