Flat Feet in Children

Flat feet, where the arch on the inside of the foot is lower than usual or appears absent when standing, are very common in infants and young children. This is typically known as flexible flat foot, a normal developmental stage where the arch is visible when the child sits or stands on tiptoes but flattens when standing normally. Most children naturally develop an arch as their muscles strengthen and ligaments tighten. While usually painless and requiring no treatment, understanding flat feet helps parents know what to expect and when to seek advice from a paediatric podiatrist in Singapore.

The most obvious sign is the appearance of the foot arch:

• Low or Absent Arch: The entire sole of the foot seems to touch the ground when the child is standing.
• Arch Reappears Off-Weight: The arch becomes visible when the child sits, dangles their feet, or stands on their tiptoes (this indicates flexible flat feet).
• Outward Heel Tilt: The heel bone (calcaneus) may appear to tilt outwards (valgus).
• Awkward Walking/Running: Some children may have a slightly clumsy gait.
• Shoe Wear: Shoes might show uneven wear, particularly on the inner side of the sole or heel.
• Pain or Fatigue (Less Common): While most children with flexible flat feet have no pain, some may complain of foot, ankle, or leg pain or fatigue, especially after prolonged activity.
• Stiffness (Rare): Difficulty moving the foot in different directions might indicate a rigid flat foot, which is much less common and requires investigation.

Understanding the type of flat foot is key:

• Flexible Flat Foot (Common & Usually Normal):
  • Normal Development: Infants are born with fatty pads in the arch area, and ligaments are naturally looser. Arches typically develop as your child grows up.
  • Ligamentous Laxity: Naturally loose ligaments (hypermobility) throughout the body can contribute to flatter arches.
  • Genetics: A tendency for flat feet can run in families.
• Rigid Flat Foot (Uncommon & Requires Attention): This type involves structural issues where the arch remains flat even when non-weight-bearing. Causes can include:
  • Tarsal Coalition: An abnormal connection (fusion) between two or more bones in the back or midfoot, restricting movement.
  • Congenital Vertical Talus: A rare birth defect causing a severe, rigid flat foot deformity.
  • Other Bone/Joint Issues: Less common structural problems in the foot bones or joints.

• Foot or Leg Pain/Fatigue: Discomfort during or after activity.
• Difficulty with Activities: Pain may limit participation in sports or prolonged walking/standing.
• Abnormal Shoe Wear: Leading to faster breakdown of footwear.
• Associated Issues: In some cases, persistent flat feet might contribute to issues like ankle pain, knee pain, or altered walking mechanics later on, although this is not always the case.
• Problems from Rigid Flat Feet: Untreated rigid flat feet can lead to significant pain, arthritis, and functional limitations.

If you have concerns, a podiatrist at Fine Podiatry Clinic can assess your child:

• History: Discussing symptoms (especially pain/fatigue), activity levels, developmental milestones, and family history.
• Observation: Looking at the feet while the child stands, walks, and runs. Checking for arch height reconstitution when the child stands on tiptoes (a key sign of flexibility). Observing heel position.
• Physical Examination:
  • Assessing foot and ankle flexibility and range of motion.
  • Evaluating muscle strength.
  • Checking for ligamentous laxity.
• Footwear Assessment: Examining shoe wear patterns.
• Imaging (Sometimes): X-rays are usually not needed for typical flexible flat feet but may be ordered if pain is significant, if stiffness is present (to check for tarsal coalition), or if other underlying bone issues are suspected.

For asymptomatic (pain-free) flexible flat feet in young children, the standard approach is reassurance and observation, as most cases resolve naturally.

• Non-Surgical Treatments:
  • Observation & Monitoring: Regular check-ups to monitor arch development and ensure no problems arise.
  • Appropriate Footwear: Guidance on selecting well-fitting, supportive shoes suitable for the child’s age and activities (Note: standard supportive shoes do not “correct” flexible flat feet but provide comfort and protection).
  • Orthotics/Arch Supports: Custom or prefabricated orthotics may be considered by our podiatrists if the child experiences significant pain, fatigue, or activity limitation related to their flat feet, or in specific cases to improve foot function or stability. Orthotics aim to support the foot and improve comfort, not necessarily to permanently create an arch. They may also be part of managing rigid flat feet.
  • Stretching/Strengthening Exercises: May be recommended in some cases, particularly if associated muscle tightness (e.g., tight calf muscles) is present.
• Surgical Options: Surgery is very rarely indicated for flexible flat feet in children. It might be considered in adolescents with persistent, significant pain that hasn’t responded to extensive conservative treatment, or for correcting underlying structural issues causing rigid flat feet (like symptomatic tarsal coalition).

Note: Our focus is on accurate diagnosis, distinguishing between normal developmental patterns and conditions requiring intervention, and providing appropriate management tailored to your child’s specific needs.

While you can’t prevent developmental flat feet, you can support healthy foot growth:

• Encourage Barefoot Time (Safe Environments): Walking barefoot on varied surfaces like grass or sand can help strengthen foot muscles naturally.
• Choose Good Footwear: Ensure shoes fit properly (length, width, depth), have a firm heel counter, and some flexibility at the ball of the foot. Avoid forcing feet into ill-fitting shoes.
• Promote Active Play: Encourage a variety of physical activities to develop strong muscles and coordination.
• Maintain Healthy Weight: Reduces excess stress on the feet.