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Flatfoot in Children
Flatfoot in young children does not need to cause concern among parents. The muscle strength in such young ones is low, and the ligaments are naturally loose, which can result in the lowering of the arch of the foot. As the child develops, the muscles and ligaments strengthen, the amount of fatty tissue in the foot decreases, and the medial part of the foot elevates. Only after several years, when the arches of the foot are fully formed, can we observe whether the foot is developing correctly.
When Does Flatfoot Disappear in Children?
Flatfoot in infants and young children is normal because forming the arch of the foot takes time. Parents should not worry, as flatfoot typically resolves by the age of 2 to 3 years. The muscles gradually strengthen, giving the foot its proper shape. In rare cases, as the child grows, the bones of the feet may fuse, causing pain. This is known as tarsal coalition, an abnormal connection between the rearfoot bones. It can also happen that the arch does not form correctly. When complete bone fusion does not occur, and the muscles and ligaments remain highly lax, this condition is referred to as early childhood flatfoot.
How to Recognize Flatfoot in a Child?
Parents play a crucial role in a child's development. They are the ones who spend the most time with their child, closely observing their growth. Therefore, it is essential to notice even small signs of potential issues. Flatfoot is a childhood condition that, if left untreated, can lead to permanent deformity, instability, and pain as the child grows. Children spend a lot of time on their feet, so maintaining foot health is vital. The first thing that should concern a parent is pain, hence the term "painful flat-valgus foot." If the child frequently complains of foot pain, tenderness, or cramps, this should raise concern. If you also notice outward tilting of the heels and clumsiness while walking, you should consult an orthopedist.
The specialist will examine the child's feet under both weight-bearing and non-weight-bearing conditions, as well as in shoes and barefoot. To assess flatfoot, the doctor will observe how the child walks and how their feet contact the ground. For detailed diagnostics, the orthopedist may recommend additional tests such as X-rays, CT scans, or MRI.
Is Flatfoot Dangerous in Children?
Flatfoot in children can be flexible or rigid. Flexible flatfoot is characterized by a normal arch when the foot is not bearing weight (e.g., while sitting), but the arch disappears when the foot bears weight during standing. In rigid flatfoot, the arch is stiff and flat in both sitting and standing positions. In children without pain, flatfoot usually does not require treatment. However, the child should remain under the care of an orthopedist and undergo periodic check-ups. For children with painful flat-valgus feet, the doctor may recommend physiotherapy, suggest changes in footwear, or prescribe special insoles.
Exercises for Flatfoot in Children
Exercises for flatfoot, as proposed by physiotherapist Kacper Abramowski from Rehasport, consist of strengthening and stretching elements. Stretching exercises focus on the triceps surae muscles and the long peroneal muscles. It is essential to approach the child positively and encourage them to exercise, possibly by incorporating playful activities.
Example Exercises for Flatfoot:
- Removing socks without using hands,
- Rolling a towel with the feet in a race,
- Cleaning up using the feet,
- Walking on heels and the outer edges of the feet,
- Clapping with the feet,
- Grasping and transferring objects with the feet.
Flatfoot in Adults
The human foot is anatomically complex. It consists of 26 bones forming 33 joints, all supported by over 100 muscles and ligaments. This complexity is not accidental, as the feet serve as the locomotor apparatus, providing stable support for the human body during standing and movement. A properly arched foot has a bow-shaped arch on the plantar side, which is clearly visible in a podoscope examination. The correct arch ensures shock absorption during walking or running and provides stable support during standing. It also determines our gait. The arches must be both strong and flexible to adapt to the stresses of walking on various surfaces.
People with flat-valgus feet have a significantly flattened arch. There is no gap between the midfoot and the heel, nor is there the characteristic medial hollowing. Flat feet also alter the vertical axis, with a noticeable inward tilting of the ankles (the feet will turn outward). Flatfoot affects the uneven distribution of body weight, as evidenced by shoes that wear out much faster on the inner side.
Flatfoot - Diagnosis
An orthopedist or physiotherapist can diagnose flatfoot using a special device called a podoscope, which allows for a static examination (for children, adolescents, and adults) to assess foot deformities through a mirrored reflection method. Another, more advanced diagnostic tool is a computer platform known as a podobaroscope, which analyzes pressure distribution on the plantar surface of the foot. However, anyone can perform a fairly simple test at home. Simply wet your feet and stand barefoot on a flat surface (e.g., concrete) where the footprints will leave an impression. A flat-valgus foot will not show the characteristic indentation on the inner side of the footprint.
