Paediatric flat feet or pes planus is a condition whereby the child has a lowered or complete loss of arch along the inside of the foot, causing the feet and ankle to roll in towards to centre of the body. It is also widely known as “pronated feet” or someone with a “pronated gait”. Most parents with children suffering from flat feet would refer to their child’s gait as “walking with toes pointing out”, “walking like a duck”, or “foot slapping the ground”.
It is estimated that 2 to 3 in 10 children have flat feet, and this number is higher in Asian countries because joint hypermobility is more prevalent among Asians.
Children are not born with a foot arch and the arch will develop gradually from the age they start to walk. Under normal progression, a foot arch can be seen from ages 2 to 3 years old onwards, and full development is achieved at around the age of 7. To find out if your child has flat feet, you can do the following:
The easiest way to determine if your child has flat feet is by looking at their footprints, for example, after swimming or at the beach. A normal footprint will have a concave curvature along the inside of the foot, whereas a flat foot will have either no curvature or a convex curvature instead.
Your child’s shoe can also help to identify his or her foot type. Children or adults with flat feet often cause the shoes to distort inwards, in the same direction as the foot and ankle as they roll inwards.The sole will often show excessive wear over the inside of the heel (in severe cases) or outside of the heel (in mild or moderate cases), together with excessive wear over the big toe region
Flexible Flat Feet are the most common type of Paediatric Flat Feet, whereby the joints of the foot are hypermobile, and a foot arch can be “created” by standing on the toes. Children with flexible flat feet will also have a noticeable arch when they are seated down or when the foot is in a non-weight-bearing position.
Causes of flexible flat feet include:
Rigid Flat Feet are far less common and are characterized by a loss of foot arch when standing, sitting, or lying down. The foot arch cannot be “created” and the foot stays flat throughout.
Rigid Flat Feet are often caused by underlying musculoskeletal conditions such as:
Flat feet cause an upward chain reaction that leads to structural malalignment of the body, commonly affecting the knees, hips, and spine. It also alters our gait pattern and the amount of stress our bones, joints and muscles withstand during movement, which leads to an increased risk of injuries.
Management for Paediatric Flat Feet involves a process of rehabilitation and often a change in habit. Most parents are often misled and have been buying inappropriate footwear for their children. It is also common for some retail establishments or practices to profit from parents’ anxiety and lack of knowledge, causing the child to undergo unnecessary treatments or programs.
A thorough assessment by a Podiatrist is necessary to determine if the child is following the normal progression of arch development. Treatment is often only required for cases where the child is complaining of symptoms or when the child’s muscular balance and coordination are not developing well.