Flat Feet

Dr. Robert Salter, a world-famous pediatric orthopedist, once stated, “If children who are flatfooted would walk on their hands, they would be called flathanded” [2]. Although he said this in jest, his statement does provide some insight into what is known about flat-footedness in most children. It is well known that most babies are born with flat feet. This is due to the fact that the musculature that supports the arch has not fully developed yet. There is also a considerable amount of baby fat in that particular area which serves to protect and cushion the baby during the early development of gait (walking), which makes the foot appear flat. This does not usually cause concern among parents unless it persists past the age of three, at which time parents should bring their children to the pediatrician for an evaluation of their feet. In most cases there is generally nothing to worry about.

Flat feet are fairly normal in infants and toddlers. A persistent flat foot in older children (over the age of six) is usually inherited and runs in the family. For most people, flat feet are symptom free. However, some children may have associated foot or leg pain, which should always constitute a doctor’s visit. A rigid flat foot, meaning the arch is absent even when not bearing weight, can frequently be quite painful. Flat feet often lead to poor foot function which predisposes the child to other foot problems such as bunions, hammertoes, and calluses.

Frequently, doctors will not recommend treatment of your child’s flat feet until the child is over three to four years of age, allowing for sufficient time for the ‘baby fat’ to disappear. Treatment is almost always conservative and consists of special shoe gear and arch supports. In extreme cases, custom molded supports may be necessary to enhance foot function, although these tend to be more expensive since the foot will likely outgrow the support within a short amount of time. In severe cases, a doctor may offer more aggressive treatments including corrective surgery, especially when pain is present, the condition is of sudden onset, one sided, or affects the child’s ability to keep up with their peers. There are some less common and serious variants of flatfoot in infants that should be diagnosed as soon as possible in order to ensure proper treatment. If the parent has any questions about their child’s feet, a foot specialist should examine them to determine if early treatment is necessary.