A child has flat feet when their foot arches are low or absent

If you ever find your child complaining that their shoes are too tight and hurt, even in their regular size, there’s a chance they may have flat feet. You may also want to check the soles of their feet. If their feet don’t have the slight arch we all have when standing, it’s highly likely that flat feet is to be blamed.

Fortunately, flat feet is usually not a debilitating condition. With proper intervention and shoe support, flat feet doesn’t have to affect a child’s quality of life. We break down exactly what flat feet are, signs and symptoms to look out for as well as treatment options. 

What is flat feet syndrome?

Source: https://runrepeat.com/guides/best-flat-feet-running-shoes  

When you have flat feet, the arches that are typically visible at the soles of the feet aren’t there when you stand. It’s also common for babies to be born with flat feet ― a condition that can persist well into their childhood.

However, don’t fret if your little one might have this problem. Most children don’t begin to form arches until they are 3 to 5 years of age. This is seen as children’s bones and joints are flexible, so their arch looks collapsed when they stand with weight on. Young children also have a fat pad on the inner border of their feet that hides the arch.

The easiest way to figure out if your child has flat feet is to get them to stand on tip toe and look for an arch. Flat feet typically “disappear” by age 7, as the feet become less flexible and the muscles supporting the feet develop. Only 10 to 20 per cent of children continue to have flat feet into adulthood. 

Flat feet can be divided into flexible or rigid categories. The former usually shows no symptoms, and the arch is visible if no weight is put on it. Some children may complain of increased tiredness in their feet as well. 

Rigid flat foot is less common, with the arch not being visible all the time. It typically shows up in individuals who have issues with the bones in their feet. Also known as tarsal coalition, doctors refers to it as an abnormal connection between the bones, cartilage or fibrous tissue. It can lead to limited motion, tight muscles and pain in the feet.

Source: https://runrepeat.com/guides/best-flat-feet-running-shoes 

Whilst there is insufficient evidence that flat feet can be hereditary, some studies indicate that genetic problems such as Down or Marfan Syndrome (disorder of the body’s connective tissues) can predispose kids to flat feet. Loose ligaments and low muscle tone cause the feet to be formed improperly. 

Signs and symptoms

The following are signs and symptoms of flat feet to take note of. 

- Clumsiness and frequent tripping
- Pain or tenderness anywhere from the foot to the knee
- Pain after physical activities, or general foot fatigue after walking or running
- Sores or pressure areas on the inner side of the foot
- A stiff foot
- Limited side-to-side foot or up-and-down ankle motion
- An outward tilt at the heel
- Changes to gait or awkwardness when walking
- Pain or difficulty when wearing shoes

Parents should also bear in mind that physical signs of flat foot are more difficult to spot, as pronation (the way the foot rolls inward) and malalignment can manifest itself in different ways. A paediatrician usually confirms the condition by taking an X-ray of the feet or assessing the child’s walking, running and standing postures, as well as their joint and bone alignment.

Problems caused by flat feet

Fortunately, there are people with very flat feet that don’t cause pain or discomfort during activities, due to good muscle strength, flexibility and good lower leg alignment.

However, when the foot structure is less than ideal or foot muscles are weak, long-term effects include possible pain in the ankle, shin, knee or hips. 

Girls with flat feet usually have lower tolerance for shoes that provide less support, such as heels and ballet pumps. Boys are more susceptible to lower-leg injuries when they increase their physical activities, 

Flat feet can also predispose a person to certain foot deformities like bunions and claw toes (toes that are bent upwards or downwards and resemble the shape of a claw).

Treatment options

- Physiotherapy in the form of special stretching exercises, particularly when issues with the Achilles tendon cause the condition or calf muscles become tight. 
- Inserting insoles into shoes to “create” a normal shape, as well as give more support. However, parents should note that insoles don’t cure flat feet − they only alleviate symptoms.
- Modify activity levels. Consider a temporary decrease in activities that cause your child foot pain, and have them avoid prolonged periods of standing or walking.
- Special footwear tailored to children with flat feet

Is surgery ever an option? 

If your child’s feet don’t respond to insoles and physiotherapy, and symptoms are disabling, surgery is the next step. Doctors usually recommend surgery between the ages of 9 and 12. This is when the child is growing actively, making it the best time to remodel the shape of the feet.

Although very rarely performed in kids, there are two recommended surgical options to choose from: 

- Medialising calcaneal osteotomy ― which is done when the calcaneus (heel bone) has moved from underneath the leg. Incisions are made outside the heel and the back half of the heel bone, and metal screws or a plate is inserted to keep the heel bone in place.
- Calcaneal lengthening osteotomy ― inserting a bone graft on the outer side or edge of the middle of the foot. This will lengthen the heel bone and ease pain and tension. During the recovery period, the leg is placed in a splint or cast for several weeks. Once the sutures are removed, the patient has to wear boots for six to eight weeks to ensure that they don’t bear too much weight on the leg. Physical therapy might be recommended after that, together with insoles or an ankle bracelet. 


Suspect your child might have flat feet? Consider a visit to a paediatrician at centres like Thomson Paediatric Centre, where you can get their condition diagnosed and treated. 

Photos: iStock

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