07 May When Are Flat Feet Problematic In Children?
A common lament made by prior military recruits and draftees is “my flat feet kept me out of the service”. It is true that a collapsing arch can create many foot problems including bunions, hammertoes, plantar fasciitis (arch pain), nerve pain, Achilles’ tendonitis and other forms of tendonitis; not to mention knee, hip, and low back pain. In most cases, flat feet are hereditary. In other words, one can blame their parents and grandparents for them. Most individuals with flat feet have inherited a tremendously flexible foot type which allows the flattening to occur as they walk and stand.
In many cases, when young parents ask their pediatrician the common question, “Are my child’s flat feet a problem?”, they are often told, “Don’t worry, they will grow out of it.” This can be true; but it can also be false, thus leading the child to develop the above mentioned foot deformities and lower extremity problems as they grow and throughout life. So how does one know if the collapsing arch needs to be addressed or not?
The answer to this question revolves around the age of the child, and the position of the heel. Our children typically begin walking when they are between 10-14 months old. At this point in a child’s development, the heel is tilted in a 6 degree position of eversion, which puts the child in a “flat footed” position. At 10-14 months, this IS normal. As the child grows and matures each year, that everted heel position reduces by 1 degree each year until age 6 at which point the child’s heel should be neutral (not tilting into a flat footed position). In other words, in children up to 6 years of age, it can be normal to have a flat foot. But, if a child has a flat foot at age 4, which is coupled with tripping, falling, and lack of coordination, this can be a sign even earlier than age 6 that the flatness of the feet may indeed be worrisome. From age 6 to 13 the child’s foot continues to mature to the point at which it should tilt outward about 4 degrees and have a normal arch. About 15% of children end up with the opposite problem of an overly high arch foot if the heel continues to rotate further into an inverted position.
If children continue with a “flat foot” appearance beyond the age of 6, this is a problem, and should be addressed by a foot specialist to avoid the foot deformities and lower extremity pains that can ensue. Parents should ask themselves the following questions in assessing their children’s feet:
- How flat are the feet?
- Who else in the family has foot problems that my children may have inherited this from?
- Does the “flat-footedness” seem to be impairing the child?
If the feet look like pancakes or appear suctioned to the ground when standing, this is quite flat. If the child’s parents, grandparents, and relatives have bunions or have suffered with plantar fasciitis, this should be considered. If the child never wants to play outside because his or her feet hurt, or they are constantly falling and tripping, or if they are constantly asking the parent to carry them, this should be considered.
If children fall into these categories, what is to be done? Is surgery necessary? Gait analysis should be performed by the evaluating podiatrist. Radiographs (x-rays) should be obtained by the physician to further evaluate the position of the bones and joints of the feet.
In most cases, surgery is not necessary. The flattening of the arches is hereditary and is simply leading to mechanical instability of the arch of the foot. The podiatric physician can make a custom device called an orthotic made by taking plaster impressions or molds of the child’s feet. These custom orthotics are simply worn in the child’s shoes to support and hold-up the flattening arch. These are worn all the time including at school and during sporting activities. By providing the child the proper foot support in this way, the parent is helping prevent future foot and lower extremity problems that develop if the flat foot issue is ignored.
In summary, in children up to age 6, a flat foot can be normal. As children grow older than this, or if they are exhibiting problems tripping or not wanting to be active before age 6, the flat foot should be addressed. Parents should remember in these cases that “an ounce of prevention is worth a pound of cure”.
This article was written by Drs. Broyles, van Brederode, and Verla of Alta Ridge Foot Specialists with offices in Boone, Mars Hill, and Spruce Pine. These physicians are members of the American College of Foot and Ankle Pediatrics, and the American College of Foot and Ankle Surgeons.