PEDIATRIC FLATFOOT
By: Sara John, C.Ped (C)., C.Ped Tech (C)
Young children and babies have feet that are flat. Before the bones are formed, much of the foot and ankle are still made up of soft tissue, fat, and cartilage. The arch is not formed fully yet. When the child starts to walk, the joints are still hypermobile.
Flat foot in childhood is a condition characterized by a low longitudinal medial arch and everted calcaneus. Flatfoot deformity can make mobility and exercise painful increasing the risk of other conditions. Not all children have symptoms, but some may complain of pain, tenderness or cramping in the foot, ankle or knee. Parents notice an outward tilting of the heel, awkward walking or difficulty with shoes. There may also be difficulty in keeping up playmates, easily tiring or withdrawal from physical activities. Uncorrected symptomatic flatfoot can lead to chronic pain and instability as the child ages into adulthood.
Pediatric flatfoot can be rigid or flexible. In rigid flatfoot, the arch is stiff and flat when both sitting and standing. It is usually associated with various symptoms.
Flexible flatfoot is characterized by normal arch when sitting or standing, and disappearance of the arch when standing. The bones are usually normal, but the supporting ligaments are lax and the joints are hypermobile. As the soft tissues, joints of the foot, and ankle attempt to maintain a normal foot position, increased stress is placed on them leading to fatigue and loss of strength resulting in sagging of the arch. This can affect the structures going up the leg.
Flexible flatfoot may be asymptomatic, and it is assumed that the child will outgrow the problem and lead a non-pathological active life. Asymptomatic flexible flatfooted children who are obese, have genetic or systemic abnormalities or have extreme hypermobility should be treated. The decrease in medial longitudinal arch and forefoot abduction with weight-bearing can lead to the use of poorly fitting shoes, extra pressure on toes and ingrown toenails. It is advisable to monitor the foot to make sure that it does not lead to hallux valgus, metatarsalgia, plantar fasciitis, knee pain or low back pain.
Footwear modifications and orthotics are recommended for flatfoot condition. The goal of the orthotic device is to reduce pain and the associated deformity by decreasing the excessive pronation of the subtalar joint. The orthotics provide added support and comfort and do not change the shape of the foot or lead to the development of the arch as the child gets older. Activities during early childhood requiring strength in the feet help to develop normal muscle, tendon, and ligaments of the foot and ankle.
