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Flat foot is a common condition evaluated by medical professions even though it is, in fact, considered to be a variant of normal. The incidence of moderate-to-severe pediatric flat foot is only about 18 percent of the general population and the prevalence of flexible flat foot reduces with age. The long-term effect of flat feet in children across their lifespan is debated among medical professionals, but currently there is no sound evidence to suggest that there is any negative consequence in the long-term as a result of having painless flat feet as a child.
Flat feet are categorized into two types: flexible and rigid. Whereas flexible flat feet are a normal variant much less likely to develop problems, rigid flat feet typically have some underlying bone or joint problem that may require treatment.
As a quick screen to distinguish between flexible and rigid flat feet, you can assess the shape of a child’s arch in various positions. Flexible flat feet have a more visible arch when the child is sitting or lying down, without any weight on the feet, or when the child stand on their tip-toes, but the feet then flatten when they stand up. Rigid flat feet remain flat whether sitting or standing and do not move as easily from side to side.
Another important fact to consider is that infants are born with flat feet. It is normal for children to have flat feet when they are young as their arch height gradually increases until six to seven years of age. Commonly, a child’s arch height increases as he or she grows, gains strength and becomes skeletally mature. Research suggests overweight children are more prone to have flat feet. Flexible flat feet may be more prevalent in boys and among certain ethnic groups.
Most children with flexible flat feet are pain-free and no treatment is needed. Therefore, if your child is asymptomatic there should be no reason to worry. If your child develops other symptoms such as pain, muscle tightness, muscle weakness or trouble keeping up with peers in performing age-appropriate activities, you may want to consider consulting your pediatrician, pediatric orthopedic doctor or physical therapist for a full musculoskeletal evaluation to rule out other potential causes and treatment recommendations.
Dr. David M. Scher specializes in pediatric orthopedic surgery at Hospital for Special Surgery, with special interests in children’s foot deformities, children’s hip disorders and the musculoskeletal care of children with cerebral palsy. He sees patients at the HSS Outpatient Center in Paramus and the hospital’s Manhattan campus.
