Flatbed for children

• General information about flat feet
• Proper foot development
• Types of flat feet
• Causes of flat feet
• Evaluation by the pediatric orthopedic doctor
• Diagnosis of flat feet
• Treatment
• Medical recommendations

General information about flat feet

Children with flat feet have a flattening of the arch when walking or standing. Flat feet are normal in infants and young children (up to 44% of children aged three to six years). At this age, in the absence of associated symptoms, treatment is highly debatable.
Flat feet usually correct naturally over time as muscles strengthen and reinforce the soft tissues. The height of the arch increases with age until approximately nine years old. The problem arises when flat feet persist, appear spontaneously in older children or later in life, or are associated with pain and disability.
Flat feet may be flexible or rigid, painful or painless, and may be associated with tight calf muscles (Achilles tendon). Most flat feet are painless, but when pain is present, it usually occurs during weight-bearing activities such as walking and running. Pain may be felt in the sole, ankle, or as nonspecific discomfort around the foot.
Flat feet are common in both children and adults. Although there are different forms of flat feet, they all share one feature — partial or complete collapse of the arch.
Flat feet in children may be classified as symptomatic or asymptomatic. Symptoms include pain and limited activity, while asymptomatic flat feet show no symptoms. These classifications help the orthopedic doctor determine an appropriate treatment plan.

Although it may seem like only a foot problem, flat feet can cause a chain reaction in a child’s body, forcing the ankles, knees, and hips out of proper alignment. Other potential problems include:

• Joint pain
• Muscle weakness
• Improper walking pattern
• Toe walking
• Incorrect foot development

Flat feet can be especially problematic in children under seven years old. If your child has not yet reached the age of 7, there is still a significant amount of cartilage in their feet. Similar to the soft spot on the head, these will eventually harden and become bone. This means that if your child does not walk properly while the bones are developing, it may influence their shape and growth.

Find out more about flat feet in the video below:

Proper foot development

Although most problems in young children are caused by incorrect shoe size, footwear often does not meet the medical requirements for healthy foot development.
Every child is different and grows at their own pace. Children’s feet can grow up to 15 mm in six months. It is important to measure your child’s feet regularly. We recommend checking foot length every two months until age 2 and every three months between ages 3 and 6. From birth to age 2, children’s feet are soft and flexible. It is perfectly normal for young children to have a so-called “fat pad” under the arch during these years.
Children at this stage feel a lot with their feet, which is why it is important to give them opportunities to experience different surfaces and touch their own feet. The foot muscles must develop properly, so allowing the child to walk in socks or barefoot is beneficial.
You may notice variations in toddlers’ walking styles. In many cases, children who walk with their feet turned inward or outward will outgrow these patterns. However, unusual walking styles may persist, and if you have concerns, visiting a pediatric orthopedic doctor is recommended.

Types of flat feet

There are 3 different types of flat feet. Knowing which type your child has will help you and your doctor decide whether treatment is needed and which treatment is best.
- Flexible flatfoot: Almost all children with flat feet have what is called flexible or hypermobile flatfoot. This condition is not painful, does not cause disability, and does not require treatment. It always affects both feet.
- Flexible flatfoot with a short Achilles tendon is rare in young children. It affects both feet and may cause pain and disability.
- Rigid flatfoot is the least common. It most often occurs in people with bone problems in the foot (tarsal coalition). About 1 in 4 people with rigid flatfoot experience pain and disability. In half of cases, it affects both feet.

Causes of flat feet

A complex interaction of bones, ligaments, muscles, and nerves within and above the foot defines its anatomy and function. Anything that disrupts the integrity of these structures and leads to arch collapse may cause symptomatic flat feet.
Evaluation begins with examining the whole child, as flat feet may have an underlying cause. Common disorders that cause symptomatic flat feet include cerebral palsy, certain forms of muscular dystrophy, juvenile arthritis, inherited nervous system disorders, and some connective tissue disorders.
Flat feet may also result from unusual anatomy such as tarsal coalition, ligament or muscle injuries, restricted ankle movement, externally rotated lower legs, or inward knee alignment.
Obesity can lead to arch collapse by increasing load on the foot. Childhood footwear was once considered a cause of flat feet. Recent research questions this theory, as populations that commonly walk barefoot tend to have flat arches more often than those who wear shoes.
Some children and adolescents develop flat feet without associated disorders or factors. Understanding the role of foot muscles in arch stabilization and lower limb function may provide answers.

