Is Flatfoot the Real Cause of My Daughter's Walking Issues?

Is it really all caused by flat feet?

My daughter is ten years old.
When she was three, she couldn't walk well and would cry from foot pain after walking for a while.
She often fell down, and her walking posture was strange.
After undergoing various assessments in early intervention, she was diagnosed with unilateral amblyopia, and her feet were deemed fine.
At six, her walking was noticeably characterized by an inward foot position, and her legs from the hips to the knees to the ankles all appeared to be externally rotated.
After another visit to the orthopedic doctor, I was told there was no issue, so I stopped worrying and just reminded her daily not to walk with her feet turned in.

Now at ten, some relatives are criticizing me for not properly treating her.
After three consultations, the doctor diagnosed her with congenital flatfoot, stating it cannot be treated and that she can only use insoles to improve her walking condition; otherwise, she would need surgery in the future.
I felt dizzy upon hearing this.
When I went back to the hospital, I had to prepare new shoes for her.
After taking a day off from school to go, I was told the shoes were unsuitable and that I needed to buy new ones.
I had to go back again to get custom insoles, wasting a day off.
I really have no idea what to do; the doctors don’t explain things clearly, and it’s exhausting! These large hospitals are also very expensive to visit now!
What kind of shoes should I get? The physical therapist suggested running shoes.
I looked into various brands and decided on New Balance, as a wide toe box is essential.
However, the shoe soles vary greatly—some are flat, some are sloped, and some are arched.
Doesn’t that mean the insoles can only fit one pair of shoes? What about sandals, flip-flops, and dress shoes? Besides using insoles, she still walks with her feet turned inward (her feet are significantly larger than mine by half a size), and her legs from the hips to the knees to the ankles are still externally rotated.
Now I’ve also noticed that her ankle bones are particularly prominent.
Are these not issues anymore? Should I just accept that my daughter has congenital bone deformities that affect her walking? Sigh, will she resent me for life?
Dear Dr.
Pan, thank you very much.
Sincerely, Ai Mami from Taipei.

Ai Mami, 40~49 year old female. Ask Date: 2007/06/17

Dr. Pan Yingda reply Rehabilitation

I apologize for the delay in responding due to the consecutive holidays.
My child is in second grade.
When he was in kindergarten, a rehabilitation department from a nearby hospital screened for flatfoot at his school, and my son was diagnosed with flat feet.
His teacher, knowing I am a rehabilitation physician, only provided me with a notification letter (the usual procedure is for parents to take this letter to the hospital's rehabilitation department for consultation and to get orthotics...).
I simply acknowledged receipt of the letter without taking any further action, correction, or getting orthotics.

In first grade, during physical education class, he jumped 168 cm in the standing long jump, which was the second-best in the class, while the second place was over 140 cm.
A few weeks ago, we walked for exercise for two consecutive hours, and he only felt hot and bored, without complaining of foot pain.
His stamina is excellent; he played baseball under the scorching sun (around noon) and outperformed two or three adults.
He still has flat feet, and I haven't done any corrections; he wears regular shoes and goes barefoot at home.
He has a high level of physical activity and has never complained of foot pain.

So, do you think flat feet are related? Perhaps you might say he is an exception.
I believe your daughter's issues cannot be solely attributed to flat feet; her amblyopia, frequent falls, and unusual walking posture suggest there may be some developmental issues.
Additionally, we did not address some developmental delays at the appropriate time (which becomes even more difficult as time passes).
The so-called correction may limit or sacrifice certain developmental aspects.
Some friends questioned why I didn't take my child for correction; my perspective is whether we prioritize function or appearance.
If the appearance is beautiful but function deteriorates, does that make sense? Many of a child's structural systems are still developing, and we should provide them with ample space and opportunities to grow.
Therefore, I encourage him to go barefoot at home and have always paid attention to his crawling and walking processes (I suspect your daughter may not have crawled much on the floor as a child), avoiding the use of walkers, and allowing him to climb up and down as long as it is safe.
I want to give him the opportunity to fully develop his sensory integration and musculoskeletal system.
If you ask me what to do, I would suggest: 1.
Identify the cause of the inward toeing, whether it is related to the hip, knee, ankle, or foot, which muscle is tight, and which is weak; stretch the tight muscles and strengthen the weak ones.
2.
Monitor his posture; if he can adjust his posture under attention, it is likely a habit issue.
If it is structural, it cannot be corrected.
3.
Encourage her to learn ballet.
4.
Provide more opportunities for him to connect with nature and use all four limbs.
I believe orthotics are not useful, especially for children (this is just my personal opinion and a minority view).
Recently, a colleague brought her two-year-old daughter to me, saying she walked strangely and had inward toeing.
I observed slight internal rotation in one foot and noted her walking was somewhat below average for her age.
I shared my thoughts, but I recently heard she underwent surgery.

