Flat feet (fallen arches) is a condition in which the arch of the foot has dropped and the sole rests almost completely on the ground. In children up to about the age of 6, flat feet are normal: the arch forms gradually as they grow. If the foot is flexible, meaning the arch appears when the child stands on tiptoe, it usually doesn’t hurt and doesn’t need treatment. In adults, flat feet may be left over from childhood or may appear with the years, after an injury or with excess weight.
Symptoms
- The whole sole rests on the ground and the arch is barely visible.
- The heel tilts inwards when the child stands.
- Tiredness and pain in the feet or calves after walking.
- Shoes wear out more on the inner side.
- In adults: pain on the inner side of the ankle and foot.
Most children with flexible flat feet have no complaints and run and play like their friends. With rigid flat feet, the arch doesn’t appear even on tiptoe, and the foot moves less. It is also worth paying attention when a child tires quickly, asks to be carried or complains of leg pain after a walk.
Why it happens
- It is natural in young children, before the arch has formed.
- Loose joints and ligaments, often running in the family.
- Weak muscles in the foot and lower leg.
- Being overweight.
- In adults: a weakened tendon that holds up the arch, an injury or arthritis.
In adults, flat feet that appear with the years are often linked to the tendon that runs behind the inner ankle. When it weakens, the arch gradually drops and the inner side of the ankle hurts.
How we treat it
Kaloyan watches how the child stands, walks and rises onto tiptoe, and checks whether the foot is flexible or rigid. He also checks the knees, pelvis and posture, because flat feet often come with other differences. If there are complaints, treatment is corrective exercises: exercises for the muscles of the foot and lower leg, for balance and for putting the foot down correctly. With children, Kaloyan works through games to keep it interesting, and parents get a short programme for home. With older children he explains why the exercises are done, so they can do them on their own.
There are usually 1–2 sessions every 2 weeks for a few months. For adults, the exercises focus on the pain and on how well the foot copes with walking and standing. If there is pain or the flat feet are rigid, Kaloyan will also refer you to an orthopaedic doctor, who decides on insoles. Insoles support the foot and exercises make it stronger, so the two often go together. With children, Kaloyan checks the feet again after a few months, because the arch changes as they grow.
What you can do yourself
- Let your child walk barefoot on grass, sand and uneven ground.
- Choose shoes with a firm heel and a flexible sole, in the right size.
- Encourage active play: climbing, jumping, cycling.
- Don’t put your child in another child’s worn shoes: they have already been shaped to someone else’s foot.
- Keep an eye on your child’s arch and take them for regular check-ups with a specialist, even when it doesn’t hurt.
- For adults: wear shoes with good support, especially if you stand for long periods.
- For adults: watch your weight, because it loads the arch.
When to see a doctor first
See an orthopaedic doctor first if:
- the foot is rigid and the arch doesn’t appear when the child stands on tiptoe;
- the child has pain, limps or often trips;
- the flat foot is on one side only;
- in an adult, the arch is dropping quickly, with pain and swelling on the inner side of the ankle.
