What Is Pediatric Flatfoot?
Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as pediatric flatfoot. Although there are various forms of flatfoot, they all share one characteristic—partial or total collapse of the arch.
Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms, such as pain and limitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.
Flatfoot can be apparent at birth or it may not show up until years later. Most children with flatfoot have no symptoms, but some have one or more of the following symptoms:
- Pain, tenderness or cramping in the foot, leg and knee
- Outward tilting of the heel
- Awkwardness or changes in walking
- Difficulty with shoes
- Reduced energy when participating in physical activities
- Voluntary withdrawal from physical activities
In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when the child stands and sits. The surgeon observes how the child walks and also evaluates range of motion of the foot. Because flatfoot is sometimes related to problems in the leg, the surgeon may also examine the knee and hip.
X-rays are often taken to determine the deformity’s severity. Sometimes additional imaging and other tests are ordered.
If a child has no symptoms, treatment is often not required. Instead, the condition will be observed and reevaluated periodically by the foot and ankle surgeon.
Custom orthotic devices may be considered for some cases of asymptomatic flatfoot.
When the child has symptoms, treatment is required. The foot and ankle surgeon may select one or more of the following nonsurgical approaches:
- Activity modifications. The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing.
- Orthotic devices. The foot and ankle surgeon can provide custom orthotic devices that fit inside the shoe to support the structure of the foot and improve function.
- Physical therapy. Stretching exercises, supervised by the foot and ankle surgeon or a physical therapist, provide relief in some cases of flatfoot.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
- Shoe modifications. The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with flatfoot.
When Is Surgery Needed?
In some cases, surgery is necessary to relieve the symptoms and improve foot function. The surgical procedure or combination of procedures selected for your child will depend on his or her type of flatfoot and degree of deformity.
Pediatric Flatfoot: Cause for Alarm?
Parents keep a close eye on their growing children, watching for proper development and being alert for any sign of a problem because small problems can have big implications. Pediatric flatfoot is a childhood condition that, if left untreated, can result in permanent deformity in adulthood. Flatfoot deformity makes mobility and exercise painful, increasing the risk of reduced cardiovascular health and obesity.
“Parents never want their child to undergo a surgical procedure,” says Mary Crawford, DPM, FACFAS, an Everett, Washington foot and ankle surgeon. “But uncorrected symptomatic flatfoot can lead to chronic pain and instability as the child ages into adulthood. Children will be on their feet for a long time to come. It’s vital to keep those feet healthy. A foot and ankle surgeon can help parents understand the options—surgical and nonsurgical—for treating pediatric flatfoot.”
Not all children have symptoms, but others will complain of pain, tenderness or cramping in the foot, leg and knee. Parents may notice an outward tilting of the heel, awkwardness or clumsiness in walking and difficulty with shoes. Pediatric flatfoot makes participating in activities more difficult, so parents should take note if their child is unable to keep up with playmates, tires easily or voluntarily withdraws from physical activities.
To diagnose a pediatric flatfoot, a foot and ankle surgeon examines the child’s foot in weightbearing and nonweightbearing positions, both in and out of shoes. The physician also notes how the child walks and evaluates the foot’s range of motion. In some cases, flat feet are associated with issues of the hip and knee, so the physician may examine those as well.
For further detailed analysis, the physician may order imaging tests, such as an x-ray, CT scan, MRI or bone scan. Family history will be evaluated as well since the presence of flatfoot disorder in the family increases the possibility of flatfoot in the child.
“There are different types of flatfoot deformities,” notes Crawford. “Thorough testing helps us pinpoint the causes of the flatfoot disorder and develop an appropriate treatment plan.”
Pediatric flatfoot can be divided into two categories, flexible and rigid. Flexible flatfoot is characterized by a normal arch when nonweightbearing, or sitting, and disappearance of the arch when standing. There may or may not be symptoms. In the case of rigid flatfoot, however, the arch is stiff and flat when both sitting and standing. In most cases, children with rigid flatfoot display symptoms associated with the condition. In either case, flexible or rigid flatfoot, there are a variety of underlying reasons requiring different treatments.
Babies often appear to have flat feet due to cramped positioning inside the womb, and the symptoms will abate with time. In other cases, the surgeon recommends stretching exercises or a soft brace for a short period. Children who do not exhibit symptoms typically do not require treatment but will be monitored and reevaluated periodically by the foot and ankle surgeon.
For children who exhibit symptoms, the physician may recommend physical therapy, shoe modifications, anti-inflammatory medications, such as ibuprofen to reduce pain and inflammation, or an orthotic device. This device fits inside the shoe and supports the structure of the foot. In some cases, surgery is the best alternative.