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Pediatric - Flexible Flatfoot

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A pediatric patient with flexible flatfoot (pes planus) stands, the arches of the foot seem to disappear, and looking from behind the heel, it seems like the little toes are peaking on the side. However, when the child sits in a chair or stands on their tiptoes, the arches of the foot reappear. This condition is commonly referred to as “flexible flatfoot,” and always affects both feet at varying degrees.  

The child may often complain of leg pain, ankle pain, re-occurring ankle sprains, foot pain, and arch pain. While parents often worry about an abnormally low or absent arch in their child’s foot and are afraid of a permanent deformity with the possibility of further injury, the majority of children will outgrow the flexible flatfoot with conservative therapy. Although the majority of the time the condition is painless and children may be asymptomatic, it may interfere with walking or participation in physical activity; therefore, requiring treatment. 

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Examination 

A flexible flatfoot may be initially discovered by your child’s Pediatrician or athletic trainer. At that point, you may be referred to a Pediatric Foot and Ankle specialist, Podiatrist or Orthopedist, who will examine your child to rule out other types of flatfeet that may require intervention. The Foot and Ankle specialist will examine your child’s walking pattern, rule out tight heel cords, and evaluate for a rigid flatfoot, which may be a more serious condition requiring surgical intervention. The physician will examine your child’s shoe wear pattern and may ask your child to sit and raise their toes while standing, as well as check the bottom of your child’s foot for calluses and pressure points which may cause pain.  

The doctor may ask you questions regarding your family, and whether or not anyone in your family has flatfeet and how it has been treated. Your doctor will need to know about any known neurological or muscular diseases pertinent to your child, and how your child participates in physical activity. 

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Treatment 

Conservative (Non-Surgical) Treatment

 

Stretching exercises, such as heel cord stretching, calf stretches, hamstring stretching, and other muscle and tendon stretches for the foot and ankle are imperative for your child. Your doctor may refer your child to physical therapy for appropriate stretching and strengthening exercises.  

Your child may benefit from custom-molded arch supports to relieve discomfort and decrease the risk for future ankle, knee, and hip pain. Over-the-counter arch supports are excellent to try before committing to custom-molded arch supports, but you should first ask your doctor what they think will be best for your child before trying various products. 

Surgical Treatment

Surgical treatment is indicated for painful (symptomatic) flexible or rigid flatfeet that has failed persistent conservative therapy. Surgical treatment is typically recommended for older children, adolescents, and adults with persistent pain. The goal of surgery for the correction of flatfoot is to create an arch in the foot and lengthen and/or tighten the tendons surrounding the foot and ankle to create a painless, stable foot. For patients with pain in both feet, surgery is typically performed in on one side and following several months of recovery and physical therapy, the second surgery for the other side may be performed.  

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