What does it mean to have flat feet?
Flatfoot is a condition that can affect both adults and children. 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 not present, whether bearing weight or not.
All children are born with flat feet. After the age of 3, children begin to develop an arch. When a child has pediatric flatfoot, the arch of the foot shrinks or disappears when he or she stands. The arch reappears when the child sits or stands on tiptoe. This is called flexible pediatric flatfoot.
A second, more rare kind of pediatric flatfoot is called rigid flatfoot. With this condition, the arches do not reappear when the child sits or stands on tiptoe. However, rarely, rigid flatfoot can be identified at birth and may be able to be treated earlier. Painless, flexible flatfeet usually do not lead to any problems in adulthood.
What causes flat feet?
Flexible flatfoot is caused by lax ligaments in the foot, resulting in a flattened arch. The condition is heredity. It can be seen 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. Adult onset flatfoot can also be caused by a bone fracture or dislocation, a torn or stretched tendon, or arthritis. Rigid flatfoot can develop among adults 40 years of age and older who are sedentary and overweight. At times, an adult can recall an injury, but more often the flatfoot is a gradual development.
Flexible flatfoot is typically not painful, though some people may experience pain after playing sports. Rigid flatfoot can cause foot pain during everyday activities.
See your doctor if:
- Your feet tire easily or become painful after standing.
- It’s difficult to move your heel or stand on your toes.
- Your feet hurt while playing sports.
- You have rheumatoid arthritis, or any other systemic illness which is contributing to your foot problem.
What are the symptoms of flat feet?
Most children with pediatric flatfoot have no symptoms. A parent or caregiver usually notices the condition.
Symptoms children may experience include:
- Pain, tenderness, and/or cramping in the feet or legs, especially along the bottom of the feet.
- Heels that tilt outward.
- A change in walking.
- Pain or discomfort while walking.
Parents may also notice their child withdrawing from sports and other physical activities that may cause pain in their feet and legs.
If your child experiences any of these symptoms, you should talk to your pediatrician about the issue.
Children affected by rigid flatfoot may experience more severe symptoms. Those affected with tarsal coalition — an abnormal joining of two bones in the feet — may begin to experience symptoms at preadolescence.
Children with a condition called congenital vertical talus, which causes a rigid rocker bottom appearance, may begin to experience symptoms at walking age.
How are flat feet treated?
Children usually outgrow flexible flatfoot as their foot ligaments develop. Rigid flatfoot may require surgery.
If your flatfoot condition is bothersome, consider the following treatment options:
- Purchase better-fitting shoes.
- Use shoe inserts, such as arch supports. These can be obtained over-the-counter, or you may require custom-made inserts with a prescription from your doctor.
- Take nonsteroidal anti-inflammatory drugs to relieve pain.
- Rest the foot and apply ice to the painful area.
- Follow a physical therapy regimen prescribed by your doctor.
- Undergo surgery if conservative treatments fail.
Surgical procedures to correct flatfoot include:
- Repairing a stretched or torn tendon.
- Fusing one or more of the bones in the foot or ankle together.
- Cutting and reshaping a bone to correct alignment.
- Using a piece of one tendon to lengthen or replace another.
What are the risks of treatment?
Risks include nerve injury, infection, and stiffness of the joints, and onset of a new callus in a different area of the foot.
Diagnosis and Tests
How are flat feet diagnosed?
Your healthcare provider can usually diagnose pediatric flatfoot. He or she may also refer you to a foot and ankle surgical specialist. The condition is usually diagnosed by viewing the foot with the naked eye. The physician will have you or your child sit, stand and walk to examine how the feet look in each situation. The physician may also examine your child's shoes to look for patterns of wear.
In more severe cases, an X-ray may be taken to determine the extent of the deformity. Your physician may also examine the child's knees and hips to determine if the foot condition is related to any problems in the leg.