Pediatric Myth Busters
In this article I will share what I fondly call my
pediatric “Myth Busters”! Learning about common
misconceptions related to children’s feet can help a
clinician overcome unwarranted fears about treating
and managing pediatric flatfeet. This article will
include easy–to–understand age-specific assessment
and treatment protocols for use of foot orthoses,
and offer tools to help the practitioner learn how to
market a pediatric program to expand their practice
and become a pioneer in their community in the
area of pediatric pedorthics.
Myth Buster #1:
“It’s ‘Normal’ For Children to Have Flat Feet”!
Yes, it is both true and quite normal for a young
ambulator (ages of 1-6) to stand and walk with
pronated arches and everted (valgus) heels(1, 2, 13).
This is partially due to the fact that at birth not
all of the bones of the foot are fully present or
ossified. The foot of a neuro-typical child requires
further postnatal development before it will achieve
a state of skeletal maturity sufficient to allow for
standing and ambulation(2, 13). Also present at
birth is a fat pad that fills up the space along the
medial longitudinal arch of the foot that further
accentuates its flatter appearance. This fat pad
serves to protect the developing osseous structures
of the foot from excessive load (11). Over time this
fat pad is fully reabsorbed by the body and the arch
should appear "normal" by ages 4-5(5, 11).
Most children take their first steps around 9 to
15 months of age, but not all children grow and
mature at the same rates. Some children may
inherit skeletally–deficient feet from their parents,
and at times this can lead to delayed ambulation
and postural deficits that can put them at risk for
future disabilities. Children with developmental
delays may take longer to begin ambulating, often
16-24 months or longer. In addition, consideration
needs to be given with reference to epidemiology,
flexibility, gender, weight, and hypermobility(2).
According to ACFAP president, Louis J. DeCaro
(American College of Foot and Ankle Pediatrics),
it is quite normal for a one-year-old child to stand
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Pedorthic Footcare Association www.pedorthics.org
Photo: @iStock.com/bst2012
Joseph C. D'Amico, DPM, defined
“Developmental Flatfoot” as an excessively pronated
flexible flatfoot in the weightbearing pediatric
population under 6 years of age; and describes it
as a poorly functioning, posturally-deficient foot
that has the potential to cause future deformity and
disability(1).