“Flat foot” or “fallen arches” is a very frequent deformity of the lower extremities and one of the major concerns of parents.
Flat foot is classified by the World
Health Organisation as a joint disorder, and defined as an acquired or congenital deformity of limb (WHO 2010).
Flat foot is a condition in which the arch of the foot is abnormally flattened down so that the entire sole makes contact with the ground.
The human foot is a very strong and complex anatomical structure, consisting of a total of 26 bones; 33 joints; 42 muscles, and more than 50 tendons and ligaments with other surrounding soft tissues. The foot’s main function is to bear the body weight and allow bipedal locomotion (walking/running).
The bones of the foot are not arranged in a horizontal plane but rather in arches. They allow the feet to bear the weight of the body when standing and act as shock absorbers during movement, i.e., during walking, running, jumping, etc. Generally, flat footed kids are believed to have gait disorders later on in their lives.
When to worry
Children almost universally are “flat-footed”, when they start walking. In newborns and toddlers, a fat pad is present underneath the skin of inner curve of the infant foot. As the development of foot takes place, this fat pad resolves between the ages of 2 and 5 years.
Flatfoot in kids can be divided into flexible and rigid categories. It is atmost important to first categorize the flat foot into two groups of flexible or rigid flatfoot.
Flexible flatfoot is characterized by a normal curvature on inner side of the foot during non weight-bearing phase. However feet flattens of the arch on walking. This condition may be asymptomatic or symptomatic. But, rarely, Flexible flatfeet cause pain or disability in infancy and childhood. Infants are born with flexible flatfoot, and the normal foot arch develops in the first 10 years of life, yet in some kids it persists into adolescence and adulthood.
Rigid flatfoot is characterized by a stiff, flattened arch in both weight bearing and non-weight bearing positions. Simpler term, if the foot is not bearing any weight, still inner curve is not seen, then it is called rigid (fixed) flatfoot.
Most of the time some underlying anomaly is responsible for rigid flatfeet that requires medical attention.
How flat foot can affect your kid?
Flat foot may be symptomatic or asymptomatic.
When we stand or walk, our feet bear our body weight. In case of flat footed kids, while walking and standing ,whole body weight falls on inner side of feet, resulting in overload. This overload is transferred to nearby areas of body such as knees, hip and lower back. Thus, flat foot can also cause back and leg pain.
These kids have high prevalence of injury and may have reduced overall gait efficiency.
Quick deformation of the shoe
Feet tire easily while walking or playing
Instability while walking on uneven surface
Painful or achy feet especially in the areas of the arches and heels after intense exercises or long walks.
Foot movement such as standing on toes is difficult.
Predisposing factors of flatfoot
Age:Flat feet are normal in infants and toddlers due to the fact that the foot arches have not fully developed yet; they develop gradually during childhood, usually within the first decade of life. It is also possible that flat foot may develop with age due to diseases or injuries
Sex: Males were twice more prone to have flatfoot as females.
Body composition: Obese and overweight children were more likely to have flatfoot than those with proper weight.
Decreased foot muscle strength and Ligamentous laxity: Children with ligamentous laxity may also be prone to flatfoot due to impairment of arch development
Family history: Positive family history of flatfoot.
Types of footwear
Age at which shoe wearing began: Shoe wearing before the age of six may be another predisposing factor for flatfoot.
Treatment of Flat Foot
Asymptomatic flexible flatfoot require no treatment. However, children with asymptomatic flexible flatfoot should be monitored clinically for onset of symptoms and signs. Usually, flat foot resolves with age. So, persistence of flatfoot in children older than 8 years necessitates further assessment, despite the lack of symptoms.
Symptomatic flexible flatfoot
Rest and ice to relieve pain and reduce
swelling if present. Physical therapy such as stretching exercises, intrinsic muscle
strengthening exercises, orthotic devices, shoe modifications, braces or casts. Arch support is used to increase arch height thus it might increase the balance performance of an individual. Non steroidalanti-inflammatory medications in more severe cases.
If conservative methods have failed, and the child does not have relief of symptoms, surgery is indicated. The goal of surgery is simple: pain reduction or resolution and realignment of the foot.
Rigid flat foot most of the time requires surgical correction to treat understanding anomaly.