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Flat Foot

Paediatric flatfoot, also known as “fallen arches” or Pes planus, is a deformity in children’s feet in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved. Rigid paediatric flatfoot however can cause joint pain in the leg when walking or an aching pain in the feet and usually requires intervention.

Paediatric flatfoot is a common condition that can run in families. It is often caused by loose connections between joints and excess baby fat deposits between the foot bones causing the entire foot to touch the floor when the child stands up. A rare condition called tarsal coalition can also cause flatfoot. In this condition, two or more bones of the foot join together abnormally causing stiff and painful flat feet.

Children with flatfoot deformity may have one or more of the following signs and symptoms:

  • Inside arch of the foot is flattened
  • Heel bone may be turned outward
  • Inner aspect of the foot may appear bowed out
  • Pain in the foot, leg, knee, hip, or lower back
  • Pain in the heels causing difficultly with walking/running
  • Discomfort with wearing shoes
  • Inability to bear weight on affected foot
  • Tired, achy feet with prolonged standing or walking

Your doctor will perform a physical examination of your child’s foot and observe the child in standing and sitting positions. If an arch forms when the child stands on his toes, then the flatfoot is flexible and no further tests or treatment are necessary unless the child is experiencing pain. If pain is associated with the condition, or if the arch does not form on standing on toes, then X‐rays are ordered to assess the severity of the deformity. A computed tomography (CT) scan is ordered if tarsal coalition is suspected and if tendon injury is presumed a magnetic resonance imaging (MRI) is recommended.

Conservative Treatment

If your child does not exhibit any symptoms your doctor may monitor your child’s condition as they grow to assess for any changes. If, however, your child has symptoms, your doctor may suggest some of the following non-surgical treatments.

  • Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time.
  • Orthotic devices: Your surgeon may advise on the use of custom made orthotic devices that are worn inside the shoes to support the arch of the foot.
  • Physical Therapy: Stretching exercises of the heel can provide pain relief.
  • Medications: Pain relieving medications such as NSAID’s can help to reduce pain and inflammation.
  • Shoe modification: Using a well‐fitting, supportive shoe can help relieve aching pain caused by flatfoot.

Surgery is rarely needed to treat paediatric flatfoot, however, if conservative treatment options fail to relieve your child’s symptoms then surgery may be necessary to resolve the problem. The goal of surgery is to eliminate pain, improve mobility, and halt progression of the condition.

Depending on your child’s condition, various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.

  • Tendon Transfer: In conditions where the tendon is ruptured and no fixed deformity is present, the surgeon takes a healthy tendon from the leg and moves it to replace the ruptured tendon.
  • Tendon lengthening (Z‐plasty lengthening): This surgery involves making a z‐shaped cut in the Achilles tendon and then stretching the tendon to the desired length and suturing it back together.
  • Joint Fusion (Talonavicular Fusion): This surgery involves reshaping the joint surfaces to correct the deformity. The joint is then fused together with screws, pins or staples. A bone graft taken from the tibia may be used with the screws.
  • Implant insertion: This surgery involves placing a small cylindrical plug just above the heel bone to correct the condition and relieve pain. Following flat foot surgery, your child will most likely have a short leg cast or removable walking boot for a few weeks.

Risks and Complications

As with any surgery, risks and complications can occur ranging from allergies to medicine to blood loss requiring transfusions.

The majority of patients suffer no complications following surgical correction of flat foot, however, complications can occur following foot surgery and include:

  • Infection
  • Nerve damage causing numbness to the skin over the toe area.
  • Inadequate correction of the deformity requiring further surgical intervention
  • Australian Orthopaedic Association
  • Royal Australasian College of Surgeons
  • The Children's Hospital at Westmead
  • University of New South Wales
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  • Australian Paediatric Orthopaedic Society – APOS
  • Sydney Children’s Hospitals Network  - SCHN
  • Australian Medical Association – AMA
  • Ramsay Health
  • The University of Notre Dame