Flat Feet in Children (Pes Planus): Causes, Symptoms and Treatment

Flat Feet (Pes Planus) in Children: When to Be Concerned and Possible Treatments?

When standing, a person with flat feet does not have a noticeable arch in their foot. Every newborn has flat feet, and during early childhood, the arches typically develop. Flat feet can cause pain and walking difficulties if the arches fail to develop, often due to hyperlaxity, which is common in many individuals.

What Are Flat Feet?

Flat feet—also called pes planus, pes planovalgus, or hyperpronation—are when the feet are flatter on the bottom, allowing the entire sole to touch the floor when standing. Flat feet are normal in babies and toddlers because their arches have not yet developed. In most people, the arch develops throughout childhood, but some individuals never develop arches. Flat feet occur when the arch collapses or remains very low. This is often inherited and usually painless, but in some cases, flat feet may affect body alignment, causing discomfort in the knees and ankles.

What Are the Types of Flat Feet?

Flat feet may cause problems at any age and can be categorized into different types:

• Flexible Flat Feet: The most prevalent type. Arches are visible when not standing, but disappear when weight is applied, due to excessive ligament flexibility. It usually appears in childhood or adolescence, affects both feet, and worsens with age.
• Rigid Flat Feet: There are no arches whether sitting or standing. This type often becomes painful in the teenage years and worsens with age. It may cause difficulty in moving the feet and can affect one or both feet. Common causes include congenital bony bridges (tarsal coalition) between foot bones.
• Adult-acquired (Fallen Arch): This occurs when the arch suddenly collapses in adulthood, causing the foot to turn outward and become painful. It typically affects only one foot and is often due to inflammation or a tear in the posterior tibial tendon.
• Vertical Talus: This is a congenital condition where the ankle’s talus bone is positioned incorrectly, preventing the arches from developing. It results in a “rocker-bottom” foot shape.

What Causes Flat Feet?

Flat Feet in Children (Pes Planus): Causes, Symptoms and Treatment

Flat feet are normal in infants and young children, with arches typically forming as they grow. However, some individuals may not develop arches due to:

• Generalized ligament hyperlaxity
• Tight Achilles tendons (“tight heel cords”)
• Abnormal foot bone formation
• Genetic conditions like Down syndrome or collagen disorders

Flat feet can also run in families.

Signs and Symptoms

Most individuals with flat feet are asymptomatic, but some may experience:

• Foot pain, especially in the arch or heel
• Increased discomfort with walking
• Tight Achilles tendons

Testing and Diagnosis

Flat feet in children are usually diagnosed by pediatricians, and further testing is often unnecessary if no symptoms are present. However, a pediatric orthopedic specialist should assess symptomatic children. The evaluation includes medical history, physical examination, and observation of walking, standing, and running. Physicians may also request the child’s shoes to evaluate wear patterns.

Imaging tests may be prescribed if severe foot pain is reported:

• X-rays can show bone structure.
• CT scans are useful for diagnosing rigid flatfoot.
• Pedobarography measures plantar pressure distribution during movement, detecting high-load areas.
• EOS imaging provides weight-bearing images for better diagnosis.
• MRI can be used to assess soft tissues without radiation exposure.

When to See a Doctor

Consult a doctor if:

• Your child experiences foot or ankle pain with flat feet.
• The feet appear deformed or stiff, with pressure points developing calluses.
• Your child’s arch collapses after initially developing normally.

How Are Flat Feet Treated?

Flat feet that cause no problems usually don’t require treatment. Supportive, well-fitting shoes are recommended, but shoe inserts are unnecessary unless the child experiences discomfort. For painful flat feet, treatment may include casting, physical therapy, specific exercises, or shoe inserts. In severe cases, surgery may be necessary to correct tight tendons or bone issues.

Rigid flat feet or rocker-bottom feet may require surgery to remove abnormal bone connections and realign the foot structure.

Conclusion

Everyone is born with flat feet, and arches typically develop by age 6. Flat feet may develop later in adolescence or adulthood, causing discomfort and mobility issues. Consult a pediatric orthopedician if flat feet cause problems. Non-surgical treatments like stretching exercises and orthotics can help reduce pain and inflammation.