Flat feet

• Most children under age 3 have flat feet
• Most children develop an arch in standing by around age 6. 
•  However, about one in five children never develop an arch. 
• Flat feet often occur in more than one member of a family. 
• Most adults with flat feet have no long-term problems or pain

• Physical examination
  • Ask the child to stand on tip toes.
    • If the arch corrects, the foot is flexible (requires no treatment)
  • Alternatively, if an arch can be seen in a non-weight-bearing position (e.g. sitting), the foot is flexible (requires no treatment)

• Investigations
  • For rigid flatfoot only: weight-bearing X-ray (AP, lateral and oblique)

• GP management
  • Reassure parents. 
  • Most children develop an arch by age six
  • The vast majority of patients with flexible flatfoot do not require orthopaedic referral
  • Painless flexible flat feet require no treatment. 
  • Orthotics do not help form an arch and are not recommended

• Refer if
  • Rigid flatfoot (arch does not reform
  • on tip toe test or in non-weight-bearing)
  • Painful flatfoot
  • Asymmetry
  • Localised tenderness
  • Difficulty in functional activities e.g. running, jumping