Childhood Flatfoot

Flexible flatfoot
Do your child's feet look flat when he or she is standing? Does an arch appear in the foot when your child sits or stands on tiptoes? Children are born with flexible flatfoot, a condition in which the arch of the foot shrinks or disappears when they stand on it. Parents and other family members often worry needlessly that an abnormally low or absent arch in a child's foot will lead to permanent deformities or disabilities. Most children eventually outgrow flexible flatfoot without any problems. This condition is usually painless, does not interfere with walking or sports participation, and corrects itself over time without surgery or other treatment.

To make the diagnosis, an examination of your child may be necessary to rule out other types of flatfeet that may require treatment. These could include flexible flatfoot with a tight heel cord, or rigid flatfoot, a more serious condition. It is important to know if anyone else in the family is flatfooted or if your child has a known neurological or muscular disease.

A flexible flatfoot has normal muscle function and good joint mobility and is considered normal. The shape of bones and lax ligaments in the foot prevent a strong arch between the toes and heel (longitudinal arch) on weight-bearing. As the child grows and walks on it, the foot's soft tissues tighten, shaping its arch gradually. Flexible flatfoot often continues until your child is at least age 5 or older. If flexible flatfoot continues into adolescence, your child may experience aching pain along the bottom of the foot.

Treatment for flexible flatfoot is required only if your child is experiencing symptoms from the condition. If your child has activity-related pain or tiredness in the foot/ankle or leg, the doctor may recommend stretching exercises to lengthen the heel cord. If discomfort continues, shoe inserts may be recommended. Sometimes physical therapy or casting if may be necessary. Occasionally, surgical treatment can help an adolescent with persistent pain. A small number of flexible flatfeet become rigid instead of correcting with growth. These cases may need further medical evaluation.
 

Tarsal coalition
A tarsal coalition is a congenital condition which most commonly manifests itself in adolescence but may also become problematic in adulthood. The underlying problem is a failure of complete separation of the tarsal bones (the bones of the hindfoot area). The most common types are the calcaneonavicular coalition and the subtalar coalition (the anatomic location of where the bones have failed to separate completely). The foot is usually flat and this flatfoot position will not correctly restore the normal arch of the foot when the foot is lifted off the ground because of the rigidity of the foot. The foot remains in a flat position at all times. Many patients may have this condition but will not have any pain. In some patients, however, the abnormal bone or tissue connecting these bones may begin to rub against each other irregularly, which most commonly occurs during the adolescent age as these tissues mature or after a traumatic injury to the foot disrupting the connections between these bones that the body had created.

Treatments involve immobilization to allow the two edges of the bone to again stabilize each other or if this treatment fails removing the coalition (surgically removing the bone connecting the involved bones). If arthritis between the joints is present and severe, then a fusion (gluing together) of the involved joints may be necessary. Many adults traditionally treated with fusions (gluing together of the bones) with this type of condition have had good outcomes utilizing new techniques removing the abnormal bone and maintaining the joints and evaluation by an orthopaedic specialist in foot and ankle conditions to be evaluated for this option should be considered.
 

Accessory navicular and posterior tibial tendon dysfunction
The navicular bone is a normal bone in the foot that is critical to the function of the foot. One of the main tendons of the foot, the posterior tibial tendon, inserts into this bone mainly and balances the foot by its pull in this area. An accessory navicular is a common “extra” bone in the foot in this region that may be part of the normal navicular bone as a large growth or may be another separate small bone adjacent to the normal navicular bone. This is commonly not painful for many patients but for some, irritation because of this extra prominence on the inside of the foot, pain due to the abnormal rubbing between the normal accessory navicular and accessory navicular bone, or weakness of the foot because of the abnormal function and insertion of the posterior tibial tendon may be present. For many patients, immobilization in a cast may cause resolution of symptoms. Orthotics may also be of benefit. For those with continued pain, surgical removal of the accessory navicular bone with reattachment of the posterior tibial tendon may be necessary.