Flat feet or flexible flatfoot is common in children. Parents and other family members often worry needlessly that the condition, characterised by an abnormally low or absent arch, will lead to permanent deformities or disabilities. Flexible flatfoot, however, is usually painless and does not interfere with walking or sports participation. Most children eventually outgrow it with no treatment.
Flexible flatfoot is considered to be a variation of a normal foot with the muscles and joints of a flexible flatfoot functioning normally. When a child with flexible flatfoot stands, the arch of the foot disappears. Upon sitting or when the child is on tiptoes, the arch reappears.
Most children are born with very little arch in the feet but as they grow and walk, the soft tissues along the bottom of the feet tighten, which gradually shapes the arches of the feet.
Children born with flexible flatfoot often do not begin to develop an arch until the age of 5 years or older. Some children never develop an arch. If flexible flatfoot continues into adolescence, a child may experience aching pain along the bottom of the foot. A doctor should be consulted if a child's flatfeet cause pain.
To make the diagnosis, your doctor will examine your child to rule out other types of flatfeet such as flexible flatfoot with a tight heel cord (Achilles tendon), or rigid flatfoot, which is a more serious condition. Your doctor will look for patterns of wear on your child's everyday shoes. He or she may ask your child to sit, stand, raise the toes while standing, and stand on tiptoe.
Tell your doctor if anyone else in the family is flatfooted as well as if the child has any known neurological or muscular disease.
Treatment for flexible flatfoot is required only if the child is experiencing discomfort from the condition. As previously mentioned, most children outgrow the condition with no treatment.
If your child has activity-related pain or tiredness in the foot, ankle, or leg, your doctor may recommend stretching exercises for the heel cord. Shoe inserts – soft but firm molded arch supports - may also be recommended.
Physical therapy or casting are usually recommended if your child has flexible flatfoot with tight heel cords. Occasionally, surgical treatment will be necessary for an adolescent with persistent pain. In a small number of children, flexible flatfeet become rigid instead of correcting with growth. These cases require further medical evaluation.