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Introduction:

The sole of our foot is usually not flat. It has a central arch (Figure 1).

Flatfoot is a condition in which the arch of foot is absent and sole is flat (Figure 2). Flatfoot is extremely common in young children (1 to 5 years age). Majority of these children develop normal arches as they grow up.

When child with flatfoot is assessed in standing position, the foot is seen to “ROLL OUTWARDS” (OUT-TOEING) (Figure 3).

Types:

Broadly, flatfoot is of two types:

Flexible flatfeet:

In flexible flatfoot, the foot appears flat when the child is standing (Figure 4). However, the arch reforms when the foot is assessed with the child not bearing weight (Figure 5).

Rigid flatfoot:

Rigid flatfoot is more severe deformity in which the foot is flat in standing as well as non-weight bearing position. It occurs due to underlying bony abnormality like rocker bottom foot in new-born babies, or, tarsal coalition in adolescents (Figure 6, 7).

Diagnosis:

Flexible Flatfoot is diagnosed on clinical examination. However, in rigid cases, X-rays are needed to look for bony abnormalities.

Treatment:

Flexible flatfoot:

Flexible flatfoot is not pathological and in majority of cases requires no specific treatment. If the child has no symptoms (pain, fatigue, difficulty in wearing shoes), parental counselling and reassurance are all that are required. In majority of cases, children with flexible flatfeet develop a strong arch by the age of 10 years.

Exercises: Few children have tight heel cords and they may be benefited by exercises to stretch the tight muscles.

Shoes: Sports shoes are usually preferred for children with flexible flatfeet.

Insoles/ orthoses: Insoles/ braces/ splints are often prescribed for children with flexible flatfoot and foot pain. However, in reality, there are no scientific studies which show beneficial effect of insoles/ orthoses in flexible flatfeet. In fact, some studies show poorer patient reported outcomes in children who wear insoles/ orthoses as compared to children who don’t wear orthoses. We usually avoid prescribing insoles/ orthoses for children with flexible flatfeet.

Surgery: In flexible flatfoot, surgical correction is reserved for severe cases in children beyond the age of 10 years, who have symptoms in form of foot pain and difficulty in shoe wear. However in clinical practice, such cases are extremely rare.

Rigid flatfoot:

Rigid flatfoot is a distinct clinical entity from flexible flatfoot. Rigid flatfoot usually needs surgical treatment. Nature of surgery depends on underlying bony abnormality.

Outcomes:

There are many professional athletes who have flexible flatfeet. Flexible flatfeet will not stop your child from participating in any sport or exclude them from any job.

Outcome of treatment of rigid flatfoot depends on nature and severity of underlying pathology.

Article written by public information by Dr Sandeep Vaidya, Chief, Division of Children’s Orthopaedics. For more information, email drsandeepvaidya@pinnacleorthocentre.org. To schedule an appointment , log in to www.pinnacleorthocentre.com, or, call 7028859555.