Denton County Living Well Magazine March/April 2018 | Page 25
What is
Pediatric
Flatfoot and
When Should
You be
Concerned?
By Dr. Lesley Richey-Smith
F
latfoot is a common condition in both
children and adults. Most infants are
born with a flatfoot. A normal arch
does not develop fully until the ages
of 5 through 7. Although there are
differences between the various forms of
flatfoot, they all share one characteristic––
partial or total collapse of the arch.
Most children with flatfeet have no symptoms.
However, when symptoms do occur, they vary
according to the type of flatfoot. Some signs
and symptoms may include: pain, tenderness,
or cramping in the foot, leg, and knee; outward
tilting of the heel; awkwardness or changes in
walking; difficulty with shoes; reduced energy
when participating in physical activities; and
voluntary withdrawal from physical activities.
A flatfoot can be flexible or rigid. Flexible
means that the foot is flat when standing,
but the arch returns when not standing. It is
also considered a foot that can be placed
into what is considered a neutral or normal
position without much effort. A rigid flatfoot
is a foot that is always flat, whether standing
on the foot or not. The most common rigid
flatfoot deformity is a tarsal coalition and a
congenital vertical talus.
A tarsal coalition is a co ngenital condition,
meaning it was present at birth. It involves an
abnormal joining of two or more bones in the
foot. A tarsal coalition may or may not produce
pain. When pain does occur, it usually starts
in preadolescence or adolescence.
A congenital vertical talus is a condition
also present at birth. The foot has a rocker
bottom appearance that occurs with this
flatfoot. Symptoms begin at walking age,
since it is difficult for the child to bear
weight and wear shoes.
In diagnosing a flatfoot, the foot and
ankle surgeon will start with a full history
including birth history, walking age,
attainment of developmental milestones,
prior trauma, activities of daily living,
recreational activities, sports, shoe gear,
and shoe wear, as well as any possible
comorbidities. The foot and ankle
surgeon will perform a comprehensive
exam. This examination of the foot will
occur when the child stands and sits.
The surgeon also observes how the child
walks and evaluates the range of motion
available in the foot. Because flatfoot is
sometimes related to problems in the leg,
the surgeon may also examine the knee
and hip. The foot and ankle surgeon will
also test the flexibility of the foot. Weight
bearing x-rays are always needed to
determine the severity of the deformity.
Sometimes an MRI or CT scan is needed
for further evaluation.
Treatment for the deformity depends
on several factors. For instance, is it
symptomatic or asymptomatic, is it
rigid or flexible, and what’s your family
history concerning foot conditions? Non-
surgical approaches are observation and
re-evaluation as well as the possibility
of custom orthotic devices. There is no
evidence in medical literature that the use
of custom-made orthotics will change the
structure of a growing foot. In symptomatic
pediatric flatfoot, treatment is required.
The foot and ankle surgeon may select
one or more approaches, depending
on the child’s particular case. Some
examples of non-surgical options include:
activity modifications, orthotic devices,
shoe modifications, and physical therapy,
stretching exercises, and strengthening
exercises supervised by the foot and ankle
surgeon or a physical therapist. These
options can provide relief in some cases
of a flatfoot.
In some cases, surgery is necessary to
relieve the symptoms and improve foot
function. Foot and ankle surgeons perform
a variety of techniques to treat the different
types of pediatric flatfoot. The surgical
procedure for your child will depend
on his or her particular type of flatfoot
and degree of deformity. Treatment and
surgical prevention of adult flatfoot can
reduce the incidence of additional foot
problems such as bunions, hammertoes,
arthritis, and calluses, while improving a
person’s overall health.
Dr. Lesley Richey-Smith completed a three-year residency program
dedicated to surgical and non-surgical treatment of pediatric flatfoot
conditions. She continues to specialize in pediatric care.
DENTON COUNTY Living Well Magazine | MARCH/APRIL 2018
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