Author
Dr. Roiman Leonardo Mejía. Pediatric Orthopedics and Traumatology, University Hospital Fundación Valle del Lili
Flat feet, also known as pes planus or fallen arches, are generally described as the flattening of the arches of the feet when standing. It is a fairly common condition in children and adolescents and is actually normal in babies and toddlers.
Flat Feet in Childhood: When is it normal and when should you consult a doctor?
Flat feet are one of the most frequent reasons parents seek medical advice, often feeling great concern and searching for effective treatment. In most cases, the arch begins to develop gradually between the ages of 5 and 10, without causing pain or functional limitations.
However, it's important to consult a specialist if flat feet persist beyond childhood, appear during adolescence, or are accompanied by symptoms such as pain in the feet, ankles, knees, or back; excessive fatigue when walking; difficulty performing physical activity; foot stiffness; or uneven wear of shoes. Medical evaluation is also recommended if the flat feet are asymmetrical, associated with gait abnormalities, or appear suddenly after an injury.
Why do flat feet occur in children?
The main cause of flat feet in childhood is related to the natural flexibility of children's bones and joints. This flexibility can cause their feet to flatten when they stand. Additionally, babies have a greater amount of fatty tissue on the soles of their feet, which gives them a flat appearance even though the bone structure is normal.
The plantar arch begins to develop gradually between the ages of four and six. This development is influenced by the gradual disappearance of plantar fat and a progressive decrease in joint laxity, along with the normal development of the foot muscles and ossification, where bone forms from a cartilaginous model of the tarsal bones. In most children, the feet become less flexible, the arch develops, and flat feet disappear by the age of five or six. It is estimated that by age ten, between 80% and 90% of children have developed an arch without requiring treatment.
Flat feet can also be hereditary. Some inherited conditions, such as Ehlers-Danlos syndrome or Marfan syndrome, can cause looser ligaments and tendons, leading to flat feet. However, although a familial tendency has been observed, no specific gene or factor has been identified as directly causing flat feet.
In rare cases, painful flat feet in children can be caused by a condition called tarsal coalition, where two or more bones in the foot grow together or fuse. In adults, flat feet can develop due to aging, injuries, or diseases that damage the tendons.
Which are the risk factors?
A recent study identified that, in children aged six to twelve, the proportion of children with flexible flat feet decreases significantly with age. Factors associated with a higher risk of flat feet included joint hypermobility, wearing closed shoes, and living in an urban environment. Conversely, increased exercise, wearing comfortable and flexible shoes, and living in a rural environment were identified as protective factors.
Types of Flat Feet and Symptoms
It is important to distinguish between two main types of flat feet in children:
Flexible Flat Foot: This is the most common type and is considered a variation of a normal foot. In a flexible flat foot, the arch is visible when the child is sitting or on tiptoes, but the arch collapses when they stand and bear weight. Generally, flexible flat feet do not cause pain or interfere with walking or participating in sports.
Rigid Flat Foot: This type is less common. In a rigid flat foot, there is no arch in the foot, even when the child is on their toes. Movement of the foot and ankle is stiff or rigid. Generally, this type of flat foot is painful and can cause functional difficulties.
Most flat feet don't cause pain or other problems. However, if your child complains of persistent foot or lower leg pain, they should be evaluated by a pediatric orthopedist.
Managing Flat Feet: Less is Often More Effective
This is where the information from studies is crucial. The good news for the vast majority of cases is that flexible flat feet do not require treatment. Clinical monitoring is simply recommended.
Contrary to popular belief or past recommendations, medical and scientific sources indicate the following:
Special insoles or shoes will not permanently change the appearance of your child's feet or alter their natural development. Your child's feet will grow and develop the same way whether they wear special shoes, insoles, or heel pads.
Use of insoles or rigid footwear
Using insoles or rigid shoes can actually make the shoe sole stiffer, which hinders the natural muscle development of the foot. Regular physical activity helps this system function effectively.
What is recommended then to promote normal foot development?
Recommendations based on orthopedic research sources focus on supporting the natural development of the foot:
Walking barefoot: Walking barefoot, especially at home, is highly recommended. It stimulates and strengthens the muscles of the foot.
Appropriate footwear: It is recommended to increase the amount of time the child spends barefoot or to use footwear that is as lightweight and flexible as possible. This allows for the natural movement of the foot and provides protection and comfort while walking.
Account management
For children with asymptomatic (painless) flexible flat feet, clinical monitoring is generally recommended without the need for active treatments such as orthotics or special shoes. If symptoms such as persistent foot or lower leg pain arise, or if walking difficulties occur, it is time to consult a doctor for a more detailed evaluation.
In case you require a consultation with a pediatric orthopedistYou can request it at the Fundación Valle del Lili to the PBX (602) 331 9090.
