Flatfoot

A flat foot often looks normal when no weight is placed on it, but the arch disappears when weight bearing is applied. Therefore, many parents of children with flat feet become concerned only when they see the unusual width of their toddler's wet footprints. They fear that flatfoot will lead to future disability. Fortunately, such worry is usually unnecessary.

To maintain balance when learning to stand or walk, babies hold their feet wide apart in a position that distributes body weight over the entrire foot, including the arch, so they appear to be flatfooted. However, as a child grows and becomes more stable, she usually brings her feet closer together, shifting the weight toward the center of the foot. In some children, this transition does not occur because of the true anatomical abnormality of flatfoot.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS FLATFOOT?
Conduct a quick test: try to place a finger under the child's arch while she is standing; if the finger does not fit, the arch is too low. If more than one finger can fit under the arch, it is probably too high. (If the arch is exaggerated and the tips of the toes are turned under, the deformity is referred to as clubfoot.)

Some infants give the false appearance of flatfoot because of a fatty pad below the arch. If they stand on tiptoe a normal-looking arch usually becomes apparent.

IS MEDICAL ATTENTION NECESSARY?
If the child still has flatfoot beyond two-and-a-half years of age, he may try to compensate for the strain the foot abnormality places on the ligaments and muscles. As a result, the child may develop aching feet and legs, muscle cramps in the calves at night, and toeing in to avoid strain. In addition, the child may become easily fatigued and avoid strenuous activity.

WHAT CAUSES FLATFOOT?
Flatfoot sometimes runs in the family, in which case it is caused by hereditary looseness or weakness of the ligaments and muscles that support the foot. Young children with flatfoot often have other lax joints, including the knees, elbows, wrists and thumbs. They may, for instance, be able to bend the thumb against the surface of the forearm.

WHAT TREATMENTS ARE AVAILABLE?
Flatfoot requires treatment only if it causes discomfort to the child. Simple measures will usually relieve symptoms, although they may be needed for several years (until the muscles and ligaments mature and properly support the foot) or, in some cases, for life. These measures include:

• A felt, rubber or leather pad placed under the inner sole of the shoe.

• Corrective shoes with arched metal prostheses or special heel wedges called Thomas heel.

In rare cases in which the foot is too rigid rather than too lax, and has a bony abnormality in place of the arch, flatfoot may require more aggresive treatment.

CARING FOR A CHILD WITH FLATFOOT
Special care is necessary only if the child has an abnormal gait or foot pain. Here are some recommendations:

• Avoid shoes with strong foot support (such as high-top or rigid boots), which may prevent the arch from forming normally.

• Ask the pediatrician about shoe inserts or another device to alleviate foot strain.

• Ask the pediatrician about foot exercises. Opinions vary as to whether such exercises can strengthen the arch. Some physicians recommend having the child walk on tiptoe five to ten minutes a day or pick up marbles with the toes.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.