Happy feet

Worried your toddler’s feet are flatter than a tone deaf duck? Don’t panic, says Dr Shah Alam Khan of the Dubai Bone and Joint Centre


What are flat feet?
Flat feet are commonly diagnosed when the arch of a foot doesn’t exist. When you look at the foot on the big-toe side, instead of rising slightly off the floor, the whole foot connects with the ground. But there are two forms of the condition: flexible flat foot, which the vast majority of children grow out of, and rigid flat foot, where certain bones are fused. Rigid flat foot is very rare, though, as is ‘rocker’ flat foot – a more severe and obvious condition.

If my child has flat feet, should I be worried?
No. All children are born flat-footed, and 90 per cent of us don’t develop arches until at least the age of five. In fact, only 10 per cent of kids will continue to have flat feet past the age of eight. Far fewer than that will have the rare rigid flat foot, which might need medical intervention. You can tell if your child has flexible flat feet, by getting them to stand on their toes. If, when they are on tip toe, an arch appears on the sole of their foot, they have flexible flat feet.

But if my child is one of those few flat-footers who stay that way, what should I do?
You’ll probably know your child is more flat-footed than his peers by about the age of two. You’ll possibly notice that his gait is a bit clumsy and he falls over more than his friends do. If his father is flat footed, he has a greater chance of having it too as it’s passed through the male line. Any earlier than two years old though, and it’s difficult to tell, because toddlers fall over a lot anyway. It generally takes them about a year of walking, to be steady on their feet. But if you’re worried, see a doctor and an examination will rule out or reveal any problems.

If rigid flat foot is diagnosed, will corrective surgery be required?
Not necessarily. Surgery is only advised in severe cases – usually when the flat foot condition is causing the child pain and walking difficulties. An operation should never be done for cosmetic purposes only. Surgery is not required for flexible flat foot.

Will having flat feet prevent my child from doing well at sports?
Absolutely not. Having flat feet can even be a bonus. Just look at Michael Phelps, considered the greatest Olympic swimmer of all time – he’s won 14 Gold medals. A study was carried out to decipher why he was so fast in the water, and the fact that he is flat footed was found to be decidedly in his favour. Approximately 23 per cent of US military recruits are flat footed too, so it’s not an issue when it comes to physical fitness.

But how about playing sports like football which require a lot of running?
Again, it’s not a condition that will affect a child’s ability to play sports well. However, very occasionally, children who play lots of sports like football for prolonged periods might suffer from a bit of discomfort. Most kids are fine though.

If my child is flat footed, is there anything I can do to improve it?
Certainly. And you can make it fun as well. One great exercise is to get them to pick up marbles with their toes and drop them into a bowl. Another activity that helps is walking on sand, so you’re in the perfect place. Get them to walk on their heels and turn it into a game. You could even have heel walking races. Any exercise that stretches the foot and toes is beneficial.

Will special inserts in his shoes help?
I’m not convinced of their value. There are far too many different types, of all shapes and sizes, on the market and their medical evidence is negligible. I sometimes recommend inserts simply because it makes the parents feel better about it, and as if they’re doing something to help the condition. But personally, I don’t think they make much difference.

Will certain shoe styles make the condition worse?
Any poor fitting, badly-designed shoe can have a negative effect on young feet. Children below the age of two shouldn’t wear shoes unless they have to – and the shoes should be sensible and supportive. Pablosky and Clarks are both reliable brands. Crocs are okay too. Anything frilly and flimsy with heels (for little girls) is a bad idea. Another form of footwear that is very bad for arch development are heelies – the shoes with the in-built wheels. In the home, we should all walk around barefoot as much as we can – not just the children, because it’s better for our feet.

So we don’t have too much to worry about then?
No. But if you do suspect that your child’s feet aren’t developing as they should, do get it checked out – if just for your peace of mind. That way, if something does come to light, it can be dealt with early and sensibly.
Dr Shah Alam Khan is a Consultant Orthopaedic Surgeon specialising in pediatric orthopaedics, musculoskeletal oncology and trauma at the Dubai Bone and Joint Centre in Healthcare City. For an appointment call (04 423 1400) or visit www.dbaj.ae.

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