Dr Kannan Kaliyaperumal
A person with flat feet has no arch on their instep. You can usually see this from their footprints, which will show the whole base of the foot. It is a very common condition in the Asian population, affecting around 1 in 5 individuals.
Flat feet are caused by issues related to the tissues and bones in children’s feet and lower legs. Babies and toddlers may have flat feet because it takes time for the tendons to tighten and form an arch in the foot. If this tightening doesn’t occur fully as the child develops, it can result in permanent flat feet when the bones collapse. In rare cases, the bones in a child’s feet fail to separate and become fused, causing painful flat feet.
Flat feet can be hereditary, and the condition can’t be prevented in this case. In East Asian countries, where kids are traditionally not a shoe wearing population, the incidence of flat feet is higher. However, early intervention and the wearing of correct shoes and supports can prevent the condition from worsening. In selected cases, a simple surgical solution exists to support the growth of the bones until a permanent arch forms when the kids pass the growth phase.
For most children, having flat feet is not a cause for concern. It is a natural part of your child’s development and most will outgrow the condition and develop a normal arch.
Of those that don’t, the condition will rarely cause a problem and most children can still take part in sports activities without feeling any pain or other complications. This is considered a normal variation in foot type.
Your child may have flexible flat feet, in which the arches are visible when they are sitting but as soon as they stand and put weight on their feet, the arches disappear. Children normally outgrow this.
While most children outgrow their flat feet, you should see a doctor if:
Look out for your child complaining about or showing the following symptoms:
Your doctor might suggest:
It is important not to overreact with very young children because, as mentioned, the condition is normal in toddlers and they usually go on to develop an arch. However, if they remain flat footed, or if you notice your child compensating for their feet in the way they walk or carry themselves, or their shoes are getting worn on one side, do see your doctor for a diagnosis so early intervention can be applied.
Flat feet should be assessed by a trained specialist who can identify the treatable causes of your child’s flat feet, and the suitable and timely intervention that can be applied.
There is an important tendon in the inner foot that helps maintain the foot arch. If flat feet are ignored, this tendon can get damaged from overuse as your child grows into adolescence and into adulthood. They may have pain and swelling on the inner side of the foot and can eventually develop a condition known as adult-acquired flat foot deformity. This is when there is a gradual loss of the arch, weakness, inability to stand on tiptoes and a permanent deformity.
In some cases, adolescents with a painful flat foot may have an underlying condition such as tarsal coalition (fused bone) or an unstable os navicular (unfused bone since birth) that may warrant further investigations. In some rare cases, the child may have a curved spine due to the chronic compensation at the spine.
Studies have shown that using special shoes, insoles or splints does not correct the shape of the foot. However, arch supports may be recommended to alleviate discomfort.
Surgery is usually a last resort. If your child’s condition persists into their teenage years, or if their flat feet are the result of another physical condition, surgery may be considered to correct the underlying cause.
Flat foot correction surgery in children is performed via a 1.5cm keyhole incision in the outer foot and a small stent is inserted to support the arch until growth is completed. Your child will be able to run and play without any disruption to the gait after 2 weeks. In almost 90% of paediatric and adolescent cases, the stenting procedure alone is all that is needed to restore foot alignment and prevent long-term tendon damage. Most kids are able to function normally after surgery without the need for special shoes or insoles.
While most cases of flat foot correct naturally as children grow, it is best to have any underlying causes identified so that early treatment can be sought. If you are worried about your child’s foot development, speak to an orthopaedic specialist.