Flat feet in children often resolve naturally without pain as they age. However, when intervention is needed, early assessment by a podiatrist is crucial. Podiatrists evaluate the arch formation and gait to recommend treatments like orthotics, physical therapy, and stretching exercises. Orthotics provide structural support for growing feet, slowing progression and reducing discomfort, but they don’t correct flat feet. Stretching exercises for Achilles tendons can also help alleviate tightness and address common issues like pronation. Physical therapy strengthens foot muscles and improves balance. In severe cases, surgery may be considered to realign and stabilize the feet, reducing pain and improving function in older children.

1. Orthotics

For most children, conservative treatment of flexible flat feet begins with recommending shoe inserts or orthotics. This is a valuable first-line intervention because there are no contraindications to their use and they provide the structural support that the skeletally immature foot needs.

It’s important to note that these inserts do not correct or cure flat feet, but they can prevent the progression of the condition and decrease the likelihood of pain and/or damage. They need to be replaced regularly as your child grows and reaches skeletal maturity.

This is because the calf muscles tighten up and compress the feet as your child grows, and the inserts help to reduce this effect. A good pair of orthotics can last up to a year for kids before they need to be replaced.

2. Stretching

Stretching exercises for the heel cords — the Achilles tendons — can be very effective. They are simple to do and generally safe for kids.

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A tight heel cord encourages the foot to roll inward, known as pronation. This can be a problem with flat feet.

The best way to improve pronation is by stretching. Stand with one leg behind the other and bend the back knee until you feel a stretch in the back foot. Repeat three times on each leg.

Other treatment options include arch supports, available over-the-counter or custom-designed to mold to the shape of the foot, which can reduce symptoms but won’t fix the flat feet. Also, supportive shoes — as opposed to sandals and flip-flops — can help prevent painful foot problems.

3. Physical Therapy

When children have flat feet, they may experience pain in their feet, ankles, or knees, especially after prolonged periods of standing or exercise. They may withdraw from sports and other activities because of the discomfort.

Physical therapy can strengthen the foot and leg muscles, increase balance, and promote the development of the arch. Physical therapists can also use exercises to stretch the Achilles tendon, which can be shortened by long-term flatfoot.

Most children with flexible flat feet won’t require surgery, but this becomes a consideration in severe cases and when non-surgical treatment doesn’t alleviate symptoms. Surgical options can range from procedures that reshape the foot bones to those that repair ligaments and tendons. Occasionally, tightness in the heel cord can also be treated by a procedure that lengthens the heel cord.

4. Medications

Despite the common belief that children “grow out of” their flat feet, many of them are actually symptomatic and require intervention. Symptoms include pain, tenderness, or fatigue in the foot, ankle, lower leg, or knee.

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Physical therapists can help. They can suggest specific shoe types and teach the child exercises to stretch the muscles. They can also give advice about modifying activities to decrease the amount of time that the child is on his or her feet.

Over-the-counter medications such as ibuprofen can reduce swelling and pain. For more serious problems, MRI may be used, which uses magnets, radio frequencies, and computer technology to produce cross-sectional images of the bones. Surgical procedures can be used to correct the condition causing flat feet, such as a coalition (fusion) of foot bones, or to remove excess bone growth (bone resection surgery). These operations generally result in a reduction in pain and stiffness in the foot.

5. Surgery

Children with painful or stiff flat feet may benefit from surgery. However, surgery does not produce an arch in the majority of cases. The foot consists of an overlapping series of ligaments, tendons, and bones that need to be properly aligned to function. This is best achieved by a combination of soft tissue and bone procedures.

This includes removing excess tissue from the bottom of the foot, repairing loose tendons, and fusing the bones to eliminate painful movement (called arthrodesis). We also perform procedures such as bone grafting, dorsal wedge osteotomy, and tendon lengthening.

It is extremely rare for healthy children to require surgical treatment of flexible flat feet. Only when good non-surgical care fails, should we consider surgery. This is particularly important in older children who are experiencing pain or problems with balance and gait.

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Conclusion: Managing Flat Feet Effectively

Managing flat feet in children involves early podiatric assessment by a podiatrist Sydney and tailored interventions like orthotics, stretching exercises, physical therapy, and, in severe cases, surgery. These strategies aim to support foot development, alleviate discomfort, and promote optimal mobility and activity levels throughout childhood and adolescence. Regular monitoring and appropriate treatment can help ensure that children with flat feet can lead active, pain-free lives as they grow and develop.