Evaluation by the pediatric orthopedic doctor

The evaluation begins with a general musculoskeletal examination, including the rotational profile of the legs. This is best assessed by measuring internal and external hip rotation while the patient lies down. A generalized laxity assessment using the 9-point Beighton score is also useful for detecting hypermobility. A score ≥5 may indicate a hypermobility disorder in children over age 5. The presence of generalized ligament laxity or external tibial torsion, especially combined with excessive femoral anteversion, requires monitoring due to the risk of symptomatic flat feet.
The examination should include inspection of the feet while standing, sitting, and walking. The doctor examines the feet from the front and back while standing. A rear view may reveal heel valgus. Normally, only the fifth and half of the fourth toe are visible from behind. In flat feet, more toes are visible due to external rotation. Counting visible toes from behind is an easy objective way to document progression. Angular or rotational deformities of the hips, knees, ankles, or feet may worsen during walking and explain pain symptoms.
It is important to determine the location of any foot pain. Pain is often located in the medial midfoot due to localized pressure on the collapsed talar head, where callus formation may be evident. Pain may also occur laterally in the sinus tarsi due to impingement from excessive subtalar eversion. Sudden onset pain, worsening at night, or associated with fever should be evaluated for more urgent causes such as infection or neoplasm.

Diagnosis of flat feet

A pediatric doctor can usually diagnose flat feet in children. They may refer you to a pediatric orthopedic specialist. The first consideration is the patient’s age. The longitudinal arch develops during the first 10 years of life, and prevalence decreases with age. The second consideration is whether the foot is flexible or rigid. A rigid flatfoot is usually painful and caused by bone or inflammatory disorders. Diagnosis is usually made by visual inspection. The doctor will ask the child to stand and walk. Shoe wear patterns may also be examined.
The doctor may also examine the child’s knees and hips to determine whether the foot condition is linked to other issues. If severe foot pain is present, tests such as:

• X-rays. X-rays use small amounts of radiation to produce images of bones and joints. Particularly useful for detecting arthritis.
• CT scan. Captures X-rays from different angles and provides more detailed images than standard radiographs.
• Ultrasound. If a tendon injury is suspected, ultrasound uses sound waves to produce detailed soft tissue images.
• MRI. Using radio waves and a strong magnet, MRI provides excellent detail of both hard and soft tissues.

To benefit from the most comprehensive imaging method, MRI, even within our clinic, schedule an appointment now.

Treatment

If a child has no symptoms, treatment is often not necessary. The condition will instead be observed and periodically reevaluated. Custom orthotics may be considered in some asymptomatic cases.
When the child has symptoms, treatment is necessary. The orthopedic doctor may select one or more of the following nonsurgical approaches:

• Activity modification. Temporarily reduce activities that cause pain and avoid prolonged standing or walking.
• Orthotic devices. Custom orthotics inserted into the shoe to support foot structure and improve function.
• Physical therapy. Stretching exercises supervised by an orthopedic doctor or physical therapist may help.
• Medication. NSAIDs such as ibuprofen may help reduce pain and inflammation.
• Shoe modifications. The orthopedic doctor will advise on appropriate footwear features.

Medical recommendations

All symptoms should always be evaluated with a thorough examination by a pediatric doctor to establish a correct diagnosis and treatment plan and to exclude serious conditions.
Before considering surgery, the pediatric doctor may suggest home remedies to help prevent complications:

• Rest.
• Applying ice to the foot.
• Over-the-counter anti-inflammatory medication such as ibuprofen.
• Using appropriate shoe inserts or footwear.
• Avoiding high-impact sports such as basketball, football, hockey, and tennis.
• Managing risk factors such as obesity, high blood pressure, and diabetes.
• Performing physical therapy and stretching exercises, especially calf and Achilles tendon stretches.
• Avoid running on hard surfaces.
• Avoid activities that place excessive stress on the feet.

To obtain an accurate diagnosis and a complete treatment plan, contact Centrokinetic.