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Children with flat feet: do they require treatment?

flat feet in children

In the past few years of practice, numerous parents have visited the clinic to enquire if it is necessary to treat a child for flat feet. Obviously they are concerned for the welfare and well-being of their children, so there is nothing “silly” about such requests and acts of devotion to their children. Hopefully this short piece can help set some minds to rest.

An important piece of information I remember from my training days is that “children are not little adults”, and as such their feet and legs are not miniature versions of an adult form, as the child undergoes various lower limb changes during its first few years. Whilst at university, we studied x-rays of children’s feet. The first thing many of us noticed is that there was hardly anything visible on the x-ray! She explained that this was because the bones of the foot have been observed to ossify (go hard) over a period of years, starting at the top and working down to the toes. Some bones only completely harden during the teenage years, however it seems that most are ossified by the age of 6 (Neales, 2010). Before ossifying, they are more like cartilage, i.e. rubbery, similar to a shark’s skeleton, only cuter (unless you really like sharks).

According to “Neale’s Disorder’s of the Foot” (2010), at the age of 2, the child would be expected to walk in a posture that is bow-legged and flat-footed, with the toes pointing outward or inward, feet positioned far apart to form a wide base, and the knees remain partly flexed throughout the gait cycle; the child will also lean forward with arms out to the sides, as if walking on a tightrope. Between the ages of 2 and 6 years, the bow-legged stance changes to a knock-kneed stance, the foot type becomes more visible (short and broad, square, hyper-mobile, long and slender, triangular, or a long inner border) and the inside arch starts becomes more noticeable.

Factors that can cause the child’s foot to function in a flat posture (lowered inside arch) beyond the age of six include bio-mechanical issues in foot and leg itself that arise from abnormalities during the growth and maturation stages (limb length differences, increase tibial rotation, tibial varum, and so on), due to obesity, or sometimes, especially in girls, benign generalised joint hyper-mobility (“double jointed”).

However, the question remains, to treat a flat foot or not. Angela Evans, in her article entitled “The flat-footed child – to treat or not to treat: what is the clinician to do?” (2008) described a “traffic light system” for just this matter. A “GREEN LIGHT” means not to treat; this means that the child has no symptoms and they are in the stage of development when it is expected to have flat feet. An “AMBER LIGHT” means that it up to the clinician’s discretion; the child has flat feet outside the developmental phase but no symptoms; for this monitoring is recommended. A “RED LIGHT” recommends treatment; the child is experiencing symptoms, regardless of the stage of development they are in; she recommends the use of functional orthoses for the treatment of such cases.

Obviously that’s a lot to take in and parents may still be unsure. That’s okay. We’re here to help. If you have any concerns about your children’s feet (or your own), then please feel free to contact us and we will do our best to assist you.

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