Let's talk about a controversial topic, flat feet, and children.
They are commonly thought of as problematic, but we have no research to support this. Now, when we talk about flat feet, it's interesting to read some of the research and literature around what really is a flat foot. We don't really have much evidence to say or to classify what a flat foot is. In most cases, people think of a foot that ‘rolls in’ to much or when they’re standing, the inside of the foot sits closer to the ground.
THIS DOES NOT MEAN ANYTHING OTHER THEN THIS IS A NORMAL PART OF THE POPULATION.
We commonly get referred patients or hear from parents that their children's feet or their flat feet are contributing to their injury or it’s one of the main reasons why they have become injured and why their injury hasn't gotten better. We then hear that they need orthotics or braces. We need to think of foot posture as a part of the whole body system. We should be more concerned about how much training they have been doing, how their fuelling around their workouts (if playing sport), how much sleep their getting, if they've had any recent injuries that may compromise the tissue that is injured currently and how strong and resilient the tissue is. It would be safe to assume that their foot posture is always going to be the way it is, so rather than saying that it's a really bad thing and it needs to be fixed because it's broken, we should be focusing on trying to build the resiliency and build up the strength of the tissue that supports the lower limb. Now, I would hope that anybody reading this that has ever been told that their flat feet are a bad thing or that their children’s foot posture will question why that is.
We don't have any high quality or low-quality evidence to support that foot posture in children is problematic or that orthotics should be used to treat flat feet. The latest systematic review that came from the Cochrane Library demonstrated that the use of orthotics in asymptomatic flat feet is not evidence based and should not be done.
When someone is in pain, we may use foot orthoses as short-term modifiers to help reduce the sensitivity and load through an area. Foot orthoses should be thought of as short-term pain modifiers rather than long-term arch supports. Another problem we see is when kids aren't in pain, and they are given orthotics to correct something that really isn't broken. There isn’t any end date. I've heard patients being told that they need to come back each year to have them replaced when they’re not in pain or were never in pain. It's a common theme that we see, here at Achieve Podiatry we try to be as transparent as possible knowing that orthotics are for the short term the goal is to always slowly reduce the need for them.