What is Flat foot
A flat foot is simply a collapse of the arch. There are flexible flat feet; where sitting the child has a good arch but upon standing the collapse is apparent. There are also rigid flat feet. These are a whole other ball game. These are typically present from birth and are non-reducible. This means no matter how hard we try, we can not force the foot into an arched position. There are a number of conditions in childhood and adolescence that can cause a flat foot. They range from congenital abnormalities (those you are born with) to simply tendon weaknesses.
The Timeline of Flexible Flat Foot
During the toddler years a flat foot is perfectly normal. Flat feet at this age rarely cause pain. It is normal developmentally and typically does not need to be treated.
By the time the child reaches kindergarten (5 years old) the arch should have begun to develop and their feet should no longer look so flat. Even during early elementary school, children with flat feet and no pain do not require treatment. Only children who have other abnormalities to their foot such as bunions or hammertoes, would suggest treatment would be necessary. Typically at this age we use a custom made orthotic. The orthotic will not change the shape of the foot. It will however put the muscles and tendons in the best possible position as the foot further develops.
Typically if the feet remain flat, as children age they will begin to complain of symptoms. It's important to remember that kids don't always complain of pain! Often they will say their feet ache or feel tired. If you take a trip to an amusement park or are on vacation, the child may continually ask to sit down or want to stop walking. At it's worst, children will not want to play with their friends and may begin to retract from sports and gym.
Treatment of flat feet
While it is rare, some kids do not find pain relief with the orthotics. In this case we consider the surgical options. There are two basic options; an arthroeresis and repair of the bones and soft tissues causing the flat foot.
The arthroeresis is where a small 'plug' or implant is placed in the joint at the back of the foot under the ankle joint-called the subtalar joint. In this procedure, the 'plug' is threaded in over a wire under a live x-ray exam. Once the arch has been re-created the implant is left in place. This procedure is only successful in flexible flat feet and sometimes requires additional procedures.
The bony procedures and fusions vary vastly and are a very aggressive form of treatment that are only needed in the worst cases. Those can be further discussed with your doctor if they feel they are right for you.