Flat feet / fallen arches

Flat feet in paediatrics can be a concern for children and their parents. Usually, the concern is regarding a lower than normal arch on the inside of the foot. This can be a completely normal finding in children, and is often observed in children of a certain age. Dependent on the presentation of the flat foot many require annual screenings to monitor the feet with no intervention.

What causes flat feet in children?

The causes are varied, the most common cause in children being hypermobility, this means someone who has particularly flexible joints and ligaments.

Other causes of flat feet in children are the following:

• Over pronation
• Leg length difference
• Being overweight
• Tibial varum - bowed legs
• Injury
• Hereditary

What are the signs and symptoms?

In some cases children have an arch when non-weight bearing, but then it collapses when standing. The main sign of flat foot is flattening of the inside arch, or the bottom of the foot has complete contact with the floor. Children may wear down one side of there shoes quickly, or find that they are unstable when walking resulting in trips and falls.

What are the benefits of podiatry for my child's flat feet?

If a child has flat feet which is concerning the parent, or a child is experiencing lower limb pain when walking, it is advisable to attend for a paediatric podiatry assessment. The podiatrist will be able to determine if this is part of the normal bony development in children, or if intervention is indicated. Following an assessment, if it is found that treatment is appropriate, the following benefits may be achieved with podiatry:

• Reduction in pain
• Improvement in foot and lower limb function
• Improvement in gait
• Reduction in trips and falls

The flat foot management is often managed by supportive footwear with or without orthoses inside the shoes, exercise may also help. The final treatment option, failing conservative methods, would be surgery. This option is reserved for those with very severe mal-alignment, perhaps due to congenital deformity, or a torn tendon that does not respond to conservative treatment

What would podiatry for my child's flat foot involve?

Your podiatrist can assess your child if you have any concerns with regards to their foot posture. It is a good idea to dress your child in loose fitting trousers that may be rolled up so that the leg is easily accessible. Sometimes it is necessary to assess the hips as well; if this is the case shorts are desirable.

A visit to our clinic will begin by obtaining a thorough history, both medical and social. Our podiatrist will then assess your child's leg and foot, and have a look at them walking.

Treatment for your child's flat foot will depend on the cause. Sometimes treatment for flat foot is not necessary, if this is the case your podiatrist will discuss this with you. Equally it may be that treatment will encompass physiotherapy, again your podiatrist will discuss this with you and we have excellent links with paediatric physiotherapists here at the clinic.

If treatment is necessary this may include:

• Orthoses
• Heel raises
• Shoe inserts
• Stretching Programmes
• Advice and education
• Footwear modification
• Exercise prescription
• Activity modification
• Lifestyle changes