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Many parents are worried that their child might have flat feet. This condition occurs when the foot doesn't have a normal arch. Feet that have a low arch or no arch at all are called flat feet, or fallen arches.

Don’t worry if your baby’s foot looks flat, because all babies' feet are flat. Arches form by the time child is 2 or 3 years old. Flat feet at this age rarely require any treatment. A person who has a low arch or no arch at all is said to have flat feet. Flat feet in children occur with high frequency, and treatment is somewhat controversial. Some pediatricians and orthopedic surgeons will tell you that flat feet are normal and that the child will grow out of flat feet.

Causes

In many people, flat-footedness is just the shape the foot is. It may be a hereditary condition. Flat feet are caused by loose joint connections between the foot bones. When this happens, the arch falls when your child stands up. You should know that the foot is made up of 26 bones held together by 33 joints, and more than 100 muscles, tendons, and ligaments. Lax ligaments can also cause flat feet.

Symptoms

Some children with flat feet feel an ache in the arch, around the ankle or down the outer side of the foot. A small percentage of children has feet so flat that they have symptoms either of pain, or a dislike for physical activities like running.

Children with very over-pronated feet tend to wear shoes out very quickly. Your child may feel foot or ankle pain. If your child is older, flat feet can cause pain in the heel or arch when the child is walking and running. If your child complains of such pain you should them to a doctor. Doctor will look at your child's feet to make sure that the pain isn't caused by a problem in the hip or the knee. The doctor will tell you what the problem is just by looking at your child's feet. Only when the foot is very flat some sort of treatment is required.

How to know if your child has flat feet

Children’s feet come in a variety of shapes, from high arch to extremely flat. When your child gets out of a swimming pool, look at the footprint left on the concrete. If the foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake.
Take the child’s shoes, and put them on a flat table and view them at eye level from behind. Flat feet will cause more wear on the inside of the sole, especially in the heel area. Both shoes should wear out about the same way.

If you think that your child has flat feet, take them to a doctor. The doctor will perform an examination, observing the feet from the front and the back, and ask the child to stand on toes so he or she can view the mechanics of the feet. When a child between ages 6 and 10 has flat feet, and a flexible flat foot is confirmed, immediate intervention is necessary to encourage normal development of the longitudinal arch, and to prevent spinal postural deformities
To view the interior structure and bones of a child’s feet, the doctor may request imaging which may include an X-ray, a computerized tomography scan or a magnetic resonance imaging scan.

Treatment

Most flat feet cause no trouble and do not need treatment. An arch support can help a mild flat foot. An in-shoe orthotic can benefit any child with flat feet. This device never causes harm. Worn from an early enough age, they might actually help the adult position of the foot. All podiatrists and orthopedists can provide you with custom orthotics. If the child is 10 or older, the flexible flat feet can be considered permanent. Long-term use of orthotics will be required to prevent future problems in the feet and spine. This is especially important when one foot is flatter than the other. Asymmetrical forces imposed during locomotor’s activities can eventually result in significant trauma to the foot. Flat feet can cause problems when a child is overweight or athletically active.

If treatment is needed, it includes:

    *      Arch supports, called foot orthotics. There are three types - rigid, semi-rigid and soft. The type that's right for your child depends on what kind of support the doctor is trying to provide. If your child has foot pain, the doctor may recommend a shoe insert. The arch support does not change the shape of the foot.
    *      Orthopedic shoes, which are only useful to keep the shoe on your child's foot.
    *      Surgery

Surgery

Very rarely, surgery is performed to remedy flat feet. Children who have an abnormal foot because it has not developed properly may need an operation to straighten the foot. There are two types of surgical procedures. If symptoms cannot be controlled with shoe changes and orthotic arch supports, then surgical procedure is the solution. In the first surgical procedure, a surgeon inserts a small cylindrical plug into the heel bone joint. The procedure to insert the plug takes approximately 20 minutes. The child is able to walk on the foot after a few days using either a short leg walking cast or a Removable walking boot. If the foot gets more deformed, first surgery may not be sufficient to correct the flat foot deformity. The second operation is performed to change the shape of the foot with bone cuts, combined with the use of a bone graft. Both procedures are a very successful in the correction of a child's flat foot.

Complications

Flat feet are not related with any complications except pain. Some causes of flat feet can be successfully treated without surgery if caught early. Surgery is the last option to relieve pain.

Surgery sometimes does not result in satisfactory results for all patients, sometimes resulting in persistent pain. Other possible surgical complications include infection and failure of fused bones to heal.

Self-care

Depending on the severity of symptoms, your doctor may advise you to limit your child’s weight-bearing activities while wearing orthopedic shoes or arch supports, and wait for the swelling and pain to subside. You should strengthen the child's lower leg muscles with home exercises. Talk about this with your child podiatrist. Insist the child wears supportive shoes with a stable heel and a strong counter.

Proper shoes are important for the developing foot. A child is going barefoot stimulates proprioceptors and encourages muscular coordination and strength. Shoes should have flexible soles to allow for proper foot joint movement. Constricting shoes stop normal growth and may result in deformity. Frequent evaluation of size and fit is an important concept for parents to understand and accept.

When symptoms have subsided, your child can return to normal activities, including exercise. Cycling and swimming are the best for your child, especially when the child first resumes activity. The doctor may suggest a continued use of orthotics.

Parents need reassurance and appropriate recommendations when their child has flat feet. Most of their child’s flat feet conditions will be resolved during normal growth and development.