Flatfeet In Children: Are Orthotics Necessary?

Many individuals have flatfeet and never have foot problems. In fact, all of us are born with flatfeet and some of the greatest athletes have flatfeet. But, flatfeet are a problem when complete arch collapse is combined with excess inward rotation of the foot and ankle (pronation). This type of flatfoot causes excess stress on the joints, ligaments and tendons in the foot and ankle and if not treated appropriately, tendon and joint problems may develop. Catching the condition early and initiating treatment can help prevent future problems. All infants have flat feet, so this makes it difficult to assess early on if an infant’s flatfeet will become a problem later on in life. Between the age of two to three, the child’s foot starts to develop into a more characteristic shape as the bones grow and become more prominent.

The foot takes on more shape and the arch develops between four and eight years of age. Up until this time, most children’s feet will appear flat. But, many children under the age of 4 may have excessively flatfeet and excess rotation in their feet. When are the flatfeet a problem? How do you tell the difference?

There may be a problem if the toddler:

  1. is over 15 months of age and has not started walking
  2. started walking around 12 months, but seems to prefer crawling.
  3. is between the ages of 2-4 and complains of foot pain or leg pain. In many instances, this leg pain is confused with growing pains.
  4. has uneven wear patterns on their shoes.
  5. has an arch that is touching the ground and the ankles look like they are rolling in, bringing the knees together.

For toddlers, the typical treatment for flatfeet is a kiddie orthotic, a pre-made rigid insert for the shoe. It will fit into any shoes and should be comfortable for them. This will help stabilize their foot while they are walking. In severe cases, or in children ages 3 and 4, a custom made orthotic may be necessary. A mold of the toddler’s foot is taken with plaster (in some cases foam) and a custom insert is made with specific corrections added. A custom made device will look like a plastic insert. The insert slips into the shoe and can be switched from shoe to shoe. Children can wear the same insert for up to 2 shoe sizes, then a new pair must be made. Although the insert will not change the way the foot develops, it will support the foot and allow for a more normal walking pattern. In some cases, children only need the orthotic during the first few years, and after the arch develops, the orthotic is no longer needed. In most cases, children will not “outgrow” their flatfeet.

As the foot and arch develop, the child’s body goes through numerous changes. The bones grow in length while the leg and thigh bones are rotating. During these years it may be difficult to determine if the flatfoot will become a problem or not. One of best indicators of a problem is pain. Children should not have pain in their feet. They should be able to run around with their friends or in an organized sport, without any pain. If your child is having foot, ankle or leg pain, make sure they see a podiatrist.

Young children between eight and thirteen years of age may have flatfeet, but not complain of any pain. This is a common occurrence in this age group, especially if the children are not involved in any competitive sports. Look for the following:

  1. The arches touch the floor and the ankles and feet rotate in.
  2. The knees are very close together (knock-knees).
  3. Shoes wear out quickly, within 3 months.
  4. The wear pattern on the heel of the shoe is on the inside.
  5. Your child’s gait is bouncy or looks awkward.
  6. Your child seems slower than his or her piers or lacks interest in sporting activities, despite being athletic.

Small problems that develop in this age group can lead to more severe problems down the road. Generalized ankle pain is the most common complaint in children this age with flatfeet. Typically, they can run and play sports, but experience deep, achy pain in and around their ankle when they are finished. Children this age have a very difficult time expressing the type of pain they are experiencing and when they experience it. Writing down when and where the pain occurs will help your doctor during the visit.

In teenagers, the most common problem associated with flatfeet is tendonitis. Growth slows in girls in the early teenage years, later for boys, and the growth plates start to fuse in the feet. Teenagers with tendonitis secondary to flatfeet experience pain at the back of the heel or at the inside of the arch. These tendons are aggravated by going up and down stairs and hills, squatting and walking on uneven surfaces. Active teenagers with flatfoot problems will experience pain during sportings events, especially sports such as soccer or tennis.

Initial treatment for tendonitis involves rest, ice and immobilization for a minimum of two weeks, but recovery time can take much longer. Addressing the problem is necessary and when tendonitis or other arch problems develop as a result of flatfeet and excess pronation, an orthotic is necessary. Not every flatfoot needs a custom made orthotic, there are many prefabricated orthotics that will work well. But, soft insoles purchased from the drug store will not help. Orthotics are rigid devices which fit into the shoe and control foot motion. A custom-made orthotic is custom to the foot with corrections built in, designed to aid foot function and minimize the stress on the ligaments and tendons in the arch. Supportive shoes are also very important. Soft, flexible shoes, flip-flops and other types of sandals can exacerbate problems. In more severe cases, surgery may be necessary.

In summary, all infants have flatfeet, but more severe flatfeet in this group can become a problem. The foot starts to take it’s shape around the ages of two to three and the arch develops between four and eight years of age. Predicting long term foot problems in this group can be difficult. Most flatfeet in this age group do not need to be treated. Many children, teenagers and adults have flatfeet, yet no associated foot problems. But, children with flatfeet and foot pain need to see a podiatrist or other foot and ankle specialist. Early diagnosis and intervention may help prevent future foot problems.


5 Responses to “Flatfeet In Children: Are Orthotics Necessary?”

  1. on 29 Aug 2009 at 11:29 am jiffriya

    my son is 6 years.he is having very flat feet.but no ains.will he have problem later?

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