You may have heard the term pes planus, flat feet, poor 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
Intrinsic Plantar Muscle (Arch) ActivationGentle Foot Massage
- Apply gentle pressure to bottom of child’s foot.
- Use circular motion to activate muscles of medial foot.
- Use vibrating node or tactile ball along arch of foot with child comfortably seated, to activate muscles of foot.
- Can do this before other more challenging activities to ensure arch is activated and ready to “work”.
- 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!
- For increased challenge, have child pick up marbles or flat “chips” with toes and drop in small container, this requires greater control and prolongs muscle activation.
- With the standing on foam balance pad or firm cushion, practice balancing on each leg for 10 second intervals to challenge arch activation.
- Pass ball back & forth while maintaining half kneel on balance pad.
- Maintain balance on dyna disc during game of catch, balloon volleyball, Velcro ball, etc.
Try single leg balance on dyna disc for extra challenge of muscles of lower extremity!
- Stand to squat on half moon foam roller – also great for arch activation!
- Standing with one foot in front of the other. Use colorful tape for helpful visual cue to promote alignment.
Tactile footprints are great visual and tactile cues for foot placement to help engage foot musculature and promote development of arch!
- Seated floor scooter, forwards and back using heels to dig in and muscles of foot to initiate movement.
- Push into dyna disc with both feet, lifting bottom for sustained hold or lift & lower for more dynamic activation.
- Hold bridge position 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!
Tactile Footprint Forward and Backward Walking
Jump Down from small platform promoting full foot contact for take off and landing.
Jump Up onto platform promoting full foot contact. Can increase height of platform as child gains mastery.
Biomechanics of Gait
- With child seated on therapy ball, balance pad under feet, encourage alternating marching movement. Engaging lower body disassociation while promoting lower body and trunk engagement.
- With child standing on balance pad or dyna disc encourage kicking down either soft blocks or cones to promote weight shifting and balance.
- 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 pillows or bubble wrap!
- Encourage child to walk forward with heels on the ground and toes up!
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 Pre-Contend
- Saucony: Saucony Cohesion & Saucony Excursion
- Keen: Keen Oakridge & Keen Newport Sandal
- Pediped: Pediped Max & PediPed Flex Dakota
- Stride Rite: Stride Rite Cannan & Stride Rite Artin Sneaker
For more information about shoe recommendations for common Pediatric gait presentations, check out our post on What a Difference a Shoe Makes!
Learn more about Dinosaur Physical Therapy!