The sole of the foot is flat along the base of the toes, around the outer side, and all the way back to the heel. The inner side has a slight C-shaped curve, and it rises up above the rest of the sole to form an arch. This is called the medial arch. It is most noticeable when standing, because this is the part of the foot that doesn’t touch the ground.
Absence of an arch causes the foot to roll in toward the midline of the body. In medical terms, this is called pes planus. More commonly, it is known as flat feet.
Various muscles and ligaments combine to make the arch, but the process takes time. This is why infants and even many toddlers have flat feet with no or minimal arches. With time, the muscles strengthen and the ligaments, especially at the ankle, tighten up and do a better job of holding the foot in place. The medial arch appears around two years of age, but it won’t look like an adult arch until about kindergarten age.
The arch is easily obscured by excess fat. Fat pads are normal in infant and toddler feet. Sometimes the fat collects underneath the arch, making the arch appear smaller. Flat-footedness is exaggerated when a child stands, because the fat obscures the usual space between the floor and the bottom of the arch. However, when a child dangles her feet while sitting in a chair, the arch is more noticeable.
So feet can appear flat because of minimal arches or because of weak ankles that allow the foot to roll inward. Either problem usually resolves on its own with time. And it is uncommon for flat feet, whether temporary or permanent, to cause significant difficulties with walking.
What can I do?
You really don’t need to do a thing if your toddler has flat feet, unless she is complaining of pain. You can let her run around barefoot at home, and you need only insist that she wear shoes when she is outside, in order to protect the feet from potential injury by contact with glass shards or nails, for example. Shoes do not “treat” flat feet. But to make your child more comfortable, choose shoes with good arch support.
When does my doctor need to be involved? Let your doctor know if your child complains of pain. Most often pain associated with flat feet is in the feet, ankles, or knees. Also tell your doctor if your child is having difficulty running or walking because of the positioning of her feet.
What tests need to be done, and what do the results mean? Flat feet do not require any specific tests. Simply by watching your child walk, your doctor can usually determine the extent of the problem.
What are the treatments?
Toddlers rarely need to be treated for flat feet. However, when the problem is severe enough that it causes pain or difficulty walking, orthotics may be necessary. Orthotics are special soles that can be put inside regular shoes. They provide extra support for the arches, helping to position the feet during walking and running. Although orthotics can be very helpful, they can also be quite costly because children outgrow them rapidly.
Years ago, children were routinely fitted with special shoes and sometimes even braces for foot problems. Parents who used these devices in childhood often worry that their children will need them, too. It is important to remember that the approach to foot problems in young children has changed dramatically over the past few decades. Braces and special shoes generally are not prescribed these days because flat-footedness is often considered short-term and benign.
What are the possible complications?
The main complication of flat feet is pain. The pain comes from a shift in the distribution of body weight. The foot is designed to support the weight of the body in very specific ways. When the positioning of the foot changes, so does the weight-bearing responsibility in the foot and subsequently in the ankle and knee. When parts of the body that are not designed to bear certain types of weight suddenly have that responsibility, significant pain can result.
In some cases of flat feet, the toes or heels may rub against your child’s shoes, causing blisters or calluses.