Flat Foot and Orthotics Treatment

Flat foot is a common condition treated by physical therapists in the pediatric field.

There are two types of flat feet: rigid and flexible flatfoot. A flexible flat foot appears when a child stands; otherwise, the arch is intact. Rigid flatfoot is a much more serious condition with no arches in the foot, regardless of whether the child is sitting or standing.

Many children have flat feet, but unless the condition is painful or affecting their quality of life, it isn’t harmful and is often outgrown by the age of five or six. In most cases, flat feet don’t require treatment unless they are causing pain or affecting mobility or alignment. In some cases, the child does not outgrow the condition, but it is often not harmful.

Causes

Many things can cause flat feet. It can be hereditary, caused by injury, or naturally developed over time due to other conditions like arthritis or obesity. However, in young children, this is pretty common as the arches of the foot develop over time as the muscle and tissues develop.   

However, it is essential to determine the cause of the flat foot, as some conditions are less severe than others, such as a tight Achilles tendon or a rigid flatfoot. In addition, some studies say that weak muscles can cause flat feet.

Common Treatments

Due to the causes behind flat feet, the most effective treatments include muscle strengthening exercises, stretches, orthotics, and corrective footwear. For example, flat feet caused by a tight Achilles tendon might respond better to more conservative treatments such as stretches and strengthening exercises. On the other hand, rigid flatfoot or a collapsed arch due to injury will require something more drastic such as corrective footwear or orthotics.

Are Orthotics Effective?

Orthotics is the standard treatment for more severe cases of flat feet that affect the child’s mobility and alignment. There isn’t one best course of action for treating flatfoot, but orthotics and strengthening exercises and stretches are commonly recommended.

Studies on the efficacy of orthotics for treating flat feet are not extensive. However, it is still a positive treatment method for more severe cases, even if some studies claim that treatment has no significant positive effects.¹

If orthotics are the recommended treatment, it’s essential to identify what the child would benefit from most. One study found that there was “low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes and CFOs versus PFOs on pain, function, and HRQoL is uncertain.”² In this case, FOs mean foot orthoses, CFOs refer to customized FOs, and PFOs are prefabricated FOs. The cost of all these vary significantly, so if the family cannot afford custom orthotics, prefabricated orthotics or therapeutic footwear can likely be a more viable option, especially if the treatment is not covered or minimally covered by insurance.

The effectiveness of orthotics also depends on whether the child will wear the orthotics. If a child is resistant to the point of refusal, especially in older children, where it is unreasonable to expect the child to wear the orthotic, then a different course of treatment would be more effective.

• In-Text Citation

  1. Ueki et al., 10.

  2. Evans et al., 2.

• Sources

  “Children’s Flat Feet (Pediatric Flat Feet),” Pediatric Foot & Ankle, accessed 14 September 2022, https://pediatricfootankle.com/foot-conditions/pediatric-flat-feet/.

  Evans, Angela M., Keith Rome, Matthew Carroll, and Fiona Hawke, “Foot Orthoses for Treating Paediatric Flat Feet,” Cochrane Database of Systematic Reviews. No. 1 (2022): 1-3, DOI: 10.1002/14651858.CD006311.pub4, https://discovery-ebsco-com.ezproxy.uakron.edu:2443/linkprocessor/plink?id=8f70d2fc-af43-36bf-99ef-582172d82642.

  “Flexible Flatfoot in Children,” OrthoInfo, accessed 14 September 2022, https://orthoinfo.aaos.org/en/diseases--conditions/flexible-flatfoot-in-children.

  Ueki, Yoshino, Eisuke Sakuma, and Ikuo Wada, “Pathology and Management of Flexible Flat Foot in Children,” Journal of Orthopaedic Science. 24, no. 1 (2019): 9–13. https://discovery-ebsco-com.ezproxy.uakron.edu:2443/linkprocessor/plink?id=92b9633c-53de-380f-9ca3-6291b36f793f.