Synonyms and Keywords
Clubfoot, flatfoot, pes planus, pes planovalgus, pronation syndrome.
What is a Pediatric Flatfoot/Talipes Calcaneovalgus?
When a flatfoot occurs in children, it is referred to as “pediatric flatfoot.” Its medical term of talipes calcaneovalgus is a combination of talipes calcaneus and talipes valgus. Since “talipes” means a deformity of the foot that you’re born with, “calcaneus” is the heel bone and “valgus” indicates “turned outward”, the term describes the inborn deformity of the foot usually marked by a curled shape or twisted position of the ankle, heel and toes.
As a form of flatfoot, it has the distinct characteristic of the condition: a partial or total collapse of the foot arch. The flattened inside arch causes the heel bone to turn outward, and as a result, the inside of the foot appears more “bowed” outward than normal. Pediatric flatfoot is not only common among infants and toddlers, but somewhat expected because all children are born with a minimal foot arch. It is not a painful condition and will generally resolve without treatment. The need to wear a corrective cast is often unnecessary. Sometimes, though, the arches don’t develop during childhood and you end up with flatfeet. Other times, it happens due to an injury or the natural wear-and-tear of aging. You have flatfeet if the arch on the inside of your feet is flat enough that your entire feet touch the floor when you stand up.
A child’s foot will start rounding into normal shape around age two or three, as the foot becomes less “fatty” and the bones begin to show more conspicuously. But if the child’s foot still shows no sign of straightening out at this age, it is wise to seek a foot specialist or podiatrist for further examination. Untreated severe flatfoot can force the child’s ankle to turn inward and throw off the alignment of the legs, causing pain when walking throughout the child’s life.
What Causes a Pediatric Flatfoot/Talipes Calcaneovalgus?
A flatfoot is normal in children, especially newborns, for the arch hasn’t yet developed in the foot. Although the exact cause is not known, the main theory for this and other related conditions, like pigeon toes (or in-toeing), holds that an infant’s legs are usually curled up in the cramp space as it grows, therefore causing a minor deformity in the feet as they are pressed into this position inside the uterus.
Most cases of pediatric flatfoot can also be attributed to ligamentous laxity, or loose ligaments and excessively flexible joints in the foot that do not support or hold up the arch well.
Who Gets a Pediatric Flatfoot/Talipes Calcaneovalgus?
Naturally, pediatric flatfoot occurs most frequently in infants and children under two years of age, when the bone structure is not yet developed and the cartilages still soft enough to bend to internal and external pressure. The “deformity” often goes away without treatment once the bones and cartilages firm up and straighten themselves out with age. However, there are other factors to increase the risk of flatfoot:
- Obesity or overweight. Excessive weight puts strain on the feet, especially when the child starts to walk.
- Traumatic injury to the foot or ankle. Any considerable force can easily damage or change the shape of a bone in an infant.
- Rheumatoid arthritis. Although this painful condition usually does not strike until much later on in life, the crippling effect contributes to developing a flatfoot.
- Aging. Not a concern for toddlers, but the constant pounding of the foot throughout a lifetime can cause the arch to collapse when we get old.
Are There Different Types of a Pediatric Flatfoot/Talipes Calcaneovalgus?
There are two types of flatfoot: flexible and rigid.
Flexible flatfoot is more common, less severe, and easier to treat (if necessary at all). The child’s arch will look normal while sitting but collapses (or flattens out) when any weight in put on the foot. It usually does not cause pain and shows no symptoms.
In a rigid flatfoot, the arch appears flat whether the child is sitting or standing. Because it usually indicates a more serious condition, you should take the child to a podiatrist for examination.
What are the Symptoms of a Pediatric Flatfoot/Talipes Calcaneovalgus?
Flatfoot can be apparent at birth or show up years later. Since most children with this condition have no symptoms, many infants who have a “fat” foot are also mistaken by the parents to have flatfeet. The most obvious sign is, of course, the lack or flatness of the arch, but other known symptoms include:
- Pain, tenderness, or cramping in the foot and ankle, particularly in the heel or arch area
- Swelling along the inside of the ankle
- A history of clumsiness
- A tight calf, common finding in all flatfoot patients
- Heels pointing or tilting outward when standing
- Often asking to be carried
- Avoiding physical activity, and reduced energy when the child does participate
- Awkwardness or changes in walking
- Pain when walking or running for any length of time
- Difficulty standing on tiptoe
- Problem with shoes; wearing shoes hurt the child’s feet when it shouldn’t
- Pain in the low back, hip, or knee from the stress of walking on in-turned legs
How do You Diagnose a Pediatric Flatfoot/Talipes Calcaneovalgus?
Pediatric flatfoot can be a deformity fairly obvious to the untrained eye; one can tell by how there’s no arch and the whole foot touches the ground completely when a child is standing. However, it is also unlikely to be properly diagnosed unless by a foot specialist, who is familiar with the structure and working of the foot.
