Hesperian Health Guides
Flat Feet
HealthWiki > Disabled Village Children > Chapter 11: Club Feet, Flat Feet, Bow Legs,and Knock-Knees > Flat Feet
Most children whose only problem is flat feet really have no problem at all — except that poorly informed doctors or greedy special-shoe salesmen make their parents think so.
Most babies have naturally fat feet, which can look flat.
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typical foot of a child under 2 years old |
| Do not confuse a FAT foot with a FLAT foot! | |
| In older children and adults there is a lot of natural variation in people’s arches. | Even a foot as flat as this, if it causes the child no pain, need not be considered a problem. Often flat feet run in families. If parents or relatives have similar feet but no pain, or if the child can move his feet strongly in all directions, do not worry about it. | ||
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| high arch | low arch (flat foot) | ||
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foot print |  | |
Do not worry about flat feet if there is no pain, obvious weakness, or loss of movement.
Children who are late beginning to walk often have weak arches with flat feet, until their feet get stronger.
Even children with very flat feet seldom develop a problem or have more than average pain or discomfort when they do a lot of standing or walking. Usually flat feet are a problem only when paralysis or brain damage is the cause —as in some children with polio, cerebral palsy, or spina bifida. Also, children with Down syndrome some times have flat feet that may lead to pain or discomfort.
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Correcting flat feetThe best treatment to help the child with flat feet and no other problem may be to go barefoot. Walking barefoot on sand or rough ground helps the feet get stronger and form a natural arch. Walking on tiptoe, skipping rope, and picking things up with the toes may also help. |
BEWARE of going barefoot where hookworm is common
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WARNING! THIS METHOD USUALLY DOES NOT WORK
| Some specialists try to straighten a foot that is tilted like this |  |
by putting a wedge under the heel of the shoe like this. |  |
| But instead of straightening the foot, this often causes further deformity, because the heel slides to the side, and the shoe stretches here and wears out here. |  | ||
INSOLES AND OTHER FOOT SUPPORTS
| An insole is a firm pad that is put inside a shoe or sandal to support the arch. |
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| Insoles can be made of leather, porous rubber, or a piece of a car tire, shaping it with care so that it will support the foot comfortably. |
Some children with flat feet resulting from polio, cerebral palsy, or Down syndrome may be helped by insoles or other foot supports. But other children will not be helped. Each child’s needs should be carefully considered. If after trying an insole for 2 weeks, the child walks with more difficulty, change the insole or stop using it.
Before making the final insole, put a piece of cardboard, wood or some other material shaped like the insole, under the child’s foot. Try different heights to find what seems to work best. Make sure the heel is in a straight line with the leg.
After making the insole, check the position of the foot. Do this with the child standing on just the insole, and then with the insole inside the shoe. Watch him walk, and ask him how it feels. If everything seems right, check it again in 2 weeks.
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| CORRECT – The heel is in a straight line with the leg. | TOO LOW – The heel tilts outward. The insole should be thicker. | TOO HIGH – The heel tilts inward. The insole is probably too thick. |
IMPORTANT! The thickest part of an insole should be directly under the ankle bone, just in front of the heel, like this. |
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| It should not be in the middle of the arch, like this. This can injure the foot more rather than supporting it. |  |
WARNING! Many commercial insoles, and even orthopedic shoes, have the arches in this incorrect position. Check them carefully. If they are like this, do not use them. Also be sure shoes are not so wide that the heel slips to the side. | |
| If the child’s foot is flat or very floppy due to paralysis, often an insole is not enough. He may need a short plastic brace that supports the foot like this, |  built-in sole |
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For instructions on making plastic braces, see Chapter 58. | |
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or a brace that supports the foot and ankle, like this. |
There is probably only one shoe or sandal alteration that does any good. A small metal plate on the inner edge of the heel stops uneven wear—and may help prevent foot pain.