Flat feet, also known as fallen arches, have either no arch in feet or one that is very low. There is usually a gap beneath the inner part of the foot when a person stands, as the arch raises off the ground slightly. Flat feet only need treatment if they cause discomfort, indicate an underlying disorder, or lead to pain elsewhere in the body. Some children appear to have a very low arch or no arch without ever experiencing problems. When flat feet do cause symptoms, simple devices and exercises can help to minimize the discomfort.
Children with flat feet, also called pes planus, have a flattening of the arch during standing and walking. Flat foot is normal in infants and young children. At this age, in the absence of any associated symptoms, treatment is highly debatable. Flat foot usually naturally corrects itself as muscles strengthen and soft tissues stiffen. The height of the arch in the foot increases with age until about nine years. The problem is when flat foot persists, spontaneously occurs in older children or later in life, or is associated with pain and disability.
Flat feet can be flexible or rigid, painful or painless and associated with a tightness of the calf muscles (Achilles tendon). The majority of flat feet are painless, but when pain is present it is usually during weight-bearing activities such as walking and running. The pain can be in the sole of the foot, the ankle, or non-specific pain all around the foot area.
A human foot has 33 joints, which hold 26 different bones together. It also has over 100 muscles, tendons, and ligaments. The arches provide a spring to the step and help to distribute body weight across the feet and legs. The structure of the arches determines how a person walks. The arches need to be both sturdy and flexible to adapt to stress and a variety of surfaces.
When children have flat feet, their feet may roll to the inner side when they are standing and walking. This is known as overpronation, and it may also cause the feet to point outward. Many children with flat feet have no symptoms, but others will experience a variety of symptoms that generally depend on the severity of the condition.
Flat feet seems like a foot problem, it actually begin in the heel. Your child’s calcaneus (heel bone) rotates inward. This causes the foot to collapse inside where the arch should be. So instead of body weight being distributed evenly, your child is walking on the inside part of the foot.
There’s a simple way to check. Have your child stand barefoot, facing away from you. Take a picture from directly behind. If you can see a pinky toe and big toe, his or her feet are likely fine. If you can see a pinky toe, ring toe, but not big toe, your child is likely pronating.
Although untreated flat feet can cause problems, they are not always a cause for alarm. As toddlers learn to stand and walk, flat feet are common. Your child is still developing. But if he or she has been walking for more than six months and you still see flat feet, keep an eye on them.
Types of Flat Feet
There are two different types of flat feet:
- A flexible flat foot is one that is flat only when weight is put on the foot. This is the most common type of flat foot.
- A rigid flat foot is flat both with and without weight being placed on the foot. Rigid flat feet may be due to the tarsal coalition (a condition in which the bones have grown together), arthritis and congenital conditions.
Causes of Flat Feet in Children
The causes of flat feet are varied. Some inherit the condition from their parents as an isolated trait, this is particularly true for children with hypermobility or double jointed. Others develop flat feet as part of another genetic condition. Still others develop the condition over time.
Footwear in early childhood has been thought to cause flat foot. Recent research questions this theory, as populations that habitually walk barefoot have flatter arches than populations that wear shoes. It is likely that children who wear shoes, are not physically active and have flat feet will have decreased muscle activation in their feet and thus impaired foot function and weakness.
Some older children and adolescents develop flat feet in the absence of any disorder or associated factors. Certain factors can increase the risk of developing flat feet over time including:
- Rheumatoid arthritis
- Foot or ankle injuries
- If your kid has low muscle tone, it can make his muscles too stretchy. When the muscles become too stretchy, they may allow movement beyond its normal range of motion. This may make your child’s heel to rotate inwards and remove the arch.
- In case, your child has high muscle tone this may result in shortening of Achilles’ tendons. All this may put pressure on child’s feet, and his feet may get pulled inwards.
Problems that arises due to Flat Feet in Children
Although it may seem like just a foot problem, flat feet can cause a chain reaction up your child’s body that forces ankles, knees, and hips out of proper alignment. Other potential problems include:
- Joint pain
- Muscle exhaustion/weakness
- Improper walking pattern
- Possible toe walking
- Poor foot development
Flat feet can be especially problematic for kids under seven years old. If your little one hasn’t reached that birthday yet, there’s a significant amount of cartilage in his or her feet. Similar to the soft spot on their head, it will eventually harden and become bone. But that means if your child isn’t walking correctly while those bones development, it can impact their shape and growth.
Symptoms of Flat Feet in Children
Flat feet can be apparent at birth or it may not show up until years later. Symptoms that should be checked by a pediatrician include foot pain, sores or pressure areas on the inner side of the foot, a stiff foot, limited side-to-side foot motion, or limited up-and-down ankle motion. For further treatment you should see a pediatric orthopedic surgeon or podiatrist experienced in childhood foot conditions. Most children with flatfoot have no symptoms, but some have one or more of the following symptoms:
- Pain, tenderness or cramping in the foot, leg and knee
- Outward tilting of the heel
- Awkwardness or changes in walking
- Difficulty with shoes
- Reduced energy when participating in physical activities
- Voluntary withdrawal from physical activities
- Ankle swelling
- Foot pain that increases with activity
Problems faced by children due to Flat Feet
As trivial as it may appear but flat feet may lead to complications and following are some of the problems that your child may face:
- Abnormal or improper walking style
- Muscle weakness
- Improper body alignment
- Improper foot development
- Joint pain
Treatment for Flat Feet in Children
If your child’s flat feet are not causing pain, no further treatment is usually necessary. For children who are experiencing pain associated with their flat feet, doctors may recommend a variety of non-surgical treatments to relieve the pain, including:
- Arch supports - Your child’s doctor may recommend arch support orthotic devices that fit inside your child’s shoes to relieve pain and reduce symptoms. These devices are available over-the-counter or can be custom-designed to mold to the contours of your child’s feet.
- Supportive shoes - Encourage your child to wear structurally supportive shoes instead of sandals, flip-flops and shoes without arch support.
- Stretching exercises - Exercises to stretch the Achilles tendon may help some children with flat feet.
- Physical therapy - Flat feet can lead to overuse injuries in some active children and runners. A video analysis of how your child runs may help identify problems with form and physical therapists can work with your child to correct it.
- Rest - Encourage children to rest and allow their bodies time to recuperate. Avoid high-impact activities such as jumping and running – and instead encourage your child to participate in low-impact activities such as walking, swimming and biking.
- Medications - Over-the-counter pain relievers may reduce pain and discomfort for children who experience it.
- Weight loss - If your child is overweight and has flat feet, a doctor may recommend structured weight loss to relive some of the stress on the child’s feet.
- Orthotic Devices - Sometimes certain orthotic devices may be suggested to improve the foot function and support the foot structure or provide arch support for flat feet for kids.
- Surgery is not usually needed for flexible flat feet, but if your child has a related foot or leg problem, such as a torn tendon, accessory or extra bone, fusion between bones in the foot and other conditions, surgery may be recommended.
Most children with flat feet will not need long-term follow-up care. However, if your child’s flat feet begin to cause pain, your child should see a pediatric orthopedic physician. The vast majority of children with flat feet will go on to live normal, healthy lives. Some children may experience intermittent foot pain, but using arch supports, wearing supportive shoes, stretching and resting when needed can ease this.