Flat Feet
How Kids in Motion can Help!
Understanding your child’s development and behaviors can be challenging and overwhelming. With many different opinions and suggestions on what your child should or shouldn’t be doing can be stressful and confusing. Although, having the proper resources and education is important to improve your knowledge on ways to help your child develop to the best of their ability and Kids in Motion is here to help.
Objectives:
- Understand typical foot development
- Identify causes of flat feet
- Recognize signs and symptoms of flat feet
- Understand associated complications of flat feet
- Learn appropriate treatment interventions for children with flat feet
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What are flat feet?
Flat feet are exactly as the name implies, the entire sole of the foot is in contact with the surface when in standing. 
Flat feet are also referred to as pes planus, pes valgus, or pronated feet. Having flat feet is normal for babies and toddlers, as the arch of their foot has not yet developed. In fact, infants have a fat pad covering their arch so that it is not visible. Around 2-3 years of age, the fat pads disappear, and the deep muscles, ligaments, and fascia develop to form the arch of our foot. However, as a child approaches six years of age, their bones and joints become less flexible, allowing the developed arch to become visible. (Children’s Hospital, 2017; American Academy of Pediatrics 2015). Many times, having flat feet is a painless condition that does not require treatment.
What causes flat feet?
Most often, a child’s flat feet are caused by an abnormal position of their heel bone called the calcaneus. With flat feet, this bone is rotated inward (calcaneal eversion) which causes the child’s weight to be shifted to the inside border of their foot where the arch is located. (Aculbertson, 2017). An easy way to determine if your child has calcaneal eversion is to view their feet from behind. If you can see both their pinky toe and big toe, it is likely that their calcaneus (heel bone) is in an appropriate position. However, if you can only see their pinky toe and ring toe, it is likely that their calcaneus is in an abnormal position.
Flat feet can also be influenced by a child’s muscle tone. With low muscle tone, a child often has ligamentous laxity meaning their ligaments are too loose, resulting in joint hypermobility. On the other end of the spectrum, children with high muscle tone may have flat feet due to their Achilles tendon being too short and pulling their foot inward. (Aculbertson, 2017)
It should be noted that flat feet may have a genetic component in that the condition may be inherited from the child’s parents. In addition, flat feet may develop over time because of conditions such as obesity, diabetes, rheumatoid arthritis, foot/ankle injuries, or simply aging. (Children’s Hospital, 2017)
What are signs/symptoms of flat feet?
When your child’s feet and ankles are not in proper alignment, the alignment of the child’s knees and hips are also out of alignment, similar to a chain reaction. It is not uncommon for signs and symptoms of flat feet to begin showing years after a child begins walking. You may notice all or some of the signs and symptoms below if your child has flat feet (Aculbertson, 2017; American College of Foot and Ankle Surgeons, n.d.; Children’s Hospital, 2017).
- Pain, cramping, or tenderness in the foot, knee, and/or hip
- Pain that increases with activity
- Wear on the inner border of the sole of their shoes
- Choosing to not participate or stop physical activity
- Decreased energy when walking or running
- Awkwardness of movement when walking or running
- Tight Achilles tendon and possible toe walking
What complications are associated with flat feet?
When a person walks, a force as much as five times their body weight is placed on each foot (Cueny & Deb, 2019). As a result, if the foot is not in a proper position to absorb and redistribute that force as in flat feet, problems can develop elsewhere. Below is a list of commonly associated complications with having flat feet:
- Calluses
- Low back pain
- Ankle pain
- Knee pain
- Bunions
- Inflammation of the Achilles tendon
- Shin splints
- Stress fractures
- Developmental delays
What can I do to help treat my child’s flat feet?
Many times, having flat feet is a painless condition. With that being said, it is always important to seek treatment regardless of pain levels as leaving the condition untreated can lead to complications. Children have an increased amount of cartilage in their feet that will eventually harden to become bone. Therefore, if your child is not walking correctly during this time of bone development, the shape and growth of the bones within their feet will be negatively impacted. (Aculbertson, 2017). Most of the time, flat feet can be treated conservatively. In more severe cases, however, surgery may be required.
Physical therapy is utilized to assist with developing a comprehensive program to address your child’s limitations contributing to their flat feet. Your child could also walk up on his or her toes (Read more here). Gait training and a stretching program may be implemented should your child have Achilles tendon tightness. In addition, a strengthening program will likely be initiated to assist with strengthening the intrinsic muscles of the foot that help to support the arch. A physical therapist can also assist with addressing common developmental delays associated with flat feet by incorporating balance training and strengthening exercises for the lower extremities.
Commonly, a child will also benefit from additional support to facilitate development of the intrinsic muscles of the feet while maintaining proper alignment of the bones within the feet and ankles. A physical therapist may utilize kinesiotape to provide this support, or collaborate with an orthotist to obtain the appropriate orthotic for your child.
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Kids in Motion Pediatric Therapy clinic provides services in all areas from speech, occupational, and physical therapy to address the signs/symptoms stated above related to flat feet.
Speech therapy will help improve your child’s communication skills by learning verbal and/or nonverbal skills. A speech therapist will engage your child in a variety of auditory and verbal stimuli such as story books, picture cards, interactive games, actual objects, etc. using different approaches and techniques to improve language skills. A speech therapist can also teach the use of an augmentative communication devices, Picture Exchange Communication System (PECS), and American Sign Language. These devices and techniques can improve communication by using pictures and symbols to ask and answer questions when interacting with others.
Occupational therapy will use creative therapeutic activities to increase independence and success in ADL, fine motor, visual motor, and sensory processing skills. Occupational therapist will introduce innovative methods to improve self-dressing, self-hygiene and self-feeding skills. Your child will engage in client centered activities to increase strength and coordination/control in hands and upper extremities to complete age appropriate fine motor and visual motor skills with greater success. Occupational therapist will demonstrate and educate family on variety of sensory diet strategies specific for your child’s needs to improve regulation to perform optimally in everyday activities.
Physical therapy will help improve your child’s strength, coordination, and balance through therapeutic exercise and activities to increase success in age appropriate gross motor skills. Child will also engage in tasks such as obstacle courses incorporating variety of gym equipment to improve motor planning skills. Physical therapist may target gait retraining if toe-walking is present by working on your child’s range of motion, strengthening and incorporating different sensory techniques. Consultation with an orthotist can also be provided if needed.
Still have questions and concerns?
We are committed to helping children of all abilities achieve and live their full potential. With experienced and compassionate Physical, Occupational and Speech Therapists and four locations to serve you, we feel confident that you will be more than satisfied with the care and support your child receives.
Check out our free Interactive Online Screener – once completed, it will respond with ideas to help your child in the areas you specify they might be having trouble with or contact us at 248-684-9610.
References:
Aculbertson. (5 Oct 2017). Flat feet in children – Problems, Causes & Treatment. Retrieved from http://surestep.net/blog/flat-feet-kids-problems-causes-treatment/
American Academy of Pediatrics (21 Nov 2015). Flat feet and fallen arches. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/orthopedic/Pages/Flat-Feet-Fallen-Arches.aspx
American College of Foot and Ankle Surgeons. (n.d.).pediatric flatfoot. Retrieved from https://www.foothealthfacts.org/conditions/pediatric-flatfoot
Children’s Hospital. (2017, March 10). flat feet. Retrieved from https://www.chop.edu/conditions-diseases/flat-feet
Cueny, D. & Deb, D. (2019). Common pediatric gait abnormalities [PowerPoint slides].