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Flat Feet in Children

Children born with flat feet could experience ankle, knee and back pain later in adulthood

Flat feet are one of the most commonly seen foot deformities. The condition, also called pes planus, is characteristic of a foot with a very low or no arch; it is completely flat when placed against the ground.

“Flat feet are associated with ‘pronated’ feet, a term used to describe the position of the foot when it is flexed upward, turned away from the body, and the heel is rolled outward – at the same time. Over a period of time, increased pronation can cause problems such as heel pain, bunions, shin splints, and knee, hip or back pain,” said Dr. Michael Vohrer, Orthopedic Surgeon, Burjeel Hospital of Advanced Surgery (BHAS).

According to Dr Vohrer, there are many different causes of flat feet.  The first type, congenital flat foot, is a condition that one is born with. In this condition, the foot can have an arch but it flattens out when placed on the ground owing to flexibility. The congenital category can include more severe forms of the condition such as vertical talus, congenital calcaneal valgus, and tarsal coalitions – all of which are more rigid with no arch at all. Flatfeet do tend to occur in families as an inherited condition.

“Most children grow out of this condition. Activities performed during early childhood that need strength in the feet help develop normal muscle, tendon, ligaments and bones in the foot and ankle. However sometimes, the arch doesn’t form and the foot stays flat into adulthood. However, it is unlikely to cause the child any difficulty in the future unless it is a severe case mentioned earlier,” said Dr Vohrer.

The other type of flat foot presents over a period of time and is not congenital. The factors that can cause that include the types of shoes a child or adult wears, or the way they sit or sleep. The way the foot compensates for injuries is also common especially if the person has a tight Achilles tendon. Repeated weight stress on a tendon can lead to the arch flattening out. Obesity can also cause strain on the legs, leading to the feet to flatten.

It’s always better to seek the counsel of a medical professional to diagnose the type of flat foot a child or adult has. Doctors check the history of a patient and conduct physical examination. Factors considered include mobility in the forefoot, hind foot, and ankle. Muscle weakness and muscle tightness will be tested. The wear pattern on shoes can also offer some helpful clues. X-rays or other more advanced imaging such as CT scans or MRIs may be ordered as well. A wet footprint and heel test may also be carried out to check for signs of a lower arch or flat foot.

Dr Vohrer believes awareness and getting treatment in time, especially for severe cases of flat feet, can make life a lot easier for both children and adults with the condition. “Mild cases of flat feet in children don’t require treatment. Younger children should walk barefoot (as often as they can) to increase sensory input to and build strength in the foot. Older children and adults should wear shoes that provide good arch support, a firm heel counter and a flexible sole; as these will support the tendon and take stress of the foot. These shoes are easily available. Orthotic devices can also be customized for individuals with special requirements such as runners.

“Patients with severe symptoms may benefit from further orthopedic evaluation and treatment, and surgical intervention to correct the problem and realign the feet. BHAS has a team of specialists that can offer excellent treatment options for children and adults suffering from pain seen in severe cases. These include double or triple arthrodesis, lateral column lengthening, tarsal-metatarsal joint fusion and other joint and tendon procedures. Patients require a period of rest (as the feet are placed in a cast) and rehabilitation post-surgery,” said Dr Vohrer.

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