WHAT ARE FLAT FEET?
A foot is described as flat if the arch on the inner border of the foot is not as high as normal. This may also give the appearance that the ankle bone on the inside is more prominent or that the whole foot seems tilted out the way.
IS IT SERIOUS?
No! Despite many scare stories by people who should know better, we know that flat feet occur as part of normal development in 97% of children. It is the 3% who do not have flat feet who are abnormal. Some children have looser ligaments, which is why some feet seem flatter than others. Your doctor has examined your child to exclude flat feet caused by abnormal bones in the feet, which produce stiff painful feet rather than flexible symptomless feet.
SHOULD THEY BE TREATED?
Studies by Professor Staheli in America have shown that insoles or arch supports do not help the arches of the foot to develop. Indeed there was a suggestion that such devices slowed down the natural development of the arches. We know that without treatment 96% of children will have normal arches by age 14. A child who "gets better" with arch supports was going to develop normal arches anyway and did so despite, rather than because, of the treatment.
CAN ARCH SUPPORTS CAUSE HARM?
Possibly. Professor Staheli found that children who were prescribed arch supports for flat feet did less well at school and in life when compared to similar children with flat feet who did not have arch supports. He thought this might be because children with arch supports were teased by their friends.
A study in Nottingham by Professor Wallace on children with flat feet and early bunions to see if arch supports would prevent the bunions getting worse showed that it was the children treated with arch supports who developed the worst bunions. However most trainer shoes have small built in arch supports which are unlikely to do harm or cause a child to be teased.
IS THERE ANYTHING THAT CAN HELP?
Yes. Professor Joseph in India found that children who did not wear shoes before age 6 always developed normal foot arches as the foot matured. Obviously in Scotland it is not possible to go outside without shoes on most occasions but whenever possible you should encourage your child to run around barefoot and on tip-toe since this will strengthen the muscles which help the arches of the foot to develop.
WHAT IF THE FEET ARE STILL FLAT AT AGE 14?
In most people flat feet cause no symptoms and can be ignored. Indeed, a study done just after the Second World War to see if flat feet should be a reason for refusing entry to the army found that soldiers with flat feet had the least problems, while high arched feet caused serious problems. Soldiers with normal arches were in between.
WHY DO SOME PEOPLE URGE TREATMENT FOR FLAT FEET?
Research has shown that some adult high class athletes with flat feet can get foot, shin or knee pain when pushing their body to the limit. Many high-class athletes have generalized loose ligaments, which also means that they are more likely to have flat feet that persist into adulthood. Arch support insoles worn during training and competition can improve their pain and performance though there is no evidence of benefit for every day activities.
Unfortunately some podiatrists and physiotherapists believe that flat feet can be eliminated in adults by giving arch supports to every child with flat feet. They seem unaware of the studies showing that such treatment does not work and may be harmful.
DO RHSC EVER RECOMMEND ARCH SUPPORTS?
Not for normal children though trainers can be useful for the child who rapidly destroys their shoes. We sometimes use supports for children with severe flat feet caused by an underlying problem such as cerebral palsy or a bony abnormality causing a painful stiff flat foot. In the adult supports are only of value in athletes and are best custom made for that individual.