In SoleScience’s clinical practice, our Pedorthists often see parents schedule an appointments for their children for gait assessments or custom orthotics for ‘preventative measures.’ But, as we all know, children’s bodies are perpetually growing, so is it really necessary for children to wear orthotic devices?
Primarily, parents’ concerns are due to a child’s flat feet (having no significant arch present), or that they are walking with a ‘toed in’ gait. Historically, the thought was that having flat feet was a precursor for injuries and joint pain later in life. However, with more research focusing on the flat foot—in particular children’s flat feet and their associated gait—the empirical evidence does not support this theory. What is important for clinicians at SoleScience is to educate parents and the medical community on what to expect as a child changes developmentally, and what warning signs are actually important to look for…not just a flat foot.
The Child’s Development
Children are most often born with flat feet due to their ligamentous flexibility and will often remain through their childhood years. Around the age of seven, an arch may be visible while in a rested position but will often diminish with standing.
1. Rested position, medial arch present.
2. Standing, medial arch diminished (1).
As strength increases through the foot, children will typically develop an arch structure. Research has shown in some cases that boys were more likely than girls to maintain a flat foot structure. Other contributing factors such as obesity and genetics can increase the likelihood of flat feet (even persisting into adulthood) (1). However, due to the limited amount of research in this area, as well as the lack of consensus on measuring the paediatric flat foot, clinicians will focus on the structure of the foot itself.
In practice, a foot care professional will determine if the child’s flat feet are flexible or have a more rigid structure, if there is pain associated with movements or activity, as well as abnormal biomechanics through their walking or running. In most cases, there is little concern for a child’s developing, flexible flat foot.
Current research dictates that treatment of a flexible, asymptomatic (pain free) paediatric flatfoot is not warranted, and little evidence exists to suggest that treatment may help arch development or decrease the likelihood of injury down the road (2).
Clinicians will often suggest monitoring the child’s foot development, activities and pain development. If any of these factors are to change, seeing a medical professional for an examination may be necessary.
In the development of pain, treatment may include:
* physiotherapy or kinesiology referral
* off-the-shelf orthotic device — as a child grows, an off-the-shelf is a more cost-effective option
* custom orthoses — if warranted and medically necessary
* off-the-shelf options — heel cups
* footwear education and recommendations
We at SoleScience are happy to work with people of all ages. If your child is experiencing foot pain or believe your child’s foot development should be monitored and analyzed don’t hesitate to make an appointment. Together we work with parents and other medical professionals to ensure your child can play, learn, and grow without foot issues. Click here to make an appointment or contact us with questions.
- Dare, DM. & Dodwell, ER. (2014). Pediatric flatfoot: Cause, epidemiology, assessment, and treatment. Curr Opin Pediatr, 26(1): 93-100.
Jane MacKenzie, A., Rome, K., Evans, A.M. (2012). The efficacy of nonsurgical interventions for paediatric flexible flat foot: A critical review. J Pediatric Orthop, 32: 830-834.