Flatfoot

Flatfoot (pes planus) is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out. One foot or both feet may be affected.

Children as well as adults may be flat-footed. Most children are flat-footed until they are between the ages of 3 and 5 when their longitudinal arch develops normally.

People who have flat feet rarely have symptoms or problems. Some people may have pain because of:

• Changes in work environment.
• Minor injury.
• Sudden weight gain.
• Excessive standing, walking, jumping, or running.
• Poorly fitted footwear.

Children sometimes have foot discomfort and leg aches associated with flat-footedness.

Your doctor will ask questions about your health and do a physical exam. They will look at your feet and may assess how you stand or walk. Imaging tests such as X-rays may be done.

Treatment in adults most often includes wearing spacious, comfortable shoes with good arch support. Your doctor may recommend padding for the heel (heel cup) or orthotic shoe devices. Orthotics are molded pieces of rubber, leather, metal, plastic, or other synthetic material that are inserted into a shoe. They balance the foot in a neutral position and cushion the foot from extra pounding.

For children, treatment using corrective shoes or inserts is rarely needed, as the arch usually develops normally by age 5.

Surgery is rarely needed.

You may be able to relieve heel pain by:

• Stretching tight calf muscles. For example, try standing calf stretches that are done against a wall.
• Doing foot-strengthening exercises with a towel and weights. Towel scrunches are one example.
• Doing foot-stretching exercises with a towel. For example, try seated calf stretches.

Some people may choose more intensive strengthening and flexibility programs. This may include competitive athletes, people who want to return to a heavy sports program, or people who are highly motivated. A physical therapist or trainer can help supervise a program recommended by your sports medicine specialist or a foot specialist, such as an orthopedist or podiatrist.

Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), heat, or massage may help with foot pain and leg discomfort. If flatfoot is related to another condition, surgery or other treatment may be needed.

• Have your child wear shoes with good arch support and lots of room in the toes.
• Put heel padding (called a heel cup) or inserts (called orthotics) in your child's shoes. Orthotics are molded pieces of rubber, leather, or other material that can help cushion and balance your child's feet.
• Try these exercises to stretch your child's feet and make them stronger, if your doctor says it is okay.
  • Stretch the calf muscles: Have your child stand about 1 foot from a wall and place the palms of both hands against the wall at chest level. Have your child step back with one foot. That leg should be straight at the knee, with both feet flat on the floor. Your child's feet should point at the wall or slightly toward the center of their body. Have your child bend the front leg at the knee and press the wall with both hands until they feel a gentle stretch in the back leg. Have your child hold this for at least 15 seconds, increasing to 30 seconds over time. Then have your child switch legs and repeat. Have your child do this 2 to 4 times a day.
  • Stretch the feet: Have your child sit on the floor or a mat with both legs stretched out in front of their body. Roll up a towel lengthwise, and loop it around the ball of one foot. Have your child hold one end of the towel in each hand and gently pull the towel toward their body. Have your child hold this for at least 15 to 30 seconds. Repeat with the other foot. Have your child do this 2 to 4 times a day.
  • Make the feet stronger: Place a towel on the floor. Have your child sit in a chair in front of the towel with both feet flat on the towel at one end. Your child should grip the towel with the toes of one foot while keeping the heel of that foot on the floor. (Your child should use the other foot to anchor the towel). Have your child curl their toes to pull the towel closer. Repeat with the other foot. Have your child do this 2 to 4 times a day.
• Give anti-inflammatory medicines such as ibuprofen (Advil, Motrin) if your child's feet or legs hurt. Be safe with medicines. Read and follow all instructions on the label.
• Try heat or massage on the area that is causing your child pain. Use a warm cloth or hot water bottle. Keep a cloth between the hot water bottle and your child's skin.