Flat Feet in Children: Concerns and Solutions

Pediatric flatfoot issues

Dear Dr.
Hsu,
Thank you for taking the time to read this letter.
I have two daughters, aged 6 and 5.
My elder daughter has a tendency for her feet to turn outward when standing, and she has an ankle misalignment with a high arch.
My younger daughter does not have an arch in her feet.
In April, we visited the pediatric orthopedic department at National Taiwan University Hospital, but the doctor advised us not to worry, stating that it might improve after the age of 10.
However, I have encountered adults with flat feet who shared their discomfort and issues related to the condition.
Previously, we tried having both daughters wear corrective shoes, but they found them very uncomfortable, so we stopped using them.
I would like to ask if there are better methods to improve their current situation, such as massage therapy, or if they still need to wear corrective shoes.
I appreciate your assistance in addressing these questions.
Wishing you all the best, and thank you.

A Jie, 30~39 year old female. Ask Date: 2005/05/14

Dr. Xu Zhenrong reply Rehabilitation

Dear Mr.
A-Jie,
The ages of 2 to 8 are critical for the development of children's arches and represent the best opportunity for correction.
After the age of 10, as the arches become established, it is advisable to use functional insoles to reduce the mechanical imbalance caused by flatfoot during walking.
Regarding your concerns, I believe that a pediatric orthopedic specialist has already conducted a thorough evaluation of your daughter.
Generally speaking, mild flatfoot can be monitored without intervention.
However, in cases of more severe flatfoot, corrective insoles in conjunction with corrective shoes are necessary for treatment.
It is common to experience discomfort when first wearing corrective insoles and shoes due to their corrective effects.
As long as there are no obvious pressure points upon removal, it is important to continue wearing them to achieve the desired correction.
Wishing you good health,
Xu Zhenrong
Rehabilitation Department, Taipei Hospital

Reply Date: 2005/05/14

More Info

Flat feet, or pes planus, is a common condition in children where the arches of the feet are either absent or not fully developed. This condition can lead to various concerns, especially if it persists into adulthood. Your inquiry about your daughters' foot conditions is quite relevant, as many parents share similar concerns regarding flat feet and its potential implications.

Understanding Flat Feet
Flat feet can be categorized into two types: flexible and rigid. Flexible flat feet are the most common form, where the arch appears when the child is sitting or on tiptoes but flattens when standing. Rigid flat feet, on the other hand, maintain a flat appearance regardless of the position and may be associated with underlying structural issues.

In children, flat feet are often a normal part of development. Most children are born with flat feet, and as they grow, the arches typically develop. By the age of 10, many children will have developed normal arches. However, in some cases, flat feet can lead to discomfort or pain, particularly in the feet, ankles, knees, or lower back, especially if there is an associated condition like overpronation.

Concerns Associated with Flat Feet
While many children with flat feet do not experience any symptoms, some may complain of discomfort, particularly after prolonged standing or physical activity. Concerns about flat feet often arise when children show signs of pain or when their foot structure appears to affect their walking or running patterns.
In your case, the fact that your older daughter’s feet turn outward and that your younger daughter has no arch at all may warrant further observation. If they are experiencing discomfort or if their foot structure is affecting their mobility or activities, it would be prudent to seek further evaluation from a pediatric orthopedic specialist.

Solutions and Management
1. Observation: If your daughters are not experiencing pain or discomfort, regular monitoring may be sufficient. Many children outgrow flat feet as their muscles and ligaments strengthen with age.

2. Footwear: While corrective shoes can sometimes help, they should not cause discomfort. It’s essential to ensure that any footwear is well-fitted and supportive. If your daughters found corrective shoes uncomfortable, it might be worth exploring different brands or styles that provide support without compromising comfort.

3. Orthotic Inserts: Custom or over-the-counter orthotic inserts can provide additional arch support and help alleviate discomfort. These can be particularly beneficial if your daughters are active in sports or other physical activities.

4. Physical Therapy: Engaging in exercises that strengthen the foot and ankle muscles can be beneficial. A physical therapist can provide tailored exercises that focus on improving foot mechanics and strengthening the muscles that support the arch.

5. Massage and Stretching: Gentle massage of the feet and calf muscles can help relieve tension and improve flexibility. Stretching exercises for the calves and Achilles tendon can also be beneficial.

6. Activity Modification: If your daughters experience discomfort during specific activities, it may be wise to modify their activities temporarily. Low-impact exercises such as swimming or cycling can be good alternatives.

7. Regular Check-ups: Regular follow-ups with a pediatric orthopedic specialist can help monitor the development of their arches and address any concerns that may arise as they grow.

Conclusion
In summary, while flat feet in children can be a source of concern, many cases resolve naturally as children grow. If your daughters are not experiencing pain, it may be best to monitor their condition. However, if they do experience discomfort, exploring supportive footwear, orthotics, and physical therapy can be effective strategies. Always consult with a healthcare professional for personalized advice tailored to your daughters' specific needs.

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