Flatfoot

There are 3 different types of flatfoot. Knowing which kind your child has helps you and your child’s doctor decide if your child needs treatment and, if so, which kind of treatment.

• Flexible flatfoot: Almost all children with flatfoot have what is called flexible, or hypermobile, flatfoot. This condition is not painful, causes no disability and does not need any treatment. It always affects both feet.
• Flexible flatfoot with a short Achilles tendon happens very rarely in young children. It affects both feet and may cause pain and disability.
• Rigid flatfoot is the least common type. Rigid flatfoot most often shows up in people who have a problem with the bones in their feet (tarsal coalition). About 1 in 4 people with rigid flatfoot has pain and disability. About half of the time, rigid flatfoot affects both feet.

Almost all babies are born with flatfoot. Studies estimate that 80% to 90% of babies born in North America have flatfoot. Studies in other countries have found similar numbers. Most of these babies have flexible flatfoot.

Children often outgrow flatfoot naturally. But at least 20% of adults in North America have flatfoot. About 25% of these adults have flexible flatfoot with a short Achilles tendon, and 9% have rigid flatfoot.

Flatfoot is treated by the experts in our Foot and Ankle Deformities Program.

For the rare cases when surgery is needed, doctors at Seattle Children’s developed the most common operation now used nationally to correct severe, painful flatfoot with short Achilles tendon in adolescents. Doctors use this operation only when other more conservative treatments do not work.

To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like medicines, physical therapy and braces), recommending surgery only when we believe it will give your child the best results.

Many of our pediatric orthopedic surgeons have expanded fellowship training in areas such as foot and ankle conditions, sports medicine, tumors, upper extremity surgery, limb deformity, neuromuscular diseases, skeletal dysplasia and spine problems.

We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

If your child has general aching pain in the feet or legs after activities, we recommend a simple and inexpensive over-the-counter cushioned arch support or a running shoe with a built-in arch support.

To treat flexible flatfoot with a short Achilles tendon, we may attempt to stretch the Achilles tendon. It is more difficult to stretch this tendon if your child has flatfoot than it is if they have an average-height arch. It requires us to rotate the foot inward to elevate the arch while the Achilles tendon is being stretched.

We suggest you avoid using hard arch supports for flexible flatfoot with a tight Achilles tendon. These