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Dallas Podiatry Works

What is Pediatric Flatfoot?

Flatfoot is typically seen as the loss of a patient’s arch. When pathologic, the condition is typically more complicated than loss of arch height.  It can be where a person’s feet are hyperpronated – functioning in an excessively relaxed state, that can lead to pain in the back, legs, knees, ankles or feet. Flat foot deformity can occur with a high degree of frequency. A study published in 2009 in the European Journal of Pediatrics, studied over 2000 school age children between the ages of 7-12 and found a prevalence of 59% of the children had flatfoot deformity. There was a higher incidence in boys and those children who were overweight. The degree of this foot deformity and symptoms associated with flatfoot can vary, and it can affect all ages. 

Some children experience pain with this condition (symptomatic), and others have no signs of pain or other symptoms (asymptomatic).  Those with pain are often unable to participate in the sport or activity of their choice and can lead a more sedentary, less healthy lifestyle. 

Pediatric Flatfoot

Are there other signs that my child has symptomatic flatfoot?

Many parents note at birth that their child appears to have no arch. This is normal, as the arch does not typically develop until age 3 or 4.  Symptoms from pathologic flatfoot usually begin as the child begins to participate in more organized activities. Other children develop this foot condition as they get older who have less active lifestyles. You might notice a change in your child’s gait as they accommodate for the pain they are experiencing. Complaining that shoes hurt their feet may be another sign that something is wrong.  Parents may notice that their young children can’t walk for prolonged periods of time, such as a couple of hours in the mall, without complaining, requesting to be held or sitting down.

The most obvious indicator that this deformity of the foot is impacting your child’s life is if they quit their normal physical play, or if they seem to do so with less enthusiasm.  

What are other identifying markers of pediatric flatfoot?

Another important distinction with this foot condition is that some children experience flatfoot that is flexible while others have rigid flatfoot. Flexible flatfoot is noticeable when the child stands. However, when the child sits, the arch is once again visible.  With this type, many children do develop an arch eventually. Walking helps with this, because the soft tissue of the foot begins to strengthen which assists in forming the foot’s arch. Either way, some have pain with this foot type.

Rigid flatfoot includes vertical talus and tarsal coalition. Both conditions are congenital, meaning they are diagnosed at birth.  

Vertical talus is very uncommon and occurs when the talus bone (just above the heel bone) develops in the wrong position. The bones that surround it then move over this bone, and the result is that the top of the foot points up towards the shin. The sole of the foot is rigid, flat, and often points out.  Surgery is typically recommended to correct this issue, and will usually be advised before a child turns one. While usually painless for a baby, if left untreated this condition can become painful and limit mobility.

Tarsal coalition is typically not symptomatic until a child is much older (often 8-16). It’s not unusual for this condition to go undetected, with symptoms arising in adulthood in response to an injury such as an ankle sprain. The bones in the back half of the foot are referred to as the tarsal bones. In this condition, there are connections between these  bones that are not supposed to be there. Unless symptomatic, treatment is unnecessary.  There are conservative and surgical options for those who do experience pain.

What are common treatments for flexible flatfoot?

The decision to treat children with flatfoot deformity is not always straightforward, with varying positions from treating physicians. If the deformity is severe, we may choose to treat in the absence of symptoms. If pain is occurring, Drs. Brook and Northcutt, at Dallas Podiatry Works, may prescribe exercises, custom orthotics, immobilization, medication, or physical therapy. Surgery is most often not indicated, and is usually not considered until the child has failed a full range of conservative treatments and the discomfort is negatively impacting their lives.

If you suspect that your child has a flatfoot deformity, don’t delay calling Dallas Podiatry Works, so that they can be evaluated and their condition can be fully explained to you. Remember, foot pain is not normal at any age, so be sure to seek medical advice at the first sign of discomfort. Call us toll-free at 888-716-5283, or schedule an appointment online.


Dr. Joel W. Brook
Dr. Joel Brook is a board-certified podiatrist and foot and ankle surgeon at Dallas Podiatry Works in TX.