Flat Feet (Pediatric and Adult)

What Is Pediatric Flatfoot?

Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as “pediatric flatfoot.” Although there are various forms of flatfoot, they all share one characteristic – partial or total collapse of the arch.

Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms such as pain and limitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.

 

Symptoms

Flatfoot can be apparent at birth or it may not show up until years later. Most children with flatfoot have no symptoms, but some have one or more of the following symptoms:

  • Pain, tenderness, or cramping in the foot, leg, and knee
  • Outward tilting of the heel
  • Awkwardness or changes in walking
  • Difficulty with shoes
  • Reduced energy when participating in physical activities
  • Voluntary withdrawal from physical activities

 

Diagnosis

In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when the child stands and sits. The surgeon also observes how the child walks and evaluates the range of motion of the foot. Because flatfoot is sometimes related to problems in the leg, the surgeon may also examine the knee and hip.  X-rays are often taken to determine the severity of the deformity. Sometimes additional imaging and other tests are ordered.

 

Non-surgical Treatment

If a child has no symptoms, treatment is often not required. Instead, the condition will be observed and re-evaluated periodically by the foot and ankle surgeon. Custom orthotic devices may be considered for some cases of asymptomatic flatfoot. When the child has symptoms, treatment is required. The foot and ankle surgeon may select one or more of the following non-surgical approaches:

  • Activity modifications. The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing.
  • Orthotic devices. The foot and ankle surgeon can provide custom orthotic devices that fit inside the shoe to support the structure of the foot and improve function.
  • Physical therapy. Stretching exercises, supervised by the foot and ankle surgeon or a physical therapist, provide relief in some cases of flatfoot.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
  • Shoe modifications. The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with flatfoot.

 

When Is Surgery Needed?

In some cases, surgery is necessary to relieve the symptoms and improve foot function. The surgical procedure or combination of procedures selected for your child will depend on his or her type of flatfoot and degree of deformity.

 

What Is Adult Flatfoot?

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

  • “Toe drift,” in which the toes and front part of the foot point outward
  • The heel tilts toward the outside and the ankle appears to turn in
  • A tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
  • Bunions and hammertoes may develop as a result of a flatfoot.

 

Flexible Flatfoot

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.  The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing.

 

Symptoms

Symptoms, which may occur in some persons with flexible flatfoot, include:

  • Pain in the heel, arch, ankle, or along the outside of the foot
  • “Rolled-in” ankle (over-pronation)
  • Pain along the shin bone (shin splint)
  • General aching or fatigue in the foot or leg
  • Low back, hip or knee pain.

 

Diagnosis

In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your surgeon will explain what you might expect in the future.

 

Non-surgical Treatment

If you experience symptoms with flexible flatfoot, the surgeon may recommend non-surgical treatment options, including:

  • Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
  • Orthotic devices. Your foot and ankle surgeon can provide you with custom orthotic devices for your shoes to give more support to the arches.
  • Immobilization. In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.

 

When is Surgery Necessary?

In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot, and one or a combination of procedures may be required to relieve the symptoms and improve foot function.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

If you are experiencing any foot problems consistent with flatfoot (pes planovalgus) near Lake Charles, Moss Bluff, Sulphur, Iowa, or Westlake, please don’t hesitate to call our office at (337) 474-2233 or schedule your appointment online with Louisiana Foot and Ankle Specialists.