Children’s feet are quite different from adult feet and legs. Adult-oriented doctors often misdiagnose normal toddler feet as being “flat” and “abnormal”, when they are perfect. For example, the arches. Adult feet have three arches which function as a spring mechanism to support body weight, absorb shock, and help you move efficiently. Arches usually form by the time the child is 3 or 4 years old. Under the age of three, children do not have arches. That is normal.
What are flat feet?
Flat feet are also known as fallen arches. One of the arches occurs on the inside of the foot. Flat feet occur when that arch does not develop. Babies are born without arches but the foot isn’t permanently flat; arches take about three years to develop.
In the meantime, while there is still some “baby fat” under the feet, it looks “flat”. That means the entire sole of the foot touches the floor when standing. That causes no problems except in the minds of some parents and doctors. This is a typical example of transferring an adult disease onto children. In adults, flat feet can cause aching after long periods of standing.
What causes flat feet?
Flat feet are genetic, so they run in families: the feet in those families are flat. That usually does not cause a problem. Sometimes the flat feet may be due to loose ligaments or out-turned legs or bone abnormalities, but this is rare.
Should you take your child to an orthopaedic surgeon or podiatrist for suspected flat feet?
No, once the baby has been given the all-clear by a paediatrician, the child’s feet will usually develop normally, unless you notice other problems, like poor coordination or difficulty walking. Flat feet in an older child may cause pain in the heel or arch, or may cause pain when walking or running. In that case, your doctor should also look at your child’s legs to make sure there isn’t a problem with the knee or hip. The child may need X-rays, but usually the doctor can tell what is wrong just by looking at them. The only good reason to see a foot specialist is if the child has a flat foot affecting only one side.
Aren’t special shoes needed for flat feet?
Definitely not! Your child’s foot development will be the same whether special shoes, with or without inserts, are worn or not. This is another example of a “treatment” in search of a disease. Flat feet are not considered a disease and there is no need for treatment. High-top or special orthopaedic shoes or wedges are only useful to keep shoes on the child’s foot. If the older child really has foot pain, a podiatrist can recommend a heel cup or a shoe insert. These relieve pain but do nothing for the development of an arch.
Will some activities make flat feet worse?
No. You do not need to try to limit your child’s activities (as if anyone ever could!). Shoe styles, foot exercises, running, jumping will not make flat feet worse or better. The best you can do is to allow the child to run about in bare feet in the hope of developing the muscles in the feet. But really, the only thing this does is to spare parents the expense of buying shoes.
Shoes, by the way, are needless items, good only for protection and to show off when you visit friends. The best shoes for toddlers are the ones that fit them (i.e. are not too tight) and that you can afford. Children should be allowed to go barefoot because there is no evidence that shoes help arches develop or make children walk better. In fact, they make children walk awkwardly and look clumsy.
Is surgery ever helpful?
Rarely, if the child’s flat feet are caused by fused foot bones and if shoe inserts and casts have not helped, surgery may be considered.
Flat feet are an old-time illusion. Fifty years ago, most doctors believed that flat feet were harmful. It takes about 30 years for medical beliefs to change. Today we know that most people who have flat feet are well and do not need any treatment. Leave well alone.
In summary: children with flat feet do not need treatment and special shoes do not help the development of an arch any better than a child’s natural growth.
