A child has flat feet when his foot arches are low or absent. Here’s advice on tackling flat foot issues.


Peter Jayan realised something was wrong with his 4-year-old son Yuvaraj’s feet when the youngster kept complaining that the shoes he was trying on were too tight and they hurt . Says Peter, 40. “He was trying on shoes in his regular size, so we were perplexed.”

A few months later, a paediatrician diagnosed his son with flat feet after running several tests. Explains Peter, “The fact that the soles of his feet didn’t have the slight arch we all have when he’s standing was a dead giveaway. Suddenly, it also made sense why Yuvaraj runs funny, like a duck!”

Since Yuvaraj’s case was in no way debilitating, nor did it affect his quality of life, the paediatrician’s advice was to slot insoles into his shoes for support and to buy well-made shoes that are broader in the front. Yuvaraj, now 6, notes that as long as he’s wearing good shoes, his feet don’t ache or tire out too quickly. “Sometimes, it can be difficult to put on socks because my feet are so flat, but I have my parents around to help,” the precocious preschooler adds.

The easiest way to figure out of junior has flat feet is to get him to stand on tip toe and look for an arch.


What is flat feet syndrome?

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 common for babies to be born with flat feet ― a condition that can persist well into their childhood, notes Fiona Hu, principal podiatrist at The Sole Clinic. Hu, who urges parents not to be too worried if they think their child might have this problem, also points out that most kids don’t begin to form arches until they are 3 to 5 years of age. “This largely occurs because children’s bones and joints are flexible, and when they stand with weight on, the arch looks collapsed,” Hu explains. “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 junior has flat feet is to get him to stand on tip toe and look for an arch. Normally, flat feet “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 will continue to have flat feet into adulthood,” Hu adds.

Find out what are the flat feet signs and symptoms to look out for…next



Flat feet can be divided into flexible or rigid categories. The former usually shows no symptoms, notes Dr Lee Wei Ting, associate consultant at the Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, National University Hospital. “Parents usually seek medical advice because they are worried their child walks funny with a ‘tap tap’ sound or the shape of the feet looks different from theirs. Some kids may complain of increased tiredness in their feet,” Dr Lee adds.

Rigid flat foot, which is less common, shows up in people who have issues with the bones in their feet. Also known as tarsal coalition, it’s an abnormal connection between the bones, cartilage or fibrous tissue and can lead to limited motion, tight muscles and pain in the feet.

While the doctors SmartParents spoke to said that there’s not enough evidence supporting the notion 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. Thanks to loose ligaments and low muscle tone, the feet aren’t formed properly.

“Children with flat feet tend to be clumsy and parents report frequent tripping.”

Signs and symptoms

“Children with flat feet tend to be clumsy and parents report frequent tripping,” Hu notes. “Some may have growing pains, pain after physical activities, or general foot fatigue after walking or running.”

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 his joint and bone alignment.

Other symptoms the doctor looks out for include foot pain, 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.

Click to find out how this condition can be treated…



Treatment options

The Sole Clinic sees about three to four cases (kids and adults) of flat feet daily. Treatment isn’t necessary if you don’t have any symptoms, but Dr Lee would normally refer patients to a physiotherapist for calf-stretching exercises if their calf muscles are tight.

If there’s pain or the condition causes other alignment issues in the hips and knees, the first course of treatment is to relieve tension from the child’s feet by inserting insoles into shoes to “create” a normal shape as well as give more support. However, it’s important to note that insoles don’t cure flat feet, even if your kid wears them 12 hours a day, Hu points out. “No treatment will ‘unflatten’ the foot, other than surgical correction.”

If junior’s feet don’t respond to insoles and physiotherapy and his symptoms are disabling, surgery is the next step. Although very rarely performed in kids, there are two recommended surgical options to choose from. The first is 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.

“There are people with very flat feet with no pain or discomfort during activities because of factors like good muscle strength and flexibility and good lower leg alignment.”

The other surgical procedure is 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, then once the sutures are removed, the patient has to wear boots for six to eight weeks to ensure that he doesn’t bear too much weight on the leg. Physical therapy might be recommended after that, together with insoles or an ankle bracelet. By the way, Dr Lee points out that such surgery should usually be done between the ages of 9 and 12, as this is when the child is growing actively, so it’s the best time to remodel the shape of the feet.

Long-term effects

“Flat feet do not always mean bad feet,” Hu stresses. “There are people with very flat feet with no pain or discomfort during activities because of factors like good muscle strength and flexibility and good lower leg alignment.”

Of course, when the foot structure is less than ideal or the 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, especially during National Service. Hu adds that 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).

Photos: iStock

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