FLAT FEET

Children trip and fall a lot as their gait is immature and they are in exploratory phase of walking. Toddlers usually have a wide-based gait and put their feet down flat, causing their toe or shoe to catch the ground while on the move. Moreover, less ground clearance than in adults, taking shorter steps to go faster, tendency to overbalance as they naturally twist & turn and some degree of intoeing due to physiological torsions of long bones of lower limbs, just make things worse. Generally, this common situation disappears by itself as the child grows older.
Flatfeet are very common in children under the age of three and most are variations of normal. Usually the foot isn’t really flat; rather the instep hasn’t developed because of some residual “baby fat”. The condition can also be due to ligamentous laxity (double-joints) and/or out-turned feet; in which case, there is a natural resolution by the age of around 4 yrs.
Bilateral flexible and painless flat-feet do not require treatment. Studies have shown that no ‘special shoes’ or any particular shoe inserts help in forming the arch and thus are unnecessary. Children can go barefoot at home as there is no evidence that shoes help them to walk better. Soft, flexible-soled leather shoes would be great for outdoors. There is every reason to believe that these children will grow up as any other normal boy.
On the other hand, if his feet are not supple, if the condition is painful or if it involves only one foot, this would require further imaging and investigations. Use of shoe-inserts is justified under these circumstances. Surgical management is almost never required in a child and would be considered only in a symptomatic adolescent under extreme circumstances.

Dr Ramani Narasimhan
Sr. Consultant Pediatric Orthopaedic Surgeon
Indraprastha Apollo Hospitals, New Delhi.

Mobile no: 09811016102