Flat feet in children due to hypermobility or joint laxity

Treating flat feet in children

Children’s flat feet are often treated by the NHS orthotic services, but sometimes access to these services can prove difficult either because of referrer’s not recognising the issues, long NHS waiting lists, or financial restraints, meaning some NHS Trust’s are not even offering this service.

Of course, on top of all this, the Coronavirus pandemic has completely closed down orthotic services across the country.

Hopefully they will open soon, but the waiting lists are going to be long and all the time children are growing.

What are the condition and reasons for using orthotic insoles?

Let us look at the condition and the reason for using orthotic insoles.

Flat feet due to hypermobility

When we first stand as infants we all have flat feet. This is perfectly natural and is because our muscles and ligaments aren’t strong enough to support the foot structure and so the feet roll inwards, ‘pronated’, giving the appearance of ‘flat feet’.

They are not really flat feet and should really be described as ‘pseudo pes planus’ or ‘pretend flat feet’.

If you manipulate these feet in your hands you will find that you can easily correct them to a good position and you will see the shaping of the arch when this is done correctly. But bear in mind that infant’s feet can be a bit puffy in appearance, so it is not always easy to see the arch.

Over the next 3 or 4 years of standing, gradually our muscles and ligaments strengthen, and the foot begins to develop into a straight position. At around 4 to 6 years old the foot posture when stood, will start to resemble what we think of as a natural adult posture with an arch developing on the inner side of the foot.

However, some children are delayed in development of the muscles and ligaments and often we don’t really know why. Muscle tone is low and tendons and ligaments remain elastic so that the foot easily rolls inwards (pronates) when standing. This is condition is known as hypermobility or joint laxity.

As these children grow the vast majority do strengthen up, at least by the time they are 18 and often before.

So why, you might ask, do we provide insoles to support the feet as they are growing?

Well there are two main reasons.

• Firstly, these children often struggle to keep up with their friends due to the following:
  • late standing and walking,
  • find themselves tripping or falling easily,
  • complain of pain in the feet, legs or even back,
  • sometimes they walk with there feet turned inwards, or perhaps walk on their toes. (this is just a way for the child to tighten the laxity in their leg muscles and so it makes them feel more stable!)

Orthotic insoles can support and stabilise the foot posture, improve balance and ease foot and leg strain and so minimise the problems these children experience.

• Secondly, if we do nothing, ignore the symptoms and simply wait for these children to ‘grow out’ of the problem then the feet might correct naturally … BUT …
  
  • There is also a chance that while we are waiting, because the feet are in this pronated or flat foot position for so long, the bones and structures in the feet grow into the wrong position such that the feet can not be manipulated into a straight position. This is Structural flat foot and this is much more serious. Potentially affecting the person throughout their lives.
  • Once a structural problem has developed, it is not easy to resolve this. Prevention is the key here.

In conclusion, we use insoles for children to simply keep the feet straight and to ensure the bones and ligaments grow in the correct biomechanical position, while we are waiting for the muscles and ligaments to strengthen up and support the feet by themselves.

If used regularly, orthotic insoles can prevent any adult issues resulting from untreated flat feet in children due to hypermobility and ensure long, healthy adult foot activity.

We hope this post helps and if you live local to Leeds please get in touch with Crossgates Chiropody and Therapy Center for advice and appointments.