Flatfoot fundamentals
The arch in your foot supports you when you stand or walk. The absence of an arch is known as flatfoot. In flexible flatfoot, the arch can be seen when the foot is not bearing any weight. In rigid flatfoot, the arch is completely invisible.
All children are born with flat feet. After the age of three, children begin to develop an arch. However, rigid flatfoot can be detected at birth and may be able to be treated earlier.
To test your child's arch, wet his or her feet and have him or her stand on a dry, flat surface. Flat feet leave a nearly complete imprint, with little inward curve where the arch should be.
What causes flatfoot?
Flexible flatfoot is caused by lax ligaments in the foot, resulting in a flattened arch. The condition is genetic and common among people with Down's Syndrome. Rigid flatfoot is caused by abnormal foot development, either due to genetics or another condition, such as cerebral palsy. It can also be caused by a bone fracture or dislocation, a torn or stretched tendon, or arthritis.
Flexible flatfoot is typically not painful, though some children may experience pain after playing sports. Rigid flatfoot causes foot pain during everyday activities.
Your child should see the doctor if:
- His or her feet tire easily or become painful after standing.
- It's difficult for him or her to move their heel or stand on their toes
- His or her feet hurt while playing sports
What are my child's treatment options?
Children may outgrow flexible flatfoot as their foot ligaments develop. Rigid flatfoot often requires surgery.
Medical Treatment
If your child's flatfoot condition is bothersome, consider the following treatment options for your child:
- Purchase better-fitting shoes.
- Use shoe inserts, such as arch supports.
- Give your child nonsteroidal anti-inflammatory drugs such as aspirin to relieve pain.
- Rest your child's foot and apply ice to the painful area.
- Follow a physical therapy regimen prescribed by your doctor.
- Schedule surgery if conservative treatments fail.
Surgical Treatment
Surgical procedures to correct flatfoot include:
- Fusing one or more of the bones in the foot or ankle together.
- Cutting and reshaping a bone to correct alignment.
- Removing a bone or bone spur.
- Cleaning the sheath covering a tendon.
- Using a piece of one tendon to lengthen or replace another.
What are the risks of treatment? Is the treatment safe?
Risks of surgery include nerve injury, infection, bleeding, and stiffness.
How do I prepare my child for surgery?
- Complete any pre-operative tests or lab work prescribed by your child's doctor.
- Arrange to have someone drive your child home from the hospital.
- Do not allow your child to take aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your child's appointment time. If your surgery is being done at Cleveland Clinic, call 216.444.0281.
What should I do the night before surgery?
Do not eat or drink anything after midnight.
What do I need to do the day of surgery?
- If your child currently takes any medications, have him or her take them the day of surgery with just a sip of water.
- Avoid having your child take diabetic pills or insulin.
- Do not allow your child to wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Have your child wear loose-fitting, comfortable clothing.
- Bring crutches or a walker.
What happens after surgery?
If your child experiences persistent numbness, tingling, or burning sensations in the foot or ankle, it may be due to a cast or surgical dressing that is too tight. Elevate the foot, and if this does not resolve the problem, call your child's doctor. Encourage your child to avoid prolonged sitting or standing or putting weight on the operative site unless given permission by the doctor. To reduce swelling, keep your child's foot elevated above his or her heart.
The doctor will most likely give your child pain medication, which may cause nausea.
Keep the cast dry.
Ask your child's surgeon for complete post-operative instructions.
How long is the recovery period after surgery?
Depending on the type of surgery performed, recovery typically takes two to eight weeks with the foot in a cast.
What is the rehab after surgery?
Depending on the procedure, physical therapy is often necessary to strengthen the muscles that have weakened while in a cast. Also, your child's doctor may prescribe orthotics and medication to reduce swelling.
How can my child manage at home during recovery from the procedure?
You will receive home-going instructions from your surgeon.
How frequently should I schedule follow up appointments with my child's doctor following surgery?
Your physician will inform of the timing of your child's appointments.
What are Cleveland Clinic physician credentials?
All doctors at Cleveland Clinic's Pediatric Orthopaedic Surgery are board-certified or board-eligible in orthopaedic surgery or have the international equivalent. In addition, our surgeons have subspecialty training and years of experience in pediatrics.
All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216/444-2606 or toll free 1/800-223-2273, ext. 42606, Monday through Friday, 8 a.m. to 5 p.m. (Eastern Standard Time).
What clinical trials and orthopaedic research are being conducted at Cleveland Clinic on the procedure?
Researchers at Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.