Pediatric Orthopaedics - Flat Feet

The most common orthopaedics disorders in children and adolescents can be treated at UPMC centers.

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UPMC provides tests and treatment for the diagnosis and care of pediatric flat feet in the following facility:

• UPMC Salvator Mundi International Hospital.

What Are Flat Feet?

Flat feet are a common condition in which the longitudinal arches of the feet are flattened or poorly developed. In this condition, the arch is flat and the entire sole touches the ground when the child is standing. The plantar arches that normally support them are flattened.

During the first phase of walking, from 10 months to 3-4 years of age, flat feet are normal, as they are part of natural growing process of the feet. Generally, this issue adjusts spontaneously within 6-7 years of age. However, if this does not happen, your child may experience fatigue and pain in the legs, ankles and knees while walking or playing sport. In these cases, using tailor-made insoles and performing specific exercises can help improve foot support and facilitate the proper development.

Although most patients with flat feet do not experience any pain, several studies have shown that children with this disorder, particularly those with inward-tilting feet (hindfoot valgus), can develop painful or disabling syndromes such as plantar fasciitis and tibialis posterior syndrome in adulthood, in addition to functional overloads of ankles, knees and forefeet. Furthermore, flat feet can contribute to secondary diseases such as osteoarthritis of the tibiotarsal and subastragalic joints, and development of metatarsalgia and hallux valgus.

Flat Feet Causes

Causes of flat feet can be:

• Congenital (such as the fusion of the bones of the foot known as synostosis or complex malformation syndromes).
• Neuromuscular (due to diseases of the nervous and muscular systems, such as infantile cerebral palsy, myopathies, and spina bifida).
• Post-traumatic (such as fractures of the heel bone or the astragalus, rupture of the tibialis posterior tendon).
• Inflammatory (such as juvenile idiopathic arthritis).
• Idiopathic (of unknown origin), the most common and frequent forms in overweight children and adolescents.

Diagnosis

A flat feet diagnosis is made after a specialist consult. Typically, this condition manifests itself with an inward foot support (pronation) and a lateral heel tilting (heel valgus).

The consult is carried out using a device called podoscope that examines the footprint under load. Moreover, radiology tests of the foot under load are used to assess the normal angles of the foot bones and the presence of synostosis (i.e., the congenital fusion of some bones). In the most complex cases, further diagnostic studies might be required by means of CT scan or MRI.

Early diagnosis is crucial to prevent the onset of future diseases, thus ensuring the long-term wellbeing of the child. In addition, state-of-the-art and timely surgery can help the proper development of feet and ankles. Early recognition of flat feet, especially presenting with hindfoot valgus, is fundamental for the wellbeing and health of your child.

Flat Feet Treatments

Different treatments are available for flat feet including preventive interventions and, in selected cases, surgery.

Preventive interventions often include conservative therapies, such as targeted exercises to strengthen the foot muscles and correct the posture. These programs are aimed at promoting proper foot growth and development in children. In addition, tailor-made orthopaedic insoles may be recommended to provide adequate foot support during walking and physical activity.

If flat feet persist and more decisive intervention is required, surgery may be considered. Luckily most flat feet surgical procedures are minimally invasive, hence well tolerated by children. These interventions enable a rapid recovery and return to normal life, including playing and sports.

Selecting the best treatment depends on the severity and on the cause of flat feet, as well as on the age and specific needs of your child. A thorough assessment by a pediatric orthopaedics will help identify the most appropriate care to ensure the best outcome.