It often happens that small children have a foot malposition, the so-called childhood flat foot, which is harmless and usually disappears on its own by the time they start school.
What is a child’s flat foot?
It is significant that the deformity only occurs after learning to walk. This phenomenon is rarely painful, does not affect the natural gait at all and usually disappears on its own at the latest by school age. See AbbreviationFinder for abbreviations related to Childish Fat Foot.
A childhood flatfoot is a harmless foot malposition that often occurs in childhood, in which the heel bends outwards in the shape of an X and at the same time the arch of the foot appears flattened, as in flat feet.
This anomaly occurs in most children and has to do with the growth of the skeleton, which is why it is also referred to as physiological flatfoot. The misalignment is only noticeable after a child has started walking. However, this does not impede the natural gait.
In most cases, the child’s flat foot recedes by itself by the time the child starts school. Treatment is only necessary if the gait is severely impaired and the deformity has not normalized sufficiently by the age of 7.
The main cause of the child’s flat foot is to be found in the physiological growth of a child. The main reason is the holding apparatus of the foot, which differs from that of an adult.
Due to their anatomy, children have to turn their foot slightly inward when walking and try to counteract this inward turning by bending the foot. As a result, the foot bends in the ankle and the arch flattens out. This is also the reason why children often have knock knees.
But other, non-developmental causes may also come into question:
- Instability of tendons and ligaments
- a weak musculature
- severe overweight (obesity)
- Knees or bow legs
- Paralysis, especially of the posterior tibial muscle
- diseases of the bones
Typical Symptoms & Signs
- the heel is bent outwards at the ankle
- X-position of the foot (knee foot)
- the foot surface is flattened (similar to flatfoot), the fallen arches are mostly on the ground
Diagnosis & History
A child’s flat foot can be recognized from the outside by the X-position of the ankle and the arch of the foot lying on the floor.
It is significant that the deformity only occurs after learning to walk. This phenomenon is rarely painful, does not affect the natural gait at all and usually disappears on its own at the latest by school age. Only in the case of severe symptoms should another possible cause be clarified, e.g. B. a congenital flat foot or malformations / adhesions in the area of the foot bones.
The pediatrician usually makes the diagnosis by examining the child’s foot, looking at the arch of the foot for flattening. In order to determine whether it is a question of the physiological childlike flat foot, he carries out further tests:
- Assess whether the arch of the foot straightens when standing on tiptoe
- Mobility of the ankle should be possible without pain
- Podogram (footprint) to see if the foot shows a normal child’s silhouette
An X-ray examination is only carried out if there is severe restriction of movement or pain in order to rule out other causes. If necessary, the status is checked again at certain time intervals.
In most cases, the flat foot does not lead to any particular complications or symptoms. This usually disappears again at school age, so that there are no consequential damages or limitations in adulthood. Those affected suffer from a misalignment of the feet. This can lead to teasing or bullying, especially in children, and thus trigger depression or other psychological problems.
It is not uncommon for patients to appear irritable as a result and suffer from a severely reduced sense of self-esteem. The so-called X-legs also occur. The malposition can lead to further limitations in movement, so that the child may no longer be able to carry out certain sports without further ado. This can also disrupt child development.
In most cases, no treatment is necessary for this disease and the symptoms will go away on their own. If necessary, the diet and lifestyle must be changed. Various therapies and exercises can also alleviate the symptoms. Usually there are no special complications. The life expectancy of the patient is not reduced by the flat foot.
When should you go to the doctor?
Parents who discover a foot malposition in their child should contact the pediatrician or an orthopedist as soon as possible. Typical signs such as a flattened arch of the foot or knock-knees indicate a child’s flat foot, which in any case requires a medical evaluation. If the misalignment is corrected at an early stage, permanent damage can be avoided. A visit to the doctor is necessary at the latest when the child complains of pain or other symptoms.
