Pes planus, medically known as flat feet, is an orthopedic problem frequently encountered in childhood. The foot has two distinct arches, transverse and longitudinal, that provide support to the foot's structure. These arches create a balanced structure, giving the foot its arched shape. The most important of these is the "medial longitudinal arch," formed by specialized structures such as foot bones and tendons and located between the heel and the first three toes.

Flat feet occur when this medial longitudinal arch collapses under pressure, causing the feet to flatten. People with flat feet have a flat appearance when viewed from the outside, with no obvious arches. Babies' feet are normally flat from birth because the arches of the feet are formed during childhood. However, if these arches do not develop properly during childhood or collapse later in life for any reason, children can develop flat feet.

Causes of flat feet in children

Flat feet in children can generally occur in two different types. The first type is called flexible flat feet. In this case, the child's foot may appear arched or cupped when sitting. However, when the child stands, the foot appears normal. Another type of flat feet is characterized by the child's foot appearing flat both when sitting and standing.

While the exact causes of flat feet in children are unknown, some research suggests that genetic factors play a role. Additionally, certain problems with the Achilles tendon and muscles can also cause flat feet. The Achilles tendon is an anatomical structure that connects the calf muscle to the heel bone.

Flat feet may not usually cause any symptoms, but the most obvious symptom is a flat foot with no arch. Some children may also experience pain, particularly in the feet, ankles, knees, hips, or calves. Children with this condition may tire more easily when walking.

Flat feet are a significant problem in childhood because feet are still developing. Therefore, if appropriate measures are not taken, flat feet can worsen and affect a child's quality of life. In this case, it's important to consult a specialist to receive appropriate treatment and exercise recommendations.

Approaches to flat feet in children

Treatment for flat feet in children can vary depending on the patient's age and the type of flat feet. Flexible flat feet, in particular, often require no treatment unless the child is experiencing severe pain. Therefore, treatment is determined by the following factors:

• Age Factor: Children's arches usually continue to develop until age 10 or 11. Therefore, surgical treatment for flat feet is generally not recommended in children without serious problems.
• Exercises: Achilles tendon problems can be a cause of flat feet. Therefore, treatment can begin with exercises that stretch the Achilles tendon, such as toe walking. These exercises can help support the child's foot structure.
• Orthotics (Arch supports): If a child has pain in the foot or leg, a specialist doctor may recommend arch supports or orthotic devices that can be adjusted appropriately to support the foot.
• Orthopedic shoes: During childhood, specially designed shoes that support the foot structure may be preferred.
• Physical therapy: Physical therapy administered by a physical therapist who is an expert in the field can help relieve the child's pain.
• Sports selection: If children have flat feet, they may be advised to do less strenuous sports, such as walking, instead of heavy sports.
• Weight management: Overweight children can put more pressure on their feet, which can increase pain. Therefore, weight management is important, and losing weight can help alleviate a child's pain.

Treatment for flat feet primarily aims to alleviate pain, and surgery is rarely necessary. However, for children experiencing uncontrolled or severe pain, surgical procedures may be considered upon doctor's recommendation. These surgical procedures aim to correct Achilles tendon shortening, anatomical issues, or bone problems. Such surgical interventions must be carefully planned and performed by a qualified surgeon.

Flat feet in children: A normal developmental condition?

Flat feet are generally considered normal in infancy and are not considered a childhood condition. As children age, their foot bones complete their development, and the archless appearance of the foot largely disappears. However, flat feet are not a problem unique to children.

Flat feet can be divided into two main subclasses: congenital flat feet and acquired flat feet.

• Congenital flat feet: This type of flat feet usually begins in infancy and corrects itself as the child ages. Congenital flat feet usually improve as the foot bones complete their development.
• Acquired flat feet: This type of flat feet can develop later in life. Factors such as obesity can lead to acquired flat feet because they place excessive pressure on the foot.

Therefore, flat feet is a condition that can appear at different stages of life and is not considered solely a childhood disease. Acquired flat feet, which can appear later in life, can be a problem that requires treatment, especially if pain or functional difficulties occur. Therefore, it is important to closely monitor flat feet and consult a specialist when necessary.

Which shoes should people with flat feet choose?

