Flat feet is a condition where the foot does not have a normal arch. It can affect one or both feet. In children, it usually affects both feet unless there is some other underlying problem. All babies' feet look flat because of the fat pad on the bottom of the foot, and because the arch hasn't formed yet. The foot arches are normally developed by the child by the time they are 2-3 years old. Flat feet usually do not cause any problems.

However, there are times that flat feet may cause problems. If your child is complaining of hip, knee, foot or ankle pain, an evaluation by a physical therapist would be recommended. An evaluation would also be recommended if they are tripping often due to their flat feet, and if they are wearing out the inside edges of their shoes very quickly.

What are the symptoms of flat feet?

Flat feet are characterized by lack of arches on the inside edge of the foot. When a child with flat feet is weight bearing, the inside edges of his feet collapse toward the floor. They often wear out the inside edges of their shoes. Some children exhibit no symptoms, some children will trip more frequently and occasionally, children will complain of hip, knee, ankle or foot pain because of the alignment of their feet.

Flat feet can be common in children with other medical diagnoses including hypotonia (low tone) and developmental delays.

How are flat feet diagnosed?

Flat feet can be diagnosed by visual examination of the feet, especially when the child is standing. A child's pediatrician can diagnose flat feet during a visit. X-rays may be taken of the foot to rule out bone changes. It can also be diagnosed by an orthopedic surgeon, although a visit to an orthopedic surgeon is only necessary if surgical repair is being considered, or if pain is a serious issue.

How are flat feet treated?

Flat feet may not require intervention or treatment, however treatment may be necessary in the following circumstances:

  • Severe cases
  • When there is pain
  • When improved alignment of the feet will improve function (i.e. decrease tripping and falling).

In some cases, flat feet will improve as the child matures and get stronger.

Treatment usually entails:

  • Pre-fabricated shoe inserts to control the foot position when standing and walking. Custom shoe inserts can also be made if necessary. Shoe inserts can be obtained from a physical therapist or orthotist.
  • Stretching exercises given by your physical therapist may be necessary if the child is experiencing pain and the heel cords are tight.
  • Strengthening exercises given by your physical therapists may be necessary if the child is experiencing pain to improve general alignment.
  • Surgery may be warranted in later childhood, depending on severity.
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