Flat Feet – What are we talking about?

Flat Feet – What are we talking about?

Dr K Kannan

Flat Feet – What are we talking about? 

What are flat feet?

Painless flexible flat feet (mobile flat feet) are the most common among the school-aged group. The prevalence of symptomatic flat feet is about 35% of Asian children. It is a condition where the parents or the child may notice the flatness of the foot arch or a very broad splayed foot. The children may present with calf pain and tiredness of the legs after strenuous activities. The parents may notice that the kid walks in a funny manner or trip easily. In some children, there is a compensatory spine misalignment and the shoulders may be unbalanced. 

There is an important tendon in the inner aspect of the foot, which helps maintain the foot arch. If the flat foot is ignored in a child, this tendon sometimes gets damaged from overuse as the child grows. As the child develops, he or she may have pain and swelling on the inner aspect of the foot and can develop a condition known as adult acquired flat foot deformity. There is a gradual loss of the arch, weakness, inability to stand on tiptoes, and a permanent deformity. 

Why do kids develop flat feet?

In the young pediatric age group, the ligaments are looser and more stretchable. It is a benign condition, and the foot ligaments strengthen over time. Flat feet are regarded as normal in infants and toddlers as the ligaments holding the foot together are still loose. The arch eventually self-corrects with the development of the lower limbs and the spine during the child’s growth spurt. Some kids may experience dull aching pain over the foot or heel cord during sports or running. These kids will benefit from Achilles stretching exercises, customized orthotics (insoles), and footwear modifications. 

When do you need to see a specialist?

If the pain is not improved or if the deformity (foot appearance) is excessive, it may be best to seek medical advice. In some rare 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 present with a curved spine. Flat feet must be assessed by a trained specialist to differentiate physiological flat feet from pathological flat feet. 

What can I do?

Most of the time, a simple assessment, reassurance, and footwear modification during the child’s growth phase is required. Eighty percent of the children remain symptom-free until they complete their growth phase. In the early stages, physiotherapy and customized insoles may help to address limb length differences and foot shape. 

Is there a permanent solution?

Occasionally, they may need surgical intervention if the flat feet are excessive and the child cannot tolerate insoles. Flat foot correction surgery in children is performed via a 1.5 cm keyhole incision in the foot and a small stent is inserted to support the arch until growth is completed. The child can run and play without any disruption to the gait after 2 weeks. In almost 90% of pediatric and adolescent cases, the stenting procedure alone is sufficient to restore the foot alignment and prevent long-term tendon damage. 

Prepared by,

Dr K Kannan

MBBS (S’pore), MRCS (Edin), MMed (Ortho Surg), FRCS (Edin) (Ortho & Trauma), FAMS (Ortho)

Senior Consultant Orthopaedic Surgeon

Specialist Orthopaedic Surgery, Singapore