Podiatrist discusses flat feet in children

Children’s feet come in a variety of shapes, from high arch to extremely flat. A small percentage of children have feet so flat that they have symptoms either of pain, tripping and falling more frequently than their peers or a dislike for extended physical activities such as running and soccer.

Treatment for flat feet in children, even for those who have symptoms, is not always provided. Some pediatricians and orthopedic surgeons will tell parents that flat feet are normal and that the child will grow out of the problem. The Seattle Shriner’s Orthopedic website declares that “flat feet in children never need treatment.” Most podiatrists respectfully disagree.

Some children improve with age and their pain or symptoms get better and some do not. In addition, many adults have a myriad of foot problems that can be traced to their lifelong flat feet. Would they have benefited from treatment of their flat feet from childhood? I believe the answer is yes.

The first level of treatment is the use of a good supportive shoe: either a high top, straight laced shoe for early walkers or an athletic shoe for older children. The shoes should be fitted by an expert and they need to be changed regularly as the foot grows. If the shoe by itself does not provide sufficient support, then an in-shoe orthotic should be considered.

While an over-the-counter aid can help the mild flat foot, the children I am talking about need a more custom device. An inshoe orthotic can actually benefit any child with flat feet and will never cause harm. Worn from an early enough age, the shoes might actually help the adult position of the foot the same way orthodontia helps the adult position of the teeth or scoliosis braces help the adult position of the back. Nearly all podiatrists and some orthopedists can provide children with appropriate custom orthotics.

Some children with painful flat feet are not helped enough by in-shoe orthotics or they participate in activities that do not use shoes that accommodate orthotics like ballet, gymnastics or martial arts.

For these children there is a small “jelly-bean” shaped motion restrictor “plug” that can be slipped into the foot using a halfinch incision. Installation of this little device takes 15 minutes and does not require that any bone be cut or shaved. It sits between two bones that normally slide past each other as the foot flattens. Reducing this sliding motion reduces the flattening of the foot. Depending on the size of the device, podiatrists can reduce flattening a little or a lot.

This little device is basically an internal orthotic. Since it requires no bone changes to put in, it can easily be removed, if necessary, with no permanent changes in the foot. If the device is left in during the developing and maturing years, the foot will mature in a more correct position.

This procedure is not new. I was first exposed to it during my residency 20 years ago when I worked with an early developer of this device. At that time, a hole had to be made in a rear foot bone and the device had to be cemented in.

That is no longer the case, as the newer devices just slip into the rear foot joint and soft tissues are sutured over the top. The procedure, called arthroereises, is nearly unheard of in the orthopedic community and is somewhat better known in the podiatric world.

It is a quite common procedure in the Northwest where my associate, Dr. Darren Payne, did his residency. He was thoroughly trained in this procedure and knows its strengths and weaknesses well.

I believe our office is the only one in the Conejo Valley that does the procedure, which is described on our website under “Children’s Flat Feet.” Also on our website parents will find links to several journal articles discussing this procedure to give them and their child’s pediatrician more information.

Michael Zapf and Daren Payne are podiatrists in private practice with offices in Agoura Hills and Thousand Oaks. For more information call their office at (818) 707-3668 or (805) 4976979 or visit their website at www.conejofeet.com.

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