When a parent brings their child to our podiatry clinic, it is often due to concerns about flat feet, and whether their child needs orthotics.
Flat feet are relatively normal from birth to about two years of age, as the arch doesn’t start to develop until the child is walking. Even after that, the soles of a child’s feet may look flat, but this does not necessarily indicate a problem.
The term “flat foot” is a fairly broad term covering a number of foot alignment issues. True flat foot is a condition where the longitudinal arch of the foot has not yet developed normally. However excess pronation can also make your child’s foot look flat, and cause you to worry.
Flat Feet or Excess Pronation?
Pronation is the natural movement of the foot and ankle, where they roll inwards when you are in motion. It can affect one foot, or both.
However in many cases it can roll in excessively – ie excess pronation. As the child walks or runs, excess pronation causes:
- the arch of the foot to flatten;
- the fore foot to splay outwards;
- and the ankle to pull upwards.
In a true case of flat foot there is no change in the arch contour (ie it remains flat), whether the child is standing or sitting.
A pronated foot on the other hand, will seem flat when the child is standing, but there is a fully developed arch profile when the child is seated.
Excess pronation is quite common in children from birth up to about age eight or nine, and is not usually painful (if your young child is complaining of aching legs, that they can’t sleep due to leg pain, or pleading for you to rub their legs to give them some relief, this merits further investigation for hidden pathologies).
The reason pronation is so common in children is because bone grows faster than soft tissue, creating a muscular imbalance. The child’s foot subsequently pronates to compensate; in some children, it might result in knock knees or bow legs for a time.
There are other factors which may contribute to a change in the arch of the child’s foot – such as limb length discrepancies, or curvature of the lower back.
By the age of five or six, the foot bones have positioned themselves, and all they have to do is grow and get bigger. At this stage if the arch does not appear to be developing, it’s worth visiting your local podiatry clinic to find out if orthotics may be of benefit. Before making a diagnosis we will likely send your child for x-ray and/or ultrasound, to make sure there’s no congenital abnormalities (eg bony fusions, ligament or tendon damage, non-development of particular structures).
Orthotics for Excess Pronation
In a true case of flat foot, there is no arch – so there is no point in using an orthotic to support an arch that does not exist. In this case, it would simply hurt the client.
We find approximately 80% of children visiting our podiatry clinic are presenting with excess pronation. Treatment may include advice on footwear choices, exercises, or possibly orthotics.
What sort of Orthotics?
If your podiatrist recommends orthotics, there are two types to consider: off the shelf, or customised.
Off the shelf are cheaper, but provide only a certain degree of correction. If there is a marked deformity, we have no choice but to prescribe custom orthotics, because one foot is functioning quite differently to the other.
At our Redlands Podiatry Clinic we see clients of all ages, so if you have any concerns about your child’s feet, need school shoes, or want guidance on the best kids shoes for orthotics, you can book an appointment now using our secure online booking system.