Managing Flat Feet in Young Children: When to Seek Help and Solutions

Flatfoot in infants

Hello Doctor: My son is currently 6 and a half years old and has flat feet.
When viewed from behind, he seems to walk with a slight inward toeing.
Last year, we went to Chang Gung Children's Hospital for a bone assessment, and the doctor said his skeletal function is healthy and that no correction or orthotic shoes are needed.
However, I am still concerned as it seems his inward toeing is getting worse.
What should I do? 1.
Should we see an orthopedic specialist or a rehabilitation specialist? 2.
If he needs orthotic insoles, where can we purchase them? Thank you.

angela, 40~49 year old female. Ask Date: 2010/05/29

Dr. Lai Yanting reply Rehabilitation

1.
Based on your description, your child likely has physiological flatfoot (it is recommended to have a professional physician confirm this).
This condition is caused by ligament laxity and typically only presents as flatfoot when weight-bearing.
Most children with this condition do not exhibit significant symptoms and generally do not require specific treatment.
However, if there are recurrent tendonitis or foot pain, considering the use of orthotic insoles may be beneficial.
It is advisable to consult a pediatric orthopedic specialist or a rehabilitation physician.

2.
For corrective insoles, you can inquire at a medical supply store.

3.
Mild internal rotation of the feet (in-toeing) usually improves gradually before the age of 8.
If the condition is severe or worsening, it is recommended to see a pediatric orthopedic specialist or a rehabilitation physician for further evaluation.

4.
You may seek a second opinion (either from a pediatric orthopedic specialist or a rehabilitation physician).
Thank you for your inquiry.

Reply Date: 2010/05/29

More Info

Managing flat feet in young children can be a concern for many parents, especially when they notice symptoms like in-toeing or excessive pronation during walking. Flat feet, or pes planus, is a common condition in children, and while it can be a source of worry, it is essential to understand when intervention is necessary and what options are available.

Understanding Flat Feet
Flat feet occur when the arches of the feet do not develop properly, leading to a flat appearance. In young children, flat feet are often a normal part of development. Many children are born with flat feet, and as they grow, their arches may naturally develop. However, if flat feet persist into later childhood or are associated with pain or functional limitations, it may warrant further evaluation.

When to Seek Help
1. Persistent Symptoms: If your child experiences pain in the feet, legs, or knees, or if they have difficulty keeping up with peers during physical activities, it is advisable to seek help. Pain is a significant indicator that further assessment is needed.

2. Gait Abnormalities: If you notice that your child walks with an unusual gait, such as excessive in-toeing or out-toeing, or if their feet appear to roll inward significantly, it may be beneficial to consult a specialist.

3. Age Considerations: While many children outgrow flat feet by the age of 6 or 7, if your child is still showing signs of flat feet beyond this age, it may be time to seek professional advice.

Which Specialist to See
For flat feet, you can consider consulting either a pediatric orthopedic surgeon or a physical therapist specializing in pediatric care.
- Pediatric Orthopedic Surgeon: They can evaluate the structural aspects of your child's feet and determine if there are any underlying skeletal issues that need to be addressed. They can also provide guidance on whether any interventions, such as orthotics or surgery, are necessary.

- Physical Therapist: A physical therapist can assess your child's gait and foot mechanics. They can provide exercises to strengthen the foot and ankle muscles, which may help improve arch development and overall foot function.

Treatment Options
1. Observation: If your child is not experiencing pain and their flat feet are not causing any functional issues, a "watchful waiting" approach may be appropriate. Many children will develop normal arches as they grow.

2. Orthotics: If your child is experiencing discomfort or if their flat feet are affecting their mobility, custom orthotic inserts may be recommended. These can help provide support and improve foot alignment. You can obtain orthotic inserts from a podiatrist or orthopedic specialist, and they may be available at specialized shoe stores.

3. Footwear: Ensure your child wears supportive shoes that fit well. Avoid flip-flops or overly flexible shoes, as these can exacerbate flat feet symptoms.

4. Exercises: Engaging your child in exercises that strengthen the foot and ankle muscles can be beneficial. Simple activities like toe curls, picking up objects with the toes, and walking on tiptoes can help.

Conclusion
In summary, while flat feet are common in young children and often resolve on their own, it is essential to monitor your child's symptoms and seek professional advice if you notice persistent issues. Consulting with a pediatric orthopedic specialist or a physical therapist can provide valuable insights and treatment options tailored to your child's needs. Remember, early intervention can lead to better outcomes, so do not hesitate to seek help if you have concerns about your child's foot health.

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