The following patient information sheet is meant to help patients and family better understand a specific pediatric orthopaedic condition. It is not meant to be comprehensive, and only reflects one viewpoint. This page does not replace a medical evaluation by a pediatric orthopaedic surgeon, and your own surgeon may have a different approach to your condition.
What is flatfoot?
Flatfoot is also called pes planus or pes planovalgus, and refers to a foot with a decreased arch in a standing position.
Why does my child have flatfeet?
Flatfoot tends to run in families. It is commonly seen in children with loose joints, also known as generalized ligamentous laxity. There are multiple joints in the foot, and with loose joints they allow the arch of the foot to fall into a collapsed position. Flatfoot is very common, and can occur in approximately 5% of the general population.
How is the diagnosis of flatfoot made?
Flatfoot can be confirmed with a careful physical exam. The most important distinction is whether the flatfoot is flexible or rigid. Flexible flatfoot is much more common, and one should see that the arch of the foot does form when the foot is resting in the air, and when the child stands on tiptoes. Rigid flatfoot is suspected when the arch will not form, and the foot is stiff on examination. X-rays are not routinely necessary for flexible flatfoot, but should be obtained for rigid flatfeet.
What non-surgical treatments are available for flatfoot?
It is very important to first determine whether there is tightness of the Achilles tendon. If so, stretching of the Achilles tendon is critical in the treatment of flexible flatfoot. If the Achilles is left tight during growth, it may lead to worsening of the flatfoot deformity. Physical therapy is occasionally helpful for stretching the Achilles, and for general strengthening of the ankle and foot.
Well fitting shoes are also important in the treatment in flatfoot. When buying shoes, it is important to look at the portion of the shoe that supports the arch, and to chose shoes where this area is relatively large. A completely flat sole allows the arch to collapse and can lead to pain in children with flatfeet. Shoewear is much more important in adolescents, who tend to have more problems because they are heavier and more athletic than younger children.
Rarely, custom orthotics can be helpful for severe flatfeet. I generally do not recommend these unless a child is having pain and or functional issues, despite all of the treatments listed above.
Rigid flatfeet occur due to a variety of causes, most of which are approached differently than flexible flatfeet. Rigid flatfeet require careful evaluation, and more often require treatment.
When is surgery recommended for flatfoot?
A child with severe flexible flatfeet who has failed the above treatments and continues to have pain and or functional issues may be a candidate for surgery. My preference for correction flatfeet is with osteotomy (reshaping) of three bones in the foot. Please see my separate section on foot osteotomy.
Children with neurologic problems such as cerebral palsy can have more disability from flatfeet. The awkward direction of the foot worsens the mechanics of the legs, and correction of this alignment can improve the efficiency of walking. Thus, I am more likely to recommend foot osteotomy for children with neurologic issues and flatfeet.
Children with Down syndrome have severe amounts of ligamentous laxity, and very commonly have severe flatfeet. Due to their ligamentous laxity, they have a lower rate of success from surgery, and I highly encourage a full attempt at all non-surgical options. However, if the child is still having significant problems despite other treatments, then surgical correction can still be beneficial.