Flatfoot in Children: How to Approach?

Although the exact incidence of flatfoot in children is unknown, it is very common and is, infact, one of the most common conditions seen in pediatric orthopedic practices. All children areborn with flat feet, and more than 30% of neonates have a calcaneovalgus deformity of both feet.This condition is not painful and generally resolves without treatment; very rarely is correctivecasting necessary. For the pediatrician evaluating flatfoot, it is important to differentiate betweenflexible and nonflexible (rigid) flatfoot, and to classify the condition as painful or painless. Mostchildren who present to a pediatrician for evaluation of flatfoot will have a flexible flatfoot thatdoes not require treatment. On the other hand, other conditions that do require treatment, such ascongenital vertical talus, tarsal coalition, and skew-foot often present as nonflexible flatfoot.Surgical management is rarely indicated for a true flexible flatfoot. The longitudinal arch of thefoot is not present at birth and slowly develops during childhood, usually by about age five orsix. It is a process that occurs throughout growth and is not affected by the presence or absenceof external arch support. Sometimes the arch takes even longer to take shape, but this stillusually does not cause any problems. A variety of tendon transfers and reconstructive procedureshave been advocated, but none has proved uniformly successful. Nor have any of the varioustypes of supports ever been shown to change the arch architecture. It should be borne in mindthat painful flexible flat foot requires treatment, often with several types of shoe inserts andsupports and as a last resort by operative procedures. Although parents are often concernedabout pediatric flatfoot, the child is usually found to be asymptomatic, and no treatment isindicated. In most instances, the best treatment is simply taking enough time to convince thefamily that no treatment is necessary.