My suggestions are not passive or neglectful, but families may feel a lack of reassurance.
When we do something for our children (like surgery or corrective devices), it provides a sense of relief, but does that really lead to better outcomes? (In reality, it seems like avoiding responsibility and passing the problem to experts.) I hope this doesn't leave you more confused about your question!

Reply Date: 2007/06/17

More Info

Dear Aima,
Thank you for reaching out with your concerns about your daughter's walking issues. It sounds like you have been through a lot trying to understand and address her condition. Based on the information you've provided, it seems that your daughter may be experiencing symptoms related to flatfoot, also known as pes planus. This condition is characterized by a lowered arch in the foot, which can lead to various walking difficulties and discomfort.

Flatfoot can indeed be a contributing factor to walking issues, especially in children. It can cause the foot to roll inward (pronation), leading to an abnormal gait pattern, which may explain the "inward eight" walking style you've observed. This condition can also lead to discomfort in the feet, knees, and even the hips and lower back due to the altered biomechanics of walking.

The fact that your daughter has been diagnosed with flatfoot and that her doctors have recommended orthotic shoe inserts is a common approach to managing this condition. Orthotics can help provide support to the arch of the foot, improve alignment, and reduce discomfort while walking. It's important to note that while flatfoot is often a structural issue, it does not always require surgical intervention. Many children with flatfoot can manage their symptoms effectively with appropriate footwear and orthotics.

Regarding your concerns about footwear, it is essential to choose shoes that provide adequate support and stability. Running shoes, like the New Balance you mentioned, can be a good option as they often have cushioning and arch support. When selecting shoes, look for features such as:
1. Arch Support: Shoes should have built-in arch support or be compatible with orthotic inserts.

2. Wide Toe Box: A wider front allows the toes to spread naturally, which can help with comfort.

3. Stability: Shoes that offer stability features can help control excessive pronation.

4. Cushioning: Adequate cushioning can absorb shock and reduce impact on the joints.

As for the concern about different types of shoes (like sandals or dress shoes), it's true that orthotic inserts may not fit well in all types of footwear. However, many brands offer sandals and casual shoes designed to accommodate orthotics. It may be worthwhile to consult with a podiatrist or a specialized shoe store that can help you find appropriate options for various occasions.

You mentioned that your daughter has a noticeable outward angle from her hips to her ankles. This could indicate a condition known as "genu valgum" or "knock knees," which can sometimes accompany flatfoot. While this may seem concerning, many children outgrow these alignment issues as they develop. Regular follow-ups with a pediatric orthopedic specialist can help monitor her growth and development.

Lastly, it's understandable to feel overwhelmed by the medical process and the costs associated with treatment. It may be beneficial to seek a second opinion from another pediatric orthopedic specialist or a podiatrist who specializes in children's foot health. They can provide clarity on the diagnosis and treatment options available.

In conclusion, while flatfoot can contribute to your daughter's walking issues, it is not necessarily a permanent condition that will lead to lifelong problems. With the right interventions, including supportive footwear and possibly physical therapy, many children with flatfoot can lead active, healthy lives. Don't hesitate to advocate for your daughter's needs and seek out the best resources available to support her.

Best wishes for you and your daughter,
Doctor Q&A Teams

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