When visiting a podiatrist, have the child wear his/her everyday shoes because the doctor may want to look at the wear patterns on the soles. The doctor may also ask you and the child these questions:
- When did you first notice any problems with the child’s feet?
- Where exactly does it hurt?
- Does anything make the symptoms better or worse?
- What other medical problems, if any, does the child have?
- Has the child ever injured his/her foot or ankle?
- Is there any case of painful flatfoot deformity in the family or family history?
Your podiatrist will then observe the child’s feet from the front and the back, and ask the child to stand on his/her toes. The podiatrist will also examine the feet while the child is standing, walking or running, and both when a foot is bearing weight and without pressure, all to evaluate their range of motion. During the examination, the foot specialist is looking for abnormal structure or function of the foot and lower extremity that can cause both short-term and long-term problems. The doctor may order x-rays of the foot to determine the severity of the deformity, or if a significant disorder is noted or suspected. Because flatfoot is sometimes related to problems in the leg, the doctor may also check the child’s knee and hip.
How do You Treat a Pediatric Flatfoot/Talipes Calcaneovalgus?
If a child has no symptoms, the condition often requires no treatment. Instead, periodic observation and re-evaluation by a foot specialist or podiatrist should suffice.
Otherwise, treatment for the milder cases of flatfoot generally begins with supportive shoes, such as high tops, in conjunction with in-shoe insert like arch padding. A more severe or painful deformity may require a greater control and restriction of the foot’s abnormal motion through functional foot orthotics. Functional foot orthotics are special devices that stops the arch from flattening out and the heel bone from rolling while the child is standing, walking and running, thus reducing the symptoms while greatly improving the appearance and function of the foot.
Self-Care at Home
Calf muscle stretching exercises are commonly prescribed for children with tight calf muscles or shortened Achilles tendon since either can worsen both the symptoms and deformity with time. Exercises twice a day to stretch those muscles and the tendon will help speed up the foot’s natural straightening process. The exercises include:
- In kneeling position, point your toes out behind and gently sit back on the heels, pressing the tops of the feet toward the ground.
- Stand at an arm’s length from the wall. Place your hands on the wall, keep the feet and knees straight, then lean forward as far as possible.
- Standing with your feet flat, bend the knees forward as far as possible while keeping the heels on the floor.
Over-the-counter arch supports can help relieve the pain caused by a flatfoot. They won’t cure the condition, but will often reduce the symptoms in the meantime.
Rest from activities that aggravate the child’s condition may be in order until his/her feet are feeling better.
If the child’s overweight, losing weight should put less stress on the feet and avoid further deformity.
If you suspect your child has a severe case of pediatric flatfoot or does not appear to be growing out of the condition, see a podiatrist as soon as possible, preferably before age three, for evaluation and, if necessary, treatment. The treatment for flatfoot typically becomes less effective and more complicated after age three.
Non-surgical approaches to treat the symptoms of a pediatric flatfoot include:
- Activity modifications. Curtail or decrease all of the child’s activities that bring pain, while avoiding prolonged walking or standing.
- Orthotic devices, the gold standard for treating pediatric flatfoot. Orthotics are shoe inserts that correct the alignment of the joints, ligaments and tendons of the foot to restore proper biomechanics. These are custom-made and designed to address each child’s specific foot structure and associated problems. They don’t cure the problem, but maintain the child’s feet in proper position long enough for them to outgrow the condition, or at the very least keep the deformity from becoming worse.
- Physical therapy. Stretching exercises supervised by a foot-and-ankle surgeon or a physical therapist to provide relief.
- Shoe modification. The podiatrist can advise you on footwear and changes beneficial to a child with flatfoot.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
In rare cases, surgery is necessary to relieve the symptoms and improve foot function when the condition fails to respond to non-surgical options. It is done only for those children with the most severe deformities. Regardless, you should always seek a second option when considering surgery on your child’s foot.
A common procedure for pediatric flatfoot is the subtalar arthroeresis, or “implantable orthotic.” Taking only seven minutes to perform, the procedure placed an implant in the rear part of the foot through a tiny incision. The implant presents an immediate arch that enables the child to bear weight immediately and seldom needs removal. This is done for children with intolerable pain in the arch or a completely collapsed arch that will cause arthritic conditions when they get older.
How to Prevent a Pediatric Flatfoot/Talipes Calcaneovalgus?
The best prevention is to have the feet of a child showing the characteristics and symptoms of the condition examined before he/she is three years old. The reason is that the young feet are still largely made of soft cartilage with very little bone present, and the exertion from moving with a flatfoot deformity can cause permanent changes to the bones and joints well into adulthood.
Even if there’s no conclusive sign of pediatric flatfoot, it is still sensible to follow most of the measures given in Self-Care at Home: Cut back or stop activities that caused pain in the child’s foot, stretch the calf muscles and Achilles tendon regularly, and eat healthy to prevent overweight.