Children with flat feet are often a cause of concern for their parents. As the parents observe their child standing they can’t help but worry about the abnormal appearance, with the arch fallen, the feet pressed flat to the floor and the heels that seem to rotate out to the sides. They wonder how the child can possibly get around on those things, and worry about the possibility of future difficulties or discomfort. These concerns spark questions like, “Will this ever get better?” “Will he need special shoes?” or “Does this need to be fixed?”
Flatfeet in children are very common and is, in fact, one of the most common conditions seen in pediatric orthopaedic practices. It is also almost always completely benign. All children are born with flat feet. The longitudinal arch of the foot is not present at birth and slowly develops during childhood, usually by about age five or six. It is a process that occurs throughout growth that is not affected by the presence or absence of external arch support. Sometimes the arch takes even longer to take shape, but this still usually does not cause any problems.
For the pediatrician evaluating flatfoot, it is important to differentiate between flexible and nonflexible (rigid) flatfoot, and to classify the condition as painful or painless. To determine flexibility, the doctor might observe the foot through a series of maneuvers. When the child stands on tiptoe, a flexible flatfoot will demonstrate an arch, with the heel pointing slightly in towards the midline. With the child seated and legs dangling, the flexible flatfoot will again show a longitudinal arch. A nonflexible or rigid flatfoot will remain without a detectable arch in both instances. This is very rare. Next, determining whether the foot is painful or painless is simply a matter of asking. The child with pain secondary to flatfoot may describe symptoms such as aching in the arch or cramps at night. In general, painless flatfoot requires no special treatment.
Examining the child with flatfoot also involves looking beyond just the longitudinal arch. Your pediatrician might ask your child to stand on his heels, as ability to do this shows good flexibility of the heel cord or Achilles tendon. A tight heel cord can sometimes be associated with a flat foot. The doctor may also have your child stand on the outer and then inner borders of the foot to demonstrate good mobility of some important joints in his foot. Often your child‘s shoes will be examined as well. Looking at what areas of the shoe are showing wear can help demonstrate what is happening to the feet during walking and running.
Flexible flatfoot in a child almost never causes any problems. If it persists into adolescence, some may experience mild aching along the bottom of the foot. It’s a good idea to see your doctor for this type of pain. Depending on the nature of the pain, treatment might begin with heel cord stretching exercises. If it persists, shoe inserts might be needed. Surgical treatment for persistent pain is rarely needed.
Overall, having a flat foot is part of being a young child. It can sometimes persist beyond childhood. But even then there’s no evidence to show this leads to any problems in adulthood, nor that any external device can alter its appearance or development. So, is painless flexible flatfoot a problem? Not unless we make it one. For an asymptomatic child, it’s best to leave well enough alone.