Patient Education

Pediatric Flatfoot

Description

You may think your child is as adorable as a little baby duck, (except perhaps, if they’ve just gotten into the flour canister for the fourth time this morning), but there are a few characteristics you probably hope they don’t share with these charming aquatic baby birds. Cuteness? Yes. Feathers? It would be completely disturbing if they got these. Fun little quack-like noises when they’re babies? Definitely. Flat feet? Well… maybe, maybe not.

Flat feet in children isn’t actually all that uncommon, and it’s not necessarily a cause for concern, particularly if the child is quite young. In fact, almost all children appear to have flat feet during the first few years of life. Their feet are pretty heavily padded in fat, and the structures of the foot are still transitioning from cartilage to bone. In fact, the arch of the foot doesn’t really tend to develop until children are about two or three years old.

Also, some people just have feet that are a bit more flat than normal. If your child has feet that remain flat (or that flatten while the child is standing) past the age of about three or four, but doesn’t experience any symptoms (i.e. pain and other problems) of flatfoot, he or she is more likely to be on the flat end of the normal foot spectrum. However, in cases like these, it’s still a good idea to bring your child in to see the podiatrist about once a year, just to keep an eye on things. (If your child starts growing feathers, you may need to take him or her to a different specialist.)

Symptoms

Unfortunately, some children do experience pain or other symptoms as a result of their flat feet. Your child may complain of pain in his or her foot or ankle. Additionally, because flat feet tend to alter the way the foot and leg are aligned, and thus affect all the parts of your body involved in walking, your child may experience pain up into his or her leg, knee, hips, or even lower back. This pain is also likely to increase when the child participates in physical activities such as extended periods of walking, running, or other activities.

There may also be some changes or irregularities in the appearance of your child’s foot. Flat feet sometimes can cause the forefoot (the toes and front region) to turn outward. This means that when you look at the child’s foot from behind, you may notice that you can see more toes on the outside of the foot than normal. The heel is also sometimes affected, and the bottom may appear to tilt outward. Your child’s gait may become awkward or painful. Shoes may not fit properly, or may be painful to wear. And your child may refuse to participate in some physical activities (although this shouldn’t be confused with a stubborn desire to watch more TV than is quite healthy).

Diagnosis

While in many instances flat feet may not be symptomatic (i.e. they don’t cause pain), it’s usually a good idea to see a podiatrist for yearly checkups if your child’s flat feet persist past the age of four or so.

In cases where your child is experiencing discomfort (or occasionally cries because he or she doesn’t want to be like a duck anymore), you most certainly want to take your child in for treatment. Your podiatrist will probably examine your child’s foot or feet while the child is standing, sitting, walking and running. The doctor may also ask your child to stand on tiptoe, or conversely, to lift the toes up. Because flat feet may sometimes be caused by a tight Achilles tendon, the podiatrist may test this tendon for tautness. He or she may also examine the child’s knees or hips, since problems with flat feet tend to affect these areas of the body.

Observing the patterns of wear on both your child’s feet may also be helpful (i.e. checking for calluses), as is seeing the wear on your child’s shoes (the inner side of the shoe’s heel may become more worn than usual).

A family history of flat feet is not uncommon, so, in addition to getting your child’s medical history, your podiatrist may inquire about any members of your family who have had flat feet, either as children or adults.

X-rays may also be used to evaluate your child’s feet (and children are sometimes completely excited about the prospect of seeing their own bones).

Treatment

So, it’s been established that your child has flat feet. Unlike duck babies (whose flat feet are specially fashioned for their environments), human children may need to be treated in order to prevent the development of more severe problems as they get older, and as those still-flexible structures in the foot start to solidify into their adult forms.

The good news is that if your child isn’t in pain, treatment is often not required, although in some cases, your podiatrist may recommend orthotics (prescription shoe inserts) in order to make sure the child’s foot develops properly. Orthotics are also often useful in treating symptomatic (painful) flatfoot by giving the foot proper support, and helping the whole walking mechanism (foot, leg, hip, etc.) to function as it should. You can also purchase shoes (or make them if you just happen to manufacture shoes in your spare time) that have high tops and padded arches, although you should consult with your podiatrist to see what shoe modifications would be most helpful. (Your child can also decorate the outside of these shoes with stickers of ducks, just to show solidarity with their quacking counterparts.)

Another step in treatment may be to help your child reduce or modify activities that are painful. This may mean temporarily trying to keep them from walking around a great deal or standing too long (and yes, given the energy level of many children, this may be more difficult than it sounds). In short, this may not be the best time for a three-day hiking expedition. Once your child’s feet have rested and recovered a bit, and once his or her feet have the support they need, it may be possible to return to normal activity.

Sometimes anti-inflammatory medications may be helpful to reduce pain associated with inflammation, although you always want to follow your doctor’s advice when taking medication (particularly when children take meds). If a tight calf muscle is contributing to your child’s flat feet, then calf-stretching exercises may be recommended.

In very severe cases, surgery may be a viable option to improve your child’s symptoms. Your podiatrist can consult with you on what is best for your child.

So, your child isn’t a little duck after all. In fact, with the right treatment, your little ones will probably not resemble ducks in the least. Except maybe for their propensity to follow you all around the house in a line. But hey, that’s kind of cute anyway, isn’t it?