Flatfoot - Symptoms
The most common symptom of flatfoot is foot pain caused by increased tension in the muscles and ligaments. Pain is usually localized in the arch of the foot, the inner ankle, and the lower leg. Improper weight distribution may also lead to pain in the knee and hip joints. Symptoms tend to worsen after long walks or prolonged standing. It is important to note that flat feet are not necessarily a cause for concern if no pain is experienced. Flatfoot requires treatment only when it causes discomfort or pain.
When Are You at Risk of Flatfoot?
The most common causes of flatfoot, or painful flat-valgus foot, include genetic factors, as the likelihood of developing flatfoot increases if it is present in the family. People who are physically very active, especially those engaged in sports that often involve foot and ankle injuries, are also at risk. Older adults, who are more prone to falls or physical injuries, are another at-risk group. Additional risk factors in seniors include hypertension and diabetes.
Another cause of flatfoot is tarsal coalition, which is an abnormal connection between the bones of the rearfoot. Subtypes include talocalcaneal and calcaneonavicular coalition, which lead to stiffness and flattening of the arches. Flatfoot is more likely to develop in individuals who are obese and in pregnant women. Flat-valgus feet can also develop with age due to weakening of the posterior tibial tendon, a key structure supporting the foot's arch, and calf muscle tightness.
How to Treat Flatfoot?
If you experience pain in the feet, ankles, or lower limbs that causes difficulties with walking or running, you should consult an orthopedist or physiotherapist. This is particularly important if symptoms persist despite using properly fitted footwear. The first step a doctor may recommend is using specially designed insoles to support the arch of the foot. However, these products address symptoms rather than provide lasting benefits.
When obesity is a key factor contributing to flatfoot, significant lifestyle changes, including diet and exercise, are necessary to reduce body weight. In some cases, the doctor may prescribe medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to alleviate pain. In more severe cases, surgery may be the only solution. Orthopedic surgery typically involves tendon and bone realignment to restore the proper arch. If the Achilles tendon is also too short, it may be lengthened to reduce tension.
Flatfoot - Surgical Treatment
If conservative treatments, anti-inflammatory therapy, or physiotherapy fail to deliver expected results, surgical intervention may be considered. Orthopedists have several surgical techniques at their disposal, depending on the severity of the deformity (flat or flat-valgus foot) and the presence of other conditions.
For flatfoot in young people caused by tarsal coalition, surgery involves removing the abnormal connection between the tarsal bones, typically between the calcaneus and talus or between the calcaneus and navicular bone.
In young individuals with joint hypermobility, painful flat-valgus foot, but adequate muscle and ligament function and correctability, a minimally invasive surgical method called subtalar arthroereisis may be used. This involves inserting an implant, such as a titanium screw, into the sinus tarsi between the calcaneus and talus to reduce valgus deformity during activity.
For flat or flat-valgus foot acquired in adults, posterior tibial tendon dysfunction is often the primary cause. Depending on the stage of the condition, various surgical techniques may be employed. If the flat deformity is correctable and the tendon is functional, treatment may involve transferring the flexor digitorum longus tendon to support the posterior tibial tendon, sometimes combined with a calcaneal osteotomy.
In cases where the flat-valgus deformity persists and is uncorrectable during orthopedic assessment, more extensive surgical treatment is required. This may involve fusing the rearfoot joints, most commonly through a double or triple arthrodesis of the tarsal bones. This procedure fuses the degenerated and deformed joints into a single bone after correcting the flat-valgus alignment to one closer to physiological norms. The goal of surgery is to reduce pain and correct the flat-valgus deformity.
Exercises for Flatfoot
Physiotherapist Jagoda Furmanek-Kulik from Rehasport in Gdańsk, a specialist in foot assessments, presents five essential exercises for flatfoot in adults.
Flatfoot Exercises - Toe Raises
Perform toe raises while squeezing a ball between the heels. Do 3 sets of 15 repetitions at a slow pace.
In a kneeling position, raise the toes on the front foot and lift the knee off the ground, keeping the body stable. Hold the position for 10 seconds and perform 10 repetitions in 3 sets.
Flatfoot Exercises - Toe Mobilization
Perform alternating movements of the big toe and other toes in 3 sets of 20 repetitions.
Flatfoot Exercises - Corrective Foot Position
Corrective foot positioning involves placing weight on the outer part of the heel while keeping the toes fully in contact with the ground to form a visible arch on the inner side.
While standing on one leg, lift the opposite hip toward the ear. Perform 3 sets of 20 repetitions.
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