A specialist should be consulted with gait difficulties and nerve disorders, but also with mental suffering as a result of the foot malposition. If the child’s flat foot develops a severe course, an individual therapy must be worked out together with an orthopaedist, which is tailored to the type and severity of the complaints. Regular visits to the doctor are necessary during treatment, as the position of the feet changes during growth and the therapy may have to be adjusted. Parents of affected children should consult their doctor regularly and pay attention to the child’s noticeable symptoms.
Treatment & Therapy
In most cases, no treatment is required for childhood flatfoot, because the arch of the foot develops on its own as a result of growth and the deformity recedes.
Even if the arch of the foot remains somewhat flat after growth, this is usually not a problem in adulthood. The best therapy is to let children walk barefoot a lot, especially on natural ground, playful foot exercises, toe gripping and tiptoeing.
In case of complaints, insoles can be prescribed as well as physiotherapy exercises. In the case of obese children, nutritional advice and a diet are also indicated in order to prevent further complaints. In particularly severe cases, there are two corrective surgical methods: soft-tissue surgery to improve traction of the muscles that straighten the arch of the foot, and bony surgery for connections to neurological disorders.
Outlook & Forecast
The prognosis for patients with childhood flatfoot is favorable in most cases. In mild to moderate cases in particular, the misalignment corrects itself before the children reach school age. In these cases, there is usually no pain.
In more severe cases, the disease can take a protracted course, although pain symptoms cannot be ruled out. If left untreated, the deformity can drag on for years and can still lead to problems in adulthood. A longstanding pronounced flat foot can lead to problems with the statics of the musculoskeletal system. Resulting knee malpositions, such as knock knees or bowlegs, can not only lead to pain in the knee joints but also to hip problems or back pain in the lumbar region.
When treating a severe form of flat foot, a treatment period of several (usually 2-3) years can be assumed. In this case, however, the prospects for the patient are positive again, and the valgus flatfoot regresses in the majority of cases during the period mentioned. Any pain that may be present usually subsides shortly after the start of treatment, thus enabling a pain-free gait.
You really can’t prevent a child’s flat foot, because it is part of a child’s natural growth. However, if children can walk barefoot a lot, mainly on natural ground, and wear shoes that are comfortable and well adapted to the foot, you can contribute a lot to healthy development.
After the cast is removed, maintaining the improved correction through good follow-up care is crucial to avoid recurrence. A splint should be worn for the first three months after treatment. After that, it is only used at night until the age of five.
This support is a bar whose length is the same distance as between the child’s shoulders. The ends of this bar are attached to the shoes at a 60 degree angle. For children with flat feet it is a 30 degree angle. The child will usually get used to walking with the splint in the course of the follow-up treatment.
Since these special shoes can cause blisters and wounds, the correct putting on and wearing of these should be discussed with the doctor treating you. Rarely, re-operation is required when difficulties arise during the splint wear period. The child’s flat foot can only be corrected with a thorough understanding of the anatomy and the movement of the healthy foot. Before considering surgery, consult with centers and clinics that are knowledgeable about non-surgical corrections.
You can do that yourself
The child’s flat foot usually disappears over the years, mostly in the pre-school age, in the children again. The disease is therefore usually not a cause for concern, but should be carefully observed. Since childhood flatfoot is not associated with pain and the children can move normally, the quality of life of those affected is not noticeably restricted.
Nevertheless, there are some factors that favor the childhood flat foot and may contribute to it not sufficiently receding. In order to improve the well-being of sick children, existing excess weight must be reduced. In addition, the physiotherapist recommends appropriate exercises for the children to do at home on a regular basis to strengthen their muscles and tendons.
It is particularly beneficial for the course of the disease of childhood flatfoot if the children go barefoot as often as possible. This strengthens the foot and legs and counteracts the deformity. By strengthening the muscles when walking barefoot, the child’s flat foot often recedes more quickly. If the doctor prescribes shoe inserts or special orthopedic shoes against the malposition of the foot, these must be worn as prescribed in order to support the natural regression of the child’s flat foot.