What is Pediatric Flatfoot and When Should You be Concerned?

What is Pediatric Flatfoot and When Should You be Concerned?

By Dr. Lesley Richey-Smith

Flatfoot is a common condition in both children and adults. Most infants are born with a flatfoot. A normal arch does not develop fully until the ages of 5 through 7. Although there are differences between the various forms of flatfoot, they all share one characteristic––partial or total collapse of the arch.

Most children with flatfeet have no symptoms. However, when symptoms do occur, they vary according to the type of flatfoot. Some signs and symptoms may include: 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; and voluntary withdrawal from physical activities.

A flatfoot can be flexible or rigid. Flexible means that the foot is flat when standing, but the arch returns when not standing. It is also considered a foot that can be placed into what is considered a neutral or normal position without much effort. A rigid flatfoot is a foot that is always flat, whether standing on the foot or not. The most common rigid flatfoot deformity is a tarsal coalition and a congenital vertical talus.

A tarsal coalition is a congenital condition, meaning it was present at birth. It involves an abnormal joining of two or more bones in the foot. A tarsal coalition may or may not produce pain. When pain does occur, it usually starts in preadolescence or adolescence.

A congenital vertical talus is a condition also present at birth. The foot has a rocker bottom appearance that occurs with this flatfoot. Symptoms begin at walking age, since it is difficult for the child to bear weight and wear shoes.

In diagnosing a flatfoot, the foot and ankle surgeon will start with a full history including birth history, walking age, attainment of developmental milestones, prior trauma, activities of daily living, recreational activities, sports, shoe gear, and shoe wear, as well as any possible comorbidities. The foot and ankle surgeon will perform a comprehensive exam. This examination of the foot will occur when the child stands and sits. The surgeon also observes how the child walks and evaluates the range of motion available in the foot. Because flatfoot is sometimes related to problems in the leg, the surgeon may also examine the knee and hip. The foot and ankle surgeon will also test the flexibility of the foot. Weight bearing x-rays are always needed to determine the severity of the deformity. Sometimes an MRI or CT scan is needed for further evaluation.

Treatment for the deformity depends on several factors. For instance, is it symptomatic or asymptomatic, is it rigid or flexible, and what’s your family history concerning foot conditions? Non-surgical approaches are observation and re-evaluation as well as the possibility of custom orthotic devices. There is no evidence in medical literature that the use of custom-made orthotics will change the structure of a growing foot. In symptomatic pediatric flatfoot, treatment is required. The foot and ankle surgeon may select one or more approaches, depending on the child’s particular case. Some examples of non-surgical options include: activity modifications, orthotic devices, shoe modifications, and physical therapy, stretching exercises, and strengthening exercises supervised by the foot and ankle surgeon or a physical therapist. These options can provide relief in some cases of a flatfoot.

In some cases, surgery is necessary to relieve the symptoms and improve foot function. Foot and ankle surgeons perform a variety of techniques to treat the different types of pediatric flatfoot. The surgical procedure for your child will depend on his or her particular type of flatfoot and degree of deformity. Treatment and surgical prevention of adult flatfoot can reduce the incidence of additional foot problems such as bunions, hammertoes, arthritis, and calluses, while improving a person’s overall health.

Dr. Lesley Richey-Smith completed a three-year residency program dedicated to surgical and non-surgical treatment of pediatric flatfoot conditions. She continues to specialize in pediatric care.