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Flat Feet in Children Care Pathway Overview

Flat feet in children is a normal part of a child's development and does not require referral into Orthopaedics. Please manage in Primary Care with advice, encouragement and self-management.

Practice Point

The advice in this pathway applies to patients up to musculoskeletal maturity at approximately 18 years of age

 

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Red Flags
  • Persistent pain, redness, heat, swelling, raised body temperature
  • History of trauma/injury/fracture
  • Inability to weight bear
  • Multiple joint pain/swelling
  • Asymmetry of foot arches or high arched feet under the age of 3 years
If fracture suspected, follow the Fracture pathway
If infection suspected, treat accordingly
If multiple joint pain/swelling consider Rheumatology referral
For persistent foot or ankle pain, weakness, limping, swelling or stiffness, encourage patient to self-refer into Core Podiatry
Presentation

Flat feet (often referred to as pronated feet) do not show an arch when standing. At first all babies and young children’s feet appear flat. The ankles also appear as if they are falling inwards. This is a normal stage in foot development and does not interfere with a child’s ability to learn to walk.

Differential Diagnosis
  • Ligamentous laxity e.g.: Hypermobility, Ehlers danlos syndrome, Marfans syndrome
  • Tarsal coalition
  • Accessory navicular
  • Fracture (follow the Fracture pathway)
  • Infection (treat accordingly)
  • Neurological disorders causing tight Achilles tendon – e.g. cerebral palsy
Initial Primary Care Assessment
  • Assess arch height weight bearing and non-weight bearing.  An arch should be visible when non-weight bearing. When weight-bearing ask the patient to rise  onto their tiptoes – if an arch appears = flexible flat foot. If no or little arch appears consider it being a rigid flat foot.
  • Assess ankle joint range of motion. Restricted dorsiflexion may indicate contracture of the Achilles tendon.
  • Assess for hypermobility using the Beighton scale. Hypermobility is often associated with Flat Foot
Primary Care Management

Flat feet in children is a normal part of a child's development and does not require referral into Orthopaedics. Please manage in Primary Care with advice, encouragement and self-management.

Provide advice/encouragement:

  • Prescription orthoses (insoles) are not a ‘cure’ for flat feet. They aim to prevent pain by improving foot function. There is no evidence that they can change the foot shape.
  • The arches of the child’s foot should start to develop around the age of three to four years. By around seven or eight years the foot arch should have completed most of its development.
  • There is a normal variation in arch height across the population
  • Stretching and strengthening lower leg muscles can often improve symptoms – provide Parent/Carers/Patient with the ‘Flat Feet’ Patient Information Leaflet which includes exercises
  • Correct footwear is important for any child to ensure support during periods of growth and development – provide Parent/Carers/Patient with the 'First shoes' Patient Information Leaflet if appropriate
  • If suspected hypermobility provide Parent/Carers/Patient with the Hypermobility Patient Information Leaflet

Practice Point

The advice in this pathway applies to patients up to musculoskeletal maturity at approximately 18 years of age

When to Refer

If additional support is required to manage the problem, Gloucestershire Care Services (GCS) provides foot and ankle services in Gloucestershire.

The main entry point for foot and ankle services is via Core services, accessed via the online self-referral form, (click here for printable link), which the patient can complete themselves if able to and willing.

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