You may have heard the term pes planus, flat feet, no plantar arch support, or overpronation… You may notice your child’s feet turning out significantly when standing or walking. You may even notice a more significant wear pattern on the inside of the child’s shoe. So what exactly does a flat footed presentation entail?
Flat Feet (aka Pes Planus)
Children who present with flat feet may have been late ambulators, may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”, denoting a lack of true control as compared to more typical gait pattern (as weight shifts from heels to toes).
Children with flat feet will experience overpronation or excessive pronation, which refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leading to poor lower extremity alignment and the potential for future orthopedic concerns.
It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. We anticipate early ambulators to display a flattened arch with forefoot pronation while weight bearing. Over time most children develop the musculature of their intrinsic foot and plantar arch. Intervention is not necessary if this presentation is not otherwise affecting function.
Here are some fun treatment ideas to promote development of the arch muscles to encourage lower extremity alignment, fluidity of gait mechanics and prevent any potential long term musculoskeletal issues that may arise as a result of this presentation.
All exercises should be done barefoot without sock or shoes, to encourage activation of the intrinsic muscles of the foot. We want child to experience both tactile and proprioceptive input through the soles of their feet.
Treatment for Flat Feet Targets:
- Arch Activation/Strength
- Lower Extremity Strength & Alignment
- Efficient and Fluid Motor Patterns
- Biomechanics of Gait
1) Intrinsic Plantar Muscle (Arch) Activation
- Gentle Foot Massage
- Apply gentle pressure to bottom of child’s foot.
- Use circular motion to activate muscles of medial foot.
- Vibration or Tactile Input
- Bean Bath
- Using bucket filled with dried beans or rice, place small toys throughout, having child use feet (curling toes to activate arch muscle) to pick objects out of bucket.
- Scarf Lift & Release
- Using fun play scarves like these, start with material flat on floor. With child seated or standing, encourage child to place one foot on top and use muscles of foot to lift scarf up!
- Toe Basketball
- For increased challenge, have child pick up object with toes and drop in small container, this requires greater control and prolongs muscle activation.
- Superhero Kicks
- With the child lying on their back, have them kick a large therapy ball thrown to their feet.
- Leg Raises
- Ball Jumps
- Have child stand atop a therapy ball secured in corner of a wall, hold child’s hands and allow them to jump up and down to encourage proprioceptive input to their feet and ankles.
- Balance Challenge
- Challenge child to a balance off! See who can balance the longest while standing on these balance pods.
2) Lower Extremity Strength and Alignment
- Dyna-Disc Balance
- Half Moon Balance
- Stand to squat on Half moon Foam Roller – also great for arch activation!
- Tandem Stance
- Standing with one foot in front of the other, make sure you practice alternating with left foot first and right foot first.
- The tactile footprints are great visual and tactile cues for foot placement to help engage foot musculature and promote development of arch!
- Scooter Adventure
- Seated floor scooter, forwards and back using heels to dig in and muscles of foot to initiate movement.
- Crab Kicks
- Hold bridge position as shown below, and perform alternate leg kicks while saying the ABCs. To increase challenge and to target muscles of the foot, place Dyna-Disc under feet, while alternating leg kicks!
- Bear Walks
- Have child walk across the room like a bear to complete a puzzle. You can increase the challenge and provide sensory input by lining the floor with bubble wrap!
3) Motor Planning
- Tactile Footprint Forward and Backward Walking
- Stair Climbing with Tactile Footprints to address alignment
- Jump Up with visual cues for alignment
- Jump Down with visual cues for alignment
4) Biomechanics of Gait
- Pillow Walks
- Line up 4-5 large pillow or couch cushions, encouraging child to walk along. Offer support for balance if necessary. Great to practice negotiation, engaging muscles of lower extremity and targeting mechanics of gait.
- Floor Skating
- Using colored spots, with child barefoot encourage them to keep feet on the spots while sliding forward on the floor. This will encourage child to grip with their feet and activate their intrinsic arch muscles as they move along.
- Heel Walking (aka Penguin Walking)
- Encourage child to walk forward with heels on the ground and toes up!
- Side Stepping
- Encourage child to step side to side with feet facing forward. Can use small obstacle to step over for increased challenge.
Shoe Suggestions for Children with Flat Feet
- Provides Support
- Offers Stability
- Facilitates Weight Bearing
- Promotes Lower Extremity Alignment
- Encourages Fluidity and Efficiency in Motor Patterns
Some great options include:
- ASICS: ASICS GT-1000 & ASICS Gel Nimbus
- Saucony: Saucony Cohesion & Saucony Excursion
- Keen: Keen Pagosa Shoe & Keen Newport Sandal
- Pediped: Pediped Boulder Boot & PediPed Flex Dakota
- Stride Rite: Stride Rite Made2Play Fleet Boot & Stride Rite Artin Sneaker
- Brooks: Brooks PureFlow & Brooks Defyance
For more information about shoe recommendations for common Pediatric gait presentations (such as Flat Feet, Idiopathic Toe Walking, and In-Toeing) read our post on What a Difference a Shoe Makes!
Learn more about Dinosaur Physical Therapy!
Thank you to Dr. Sneha Gosalia, PT, DPT for her helpful contributions to this post in the form of exercise/activity ideas as well as wonderful photos! Take a moment to visit her practice website, Big Leaps CT.