When people have babies, they’re always warned about the “soft spot” on the head – that the skull bones haven’t fused enough to adequately cover the brain.
It’s such a well-known fact, most people don’t give it a second thought. But in reality, babies are born with nearly 100 bones that need to close and grow to create bones and joints.
Some of those bones are in the feet, and they make up your foot arch. Most people don’t realize it, but arches don’t develop until around the age of 6, after walking, standing and other activities have strengthened the bones and cartilage.
Before that, babies and toddlers have a stage of development called flexible flat feet. This is characterized by the presence of arches when children are sitting or standing on their toes, but the arch disappears when they put weight on their feet.
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Flexible flat feet are normal, and for 80-90 percent of children, they’re temporary. However, for a smaller portion of the population, arches never develop, which is a condition called pediatric flat feet.
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Some children with flat feet are able to accommodate their condition quite well. These cases – called asymptomatic flat feet – will likely never require treatment.
However, if children develop pain, tenderness or cramping in the feet, legs and knees, or if they find difficulty walking, wearing shoes or participating in activities, they likely have symptomatic flat feet. In these cases, medical advice and treatment should be sought.
Pediatric orthopedic surgeons are well-versed in the bones and structure of children’s feet, and they know best how arches should develop and function.
When you first have an appointment, the physician will conduct a physical examination of the foot and will observe children standing, sitting and walking.
If flat feet are present, the doctor will likely order an X-ray. Occasionally, additional imaging and tests are needed to determine the severity and details of the flat feet.
After diagnosis, treatment options can vary. Children with asymptomatic flat feet – when there’s no pain or difficulty walking – typically only need periodic checkups. Children with symptomatic flat feet, however, typically need intervention and additional care.
In some cases, surgery is needed to relieve flat feet symptoms and improve foot function. The exact procedure will depend on the child and his or her type of flat feet.
For most cases, non-surgical approaches are best, often starting with activity modification. This could mean cutting down on time playing sports or avoiding prolonged periods of standing.
To help children with their daily activities, a wide range of orthotic accessories – such as shoe inserts – are available. Your doctor can also recommend styles and brands of shoes that can help ease flat feet. In some cases, custom orthotic devices can be created that support the structure of the foot and improve function.
Ongoing support measures can include physical therapy, where children can work with a therapist on stretching exercises that provide relief for flat feet. Certain medications, ranging from ibuprofen to prescriptions, can also reduce pain and inflammation.
In general, pediatric flat feet are a relatively normal, treatable condition. If you have additional questions, or think your child may have flat feet, talk to a pediatric orthopedic surgeon.
S. Matthew Hollenbeck is a pediatric orthopedic surgeon with Kansas Orthopaedic Center, PA.