Kids who have flat feet at an early age have a difficult problem and life.  Usually the biomechanics are messed up.  This can cause problems in their hips and knees and sometimes their back.

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Children with flat feet generally become sedentary and choose activities that don’t require prolonged weightbearing or running.  I guess you could say that most of these kids end  up as couch potatoes.  This frequently leads to obesity that makes  the problem worse.   But it’s not their fault.  If the child is born with poor biomechanics and flatfeet, they generally DO NOT generally complain of pain.  They just grow up with it and so they think it is normal.  They usually complain of being just “being tired” after a short period of walking or standing.    This can adversely affect their social status and self-esteem.  Sometimes they become the subject of bullying because they walk or run funny and they have trouble keeping up with their peers.

Generally speaking there are two types of flat feet in children. Rigid and flexible. They are not the same type of flat foot. Rigid flat feet NEVER respond to arch supports. Flexible flat feet ALMOST NEVER respond to arch supports.

That being said some type of support is a reasonable first step. Over the counter supports are much less expensive and can help some kids with minimal, easily reducible flat feet. Custom supports are more expensive and can help more severe deformities.

The advantage of any supports is that it can be done quickly and easily and really doesn’t cause any problems.

The disadvantage is that they really never really CORRECT the problem they just temporarily support the foot in a better position, maybe. Long term studies show that they cause no significant improvement in  the arch height. In February of 2020 a review of the literature article published in Foot Ankle Surgery exploring the effectiveness of orthotics or arch supports concluded that: “There is no strong evidence that the long-term use of orthoses improved the structural problem of pediatric flexible flat foot .”

Orthotics DO NOT improve the structure of a flat foot. Most other clinics will recommend some type of arch support or orthotic as a primary treatment for flat feet. Oftentimes, a simple over-the-counter arch support can be helpful to some degree. There is nothing wrong with that treatment.  However, these treatments do not affect the long-term outcome of flat feet. The feet will remain flat and generally do not heal into a corrected position. Unfortunately, that is where the treatment offered ends in most clinics. The patients is stuck with feet that continue to be flat and painful with supports that limit the shoes they can wear.  

The European Journal of Physical and Rehabilitation Medicine published a review article in 2011. This article reviewed 146 articles reviewing thousands of patients on the efficacy of different treatments for flat feet. The title was:  A Review of the Evidence for Nonsurgical Interventions for Flexible Pediatric Flatfeet. The article found that NO evidence indicates that orthopedic footwear or foot orthosis improve the radiographic parameters in children with flexible flat feet.  In other words it makes little difference if you wear orthotics or arch supports or not. The studies which evaluated the effective interventions on radiographic parameters over time found no significant difference between those who used arch supports or orthotics and those who didn’t. The foot essentially remains the same.  

Not every child needs surgery. Often only minor changes in shoe gear can help. But in our experience more children need surgery than are offered it. Often we see children who have struggled for years with flat feet with promises of “you will outgrow it” or “just wear these supports or orthotics” with no discernible improvement.

No one wants to have surgery and many parents are really hesitant to consider surgical correction for their children. But the child will need their feet for a LONG time. Not fixing the problem is not a great option either. Foot, Knee, Hip and Back problems all can come from chronic poor biomechanics of the foot.  

There are many different surgeries that are used to correct flat feet. These surgeries vary a great deal depending on the severity, flexibility and type of flat foot. Some surgeries have very short recoveries of just a couple of weeks and others require 6 weeks of no weight on the foot. 

See below to learn more about our minimally invasive treatments for flat feet in children.

The huge advantage of surgery is that it changes everything about how the foot works. Frequently the child is able to more easily participate in sports and games. Trips to places like Fiesta Texas become a pleasure instead of a struggle. With the new way the foot functions there is less likelihood of arthritis in the knees and hips later in life.

We have seen many patients who have worn supports for years with limited results who undergo surgery and regret they did not do it sooner. Frequently we will see a young person who has had flat feet for years. They frequently already have bunions, are overweight, won’t play outside very much and struggle socially as a result of their flat feet. Often they have tried arch supports or orthotics with no benefit. They have had difficulty in sports and going to the mall.

The disadvantage of surgery is that it carries risks of failed procedure, recurrence of deformity, over correction, chronic pain, infection, or numbness by the surgery site. These are rare but do happen from time to time. Usually most of these resolve with patience and appropriate treatment.   

Every week in our clinic we have a patient come in as an adult who has had flat feet since childhood. They usually have seen well intentioned doctors who have provided arch supports or orthotics.

As adults they are miserable.

They have arthritis in their feet and knees. They cannot be on their feet for long periods. Exercise is usually out of the question. It is hard for them to play with their children or go places with their families because of the pain in their feet and ankles.

Fixing the feet as an adult is often much more difficult and requires more recovery time. Frequently this is not possible because of financial concerns and being off work once the patient reaches adulthood and its associated responsibilities.