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Developmental Flatfoot in Children By Robert H. Sheinberg, DPM
D
evelopmental flatfoot is one of the most com-
mon conditions affecting the musculoskeletal system of children and teenagers. There is a tendency for the child’s flatfoot to be ignored or treated with benign neglect. The facts are that it is NOT normal, the majority of children do NOT outgrow it, and there IS cause for some concern.
CAUSES
▸▸ Ligaments in the arch which connect the bones together are loose, allowing the arch to collapse. ▸▸ Congenital bone abnormalities. ▸▸ Trauma to the tendons and ligaments in the inner arch. ▸▸ Tightness in the calf muscles, which aggravates the foot deformity.
SYMPTOMS
▸▸ Young children may constantly prefer to be carried by a parent or be put in a stroller due to fatigue in their legs. ▸▸ Leg pain, especially at night. ▸▸ Premature fatigue with activity, especially in young children or teenagers. ▸▸ Inner leg, ankle and foot pain with activity. ▸▸ Occasionally associated with inner knee pain and lower back pain.
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▸▸ Lowering or complete collapse of the arch. ▸▸ Front part of the foot is turned out relative to the back part of the foot and the arch bulges towards the inside of the ankle. ▸▸ Knock-Knees. ▸▸ The feet, ankles, and legs just do not appear right upon examination when the patient is standing. ▸▸ A child that is overweight and lacks athletic ability. ▸▸ General inactivity or avoidance of activity in children. ▸▸ Abnormal shoe wear. ▸▸ The child or teenager does not run correctly.
TREATMENT
▸▸ Complete physical examination of the lower extremity and spine to find the underlying cause. This includes examining the child’s gait (walking pattern). ▸▸ Physical therapy to strengthen weak muscles and loosen tight muscles and help to improve overall coordination. ▸▸ Occasionally immobilization of the extremity to loosen up tight muscles. ▸▸ Custom molded shoe insoles (orthotics) to help permanently support the foot and put it in its proper position. In most cases this will overnight correct fatigue and leg pain that the child experiences. It will also help to allow better performance in activities of daily living or sports. ▸▸ In some cases when conservative treatment fails, surgery can be done to help with the problem. Most often very simple procedures can be performed to give the child or teenager an arch, allowing them to walk, stand and run correctly and efficiently.
Robert Sheinberg, DPM, is a Board Certified Foot and Ankle Surgeon, Fellow American College of Foot and Ankle Surgeons, Diplomat American Board of Podiatric Surgery. He is a partner in Foot, Ankle and Leg Specialists of South Florida and specializes in treating infants, children, teens and adults. His partners are Dr. Al DeSimone, Dr. Fernando Moya, Dr. Alexander Bertot, Dr. Mark Fishman, Dr. Carlo Messina, Dr. David Shenassa, and Dr. Nathan Vela. The South Florida Institute of Sports Medicine in located in Weston at 1600 Town Center Blvd., Suite C, (954) 389-5900, and in Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901.
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