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Your Child’s Arch

Do All Babies Have Flat Feet?

Before the age of three, most children's feet appear flat. There is a pad of fat in the instep that hides the arch which is between the heel and the ball of the foot. As children get older, and they start walking, running and jumping, the fat disappears and the arch becomes visible. The fat pad disappears at different ages so we should not diagnose a child as having a flat foot before the age of three. It is important to note that children tend to have looser joints throughout their bodies, but as they get older, those joints eventually tighten up. That usually happens around the time that an arch appears in the foot.

When we look at children's feet, we must first determine if they inherited a high or a low arch. This is critical because it will determine future treatment, shoes, exercises, and even in what sports the child may excel.  The arch height is determined before birth so there does not seem to be any way of predicting this.  Anecdotally, I have found that the grandmother's foot is often a good predictor of the child's arch and muscle type.

A common and universal finding--- ligaments have not developed their strength until after three years of age. Consequently, it is essential to help support the young soft and weak ligaments. Encouraging children to run barefoot through the grass also helps develop balance and muscle/ligament strength so I highly recommend this. 

The first and most important information for all parents and grandparents, aunts, uncle and friends is: Like the color of our eyes, flat feet or high arch feet are not good or bad.  They are what we have inherited.  It is the responsibility of the healthcare provider to try to predict if and when interventive treatment is necessary.

What is Pronation?

Pronation is the movement of the ankle bone (talus) on the heel bone (calcaneus). If it moves too much, then we refer to this as pathological pronation.  If it doesn't move enough, then we call this pathological supination.  All feet must pronate and supinate in order for the foot to work correctly.

Flat Feet: Flat feet have a tendency to run in families, and they are also associated with other conditions in which muscles are lax throughout the entire body.

Flat feet are divided into two categories: rigid or flexible. In the flexible flat foot, the arch can be seen when the foot is not bearing any weight, or while walking on the toes. But as soon as weight is distributed across the foot, the arch falls and is flat to the surface. In a rigid flat foot, the arch is never visible.

Congenital Rigid Flat Feet may be the result of who the baby's grandparents are. We inherit much of who we are from our genetic mapping. Other causes might be abnormal foot development associated with conditions such as cerebral palsy, rheumatoid arthritis, Down's syndrome or the lack of certain ligaments and/or bones that are considered to be genetic or from fetal birth development problems. In some cases, flaring of the heels may be visible at birth, and the foot may be very rigid. The child does not usually have pain with this condition until around the age of 10 when the rigid flat foot may cause foot pain during activities.

Flexible Flat Feet may be caused by several conditions, but the most common is a genetic predisposition. The child with a flexible flat foot usually has lax ligaments in other parts of the body as well. A person may also develop a flat foot later in life due to some severe trauma or due to ruptured tendons/ligaments in the foot. In most conditions of flexible flat foot, the child's heel will roll out, causing the foot to be in a pronated position. The degree of pronation may vary from the left foot to the right foot. When an imbalance exists in the amount of pronation or flat footedness from left to right, it may cause other biomechanical conditions to occur in the child's ankles, knees, hips, sacroiliac joints, and lower back.

Treatment for Rigid and Flexible Flat Feet usually does not require surgery; for most children, wearing a good shoe and having a custom made flexible orthotic is one of the best methods of treatment. When the arch has the proper support, it will withstand the stress of prolonged standing and walking. Orthotics are not designed to completely correct the flat foot. They are designed to support the feet equally on both sides to relieve tension and equalize any biomechanical imbalances that may be occurring. Ligament laxity causes the foot to pronate and appear flat, which may be distorting the child's foundation for the rest of the body. Many times, a proper orthotic will extend the life of shoes worn by a child who seems to go through footwear extremely fast because of a foot problem.

High Arch Feet: An equal problem that has the same beginnings as the flat foot is the unstable high arch foot. The children never seem to stand straight and their shoulders are always slumped over. They tend to be toe-walkers' and love to wear their mother's heels. The reason for this seems to be their inherited tight heel cords. Exercise does not help their posture, but special exercises geared to strengthen the back muscles along with orthotics that compensate for the inherited short heel cords are essential. These children tend to be very fast runners but tire easily.    It is interesting to note that these children tend to have knee pain and may even develop scoliosis.

A commonly asked question:  When should I seek professional advice?

Answer:  Whenever you as a parent have a concern.

The second most common problem for the parent is when the pediatrician says that the child will outgrow the problem. This maybe true, but do you want to take the chance that your child won't?

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