The issue of shoe choice for people with flat feet was previously well-known due to the widespread belief that orthopedic shoes would correct flat feet. However, recent research suggests that shoe selection is not as crucial in treating flat feet. Flat feet, especially in children, generally do not require treatment.

However, flat feet can cause problems such as pain and difficulty walking in both children and adults. In this case, careful shoe selection can help alleviate pain and allow for more comfortable movement. Here are some suggestions for people with flat feet to consider when choosing shoes:

• Cushioning and support: The insoles of shoes should provide adequate cushioning and support. This can help distribute weight evenly across the ball of the foot.
• Comfort: Shoes should feel comfortable and not cause any discomfort such as pinching or rubbing.
• Shoe insoles: For adults in particular, shoe insoles can be used to provide extra support inside the shoe. These insoles can support the arch and reduce pain.
• Proper size: Shoes should match your foot size and width. Shoes that are too tight or too wide can cause foot problems.
• Shoe selection: When choosing shoes, consider your daily activities and needs. For example, for sports, specialized athletic shoes may be a better option.
• Consult a doctor: Especially in cases of severe pain or discomfort, it is important to consult a doctor and get recommendations appropriate for your foot structure.

In conclusion, shoe selection alone may not be a solution for treating flat feet, but comfortable and supportive shoes can help people with flat feet with their pain and discomfort.

Can flat feet in children be corrected with exercises?

Flat feet in children can occur due to factors such as shortened Achilles tendons. Experts suggest that Achilles stretching exercises can alleviate symptoms associated with flat feet. These exercises include walking on tiptoe, walking on heels, using the insides and sides of the feet, dance forms like ballet, rolling a ball underfoot, and walking without shoes on various surfaces.

These types of Achilles tendon stretching exercises can also help strengthen the muscles in the sole of the foot. However, it's important to perform these exercises under the supervision of a qualified physical therapist. Improperly performed exercises or excessively strenuous movements can lead to injury. Therefore, it's important to consult a healthcare professional before beginning exercises for flat feet in children. A qualified physical therapist can assess the child's condition, determine an appropriate exercise program, and ensure they are performed correctly. Exercises can alleviate the symptoms of flat feet and help support the foot structure, but any treatment plan is best guided by a professional.

Activities that children with flat feet should pay attention to

Children with flat feet may tire more easily than other children and should be more careful with their feet. Therefore, children with flat feet are advised to avoid or exercise caution in the following activities:

• Jumping and running on hard surfaces: Running on hard surfaces and frequent jumping can put excessive pressure on the soles of your feet. These activities can increase the pain associated with flat feet.
• Standing for long periods: Children with flat feet should avoid standing for long periods. If they must stand for long periods, they should take breaks at intervals.
• High-impact sports: High-impact sports can put too much stress on children's feet with flat feet. It's best to opt for less challenging sports instead.

Activities that are more suitable for children with flat feet may include:

• Dancing on tiptoe: Dancing on tiptoe can strengthen the muscles in the soles of the feet and support the foot structure.
• Walking: For children with flat feet, regular walking can help strengthen foot muscles.
• Swimming: Swimming is a low-impact activity that doesn't put much pressure on the feet, making it a suitable option for children with flat feet.

Consequently, it's important for children with flat feet to pay attention to their foot health and avoid overly strenuous activities. It's also important to consult a healthcare professional if you experience any severe pain or discomfort.

How is flat feet diagnosed?

A series of physical examinations and imaging tests are used to diagnose flat feet. More detailed information on how flat feet are diagnosed is provided below:

• Physical Examination: A qualified physician will perform a physical examination to examine the patient's feet. The arches will be assessed by checking for elevation in the center of the sole.
• Patient history: The doctor will listen to the patient's complaints and history of flat feet. They will also consider family history and any previous treatment.
• Gait examination: The doctor may ask the patient to walk in specific positions. This gait examination is important to evaluate how the feet and legs are positioned.
• Imaging methods: Imaging methods such as X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) may be used to diagnose flat feet. These methods help examine the foot bones and joints in more detail.
• Computerized foot analysis: In some cases, computerized foot analysis may be used to analyze foot structure in more detail. This analysis measures factors such as foot strike, arch height, and foot movement.

Flat feet can be a common condition, especially in children, and is generally not cause for concern. However, if severe pain, discomfort, or functional difficulties persist, it is important to consult a healthcare professional and receive appropriate diagnosis and treatment.