Flatfoot: Frequently Asked Questions

Que.1-What is flatfoot?

Ans: The sole of our foot is usually not flat. It has a central arch (Figure 1). Flatfoot is extremely common in young children (1 to 5 years age). Majority of these children develop normal arches as they grow up.

In flatfoot, the arch is absent and the sole is flat (Figure 2).

Figure 2: Flatfoot

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

Figure 3: Out-toeing in standing position

Que.2- What are the types of Flatfoot?

Flatfoot are broadly of two types:

(a) Flexible flatfoot:

• Foot appears flat when child is standing (Figure 4).
• Arch reforms when the foot is assessed with the child not bearing weight (Figure 5).

Figure 4: Flatfoot in standing

Figure 5: Restoration of normal arch in non-weight bearing position

(b) 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).

Figure 6: Rigid flatfoot in new-born due to rocker bottom foot

Figure 7: Rigid flatfoot due to tarsal coalition

Que.3- How is flatfoot diagnosed?

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

Que.4- How is flexible flatfoot treated?

Ans: Flatfoot which is flexible, as is seen in majority cases, does not need any specific treatment. Most of the children with flexible flatfeet develop a strong arch by the age of 10 years.

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

Sports shoes are usually recommended for children with flexible flatfeet.

Insoles/ braces/ splints are often prescribed for children with flexible flatfoot and foot pain. However, scientific evidence suggests that insoles do not help in early restitution of arch in child with flatfeet. Arches may be used by children who have aching sensation in the feet after periods of prolonged activity/ sports.

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.

Que.5- How is rigid flatfoot treated?

Ans: Rigid flatfoot usually needs surgical treatment. Form of surgery depends on underlying bony abnormality.

Que.6- Will my child’s flat feet prevent him/her from playing sports or joining any job?

Ans: There are many professional athletes who have flat feet. Flat feet will not stop your child from playing any sport. It also does not exclude them from any job.

Dr Sandeep Vaidya, Division of Children’s Orthopaedics, Pinnacle Orthocentre Hospital, Thane. For more information, write to drsvvaidya@gmail.