Paediatric Flat Feet

What are Paediatric Flat feet (Paediatric Pes Planus)?

Paediatric flat feet or pes planus is a condition whereby the child has a lowered or complete loss of arch along the inside of the foot, causing the feet and ankle to roll in towards to centre of the body. It is also widely known as “pronated feet” or someone with a “pronated gait”. Most parents with children suffering from flat feet would refer to their child’s gait as “walking with toes pointing out”, “walking like a duck”, or “foot slapping the ground”.

It is estimated that 2 to 3 in 10 children have flat feet, and this number is higher in Asian countries because joint hypermobility is more prevalent among Asians.

How Do I Know if My Child has Flat Feet?

Children are not born with a foot arch and the arch will develop gradually from the age they start to walk. Under normal progression, a foot arch can be seen from ages 2 to 3 years old onwards, and full development is achieved at around the age of 7. To find out if your child has flat feet, you can do the following:

1. Observe the Footprints

The easiest way to determine if your child has flat feet is by looking at their footprints, for example, after swimming or at the beach. A normal footprint will have a concave curvature along the inside of the foot, whereas a flat foot will have either no curvature or a convex curvature instead.

2. Check the Shoes

Your child’s shoe can also help to identify his or her foot type. Children or adults with flat feet often cause the shoes to distort inwards, in the same direction as the foot and ankle as they roll inwards.The sole will often show excessive wear over the inside of the heel (in severe cases) or outside of the heel (in mild or moderate cases), together with excessive wear over the big toe region

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Types and causes of Paediatric Flat Feet

Flexible Flat Feet (Flexible Pes Planus)

Flexible Flat Feet are the most common type of Paediatric Flat Feet, whereby the joints of the foot are hypermobile, and a foot arch can be “created” by standing on the toes. Children with flexible flat feet will also have a noticeable arch when they are seated down or when the foot is in a non-weight-bearing position.

Causes of flexible flat feet include:

Hypermobile foot joints (Ligamentous laxity)
Low muscle tone
Genetics
Congenital abnormality (e.g tarsal coalition, congenital vertical talus)
Connective tissue disorders (e.g Ehler-Danlos, Marfan’s syndrome)
Down syndrome

Rigid Flat Feet (Rigid Pes Planus)

Rigid Flat Feet are far less common and are characterized by a loss of foot arch when standing, sitting, or lying down. The foot arch cannot be “created” and the foot stays flat throughout.

Rigid Flat Feet are often caused by underlying musculoskeletal conditions such as:

Tarsal coalition (congenital fusion of tarsal bones of the foot)
Peroneal spasm
Congenital vertical talus

Signs and Symptoms of Paediatric Flat Feet

Pain or cramps in the foot, ankle, leg, and knee during activities or after long periods of walking
Frequently tired legs when going for walks
t tripping and falling
Walks with a forward-leaning position
Likes to be carried around or be in the stroller
Frequently needing massages to relieve aches and pains
Excessive wear of the shoe often requires frequent replacement

Why Should You Address Paediatric Flat Feet?

Flat feet cause an upward chain reaction that leads to structural malalignment of the body, commonly affecting the knees, hips, and spine. It also alters our gait pattern and the amount of stress our bones, joints and muscles withstand during movement, which leads to an increased risk of injuries.

Common injuries or conditions associated with flat feet include: