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Paediatric Orthopaedics

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Flat foot

What is a flat foot?

The sole of the foot has an arch on the inner side (instep) that extends from the heel to the base of the big toe. The foot is called flat when it does not have this arch.

What is the cause of flat feet in children?

Many people have a long-standing belief that flat feet are abnormal and require treatment with special shoes, insoles or even splints or braces.

We now know that the majority of children between 1-5 years of age have flat feet. This is part of normal development of their feet and over 95 percent of children grow out of their flat feet and develop a normal arch. The other 5 percent continue to have flat feet, but only a small number will ever have a problem. Most children with a persistent flat foot participate in physical activities, including competitive sports, and experience no pain or other symptoms.

Very rarely, there can be an underlying problem. The doctor examining the child will check for these and plan ongoing care. Older children with painful or stiff flat feet and children who had initially normal arches and develop flat feet later require particular attention.

Is any treatment required?

Studies involving large numbers of children have shown that treatment with special shoes, insoles or splints does not alter the shape of the foot and does not give them an arch.

The great majority of children under the age of five with a flat foot develop an arch in time without the use of insoles. Some children wear their shoes unevenly. Occasionally a small shoe insert may help - it will not alter the shape of the foot but may reduce shoe wear.

When flat feet persist in children after the age of five years and they complain of pain in their feet, treatment with insoles / arch supports is used more often to alleviate discomfort.

In rare cases, young teenagers with persisting symptoms may require surgery. Children who are found to have additional problems causing their flat feet may also require an operation.

What is the outcome?

Flat feet are part of normal development in the vast majority of young children and have no long-term implications. Treatment (insoles or surgery) of older children with persistently painful flat feet has good results in approximately 90 percent of cases. The outcome for children with underlying problems depends on the condition causing flat feet.