What is Pediatric
Flatfoot is common in both
children and adults. When this deformity occurs
in children, it is referred to as “pediatric flatfoot,” a term that
actually includes several types of flatfoot.
Although there are differences between the various forms of
flatfoot, they all share one characteristic-partial or total
collapse of the arch.
Most children with flatfoot have
no symptoms, but some children have one or more
symptoms. When symptoms do occur, they vary
according to the type of flatfoot. Some signs
and symptoms may include:
· Pain, tenderness, or cramping in
the foot, leg, and knee
· Outward tilting of the
· Awkwardness or changes in
· Difficulty with shoes
· Reduced energy when participating
in physical activities
· Voluntary withdrawal from physical
Flatfoot can be apparent at birth
or it may not show up until years later, depending on the type of
flatfoot. Some forms of flatfoot occur in one
foot only, while others affect both feet.
Types of Pediatric
Various terms are used to describe
the different types of flatfoot. For example,
flatfoot is either asymptomatic (without symptoms) or symptomatic
(with symptoms). As mentioned earlier, the
majority of children with flatfoot have an asymptomatic
Symptomatic flatfoot is further
described as being either flexible or rigid.
“Flexible” means that the foot is flat when standing
(weight-bearing), by the arch returns when not
standing. “Rigid” means the arch is always stiff
and flat, whether standing on the foot or
of flatfoot are categorized as rigid. The most
· Tarsal coalition.
This is a congenital (existing at birth)
condition. It involves an abnormal joining of
two or more bones in the foot. Tarsal coalition
may or may not produce pain. When pain does
occur, it usually starts in preadolescence or
· Congenital vertical
talus. Because of the foot’s rigid “rocker
bottom” appearance that occurs with congenital vertical talus, this
condition is apparent in the newborn. Symptoms
begin at walking age, since it is difficult for the child to bear
weight and wear shoes.
In diagnosing flatfoot, Dr.
Piccarelli examines the foot and observes how it looks when the
child stands and sits. Dr. Piccarelli also
observes how the child walks and evaluates the range of motion of
the foot. Because flatfoot is sometimes related
to problems in the leg, Dr. Piccarelli may also examine the knee
X-rays are often taken to
determine the severity of the deformity.
Sometimes an MRI study, CT scan, and blood tests are
If a child’s flatfoot is
asymptomatic, treatment is often not required.
Instead, the condition will be observed and re-evaluated
periodically. Custom orthotic devices may be
considered for some cases of asymptomatic
In symptomatic pediatric flatfoot,
treatment is required. Dr. Piccarelli may select
one or more approaches, depending on the child’s particular
case. Some examples of non-surgical options
· Activity modifications
· Orthotic devices
· Physical therapy
· Shoe modifications
When Is Surgery
In some cases, surgery is
necessary to relieve the symptoms, improve foot function, and
prevent future deformity or arthritis. Dr.
Piccarelli can perform a variety of techniques to treat the
different types of pediatric flatfoot. The
surgical procedures selected for your child will depend on his or
her particular type of flatfoot and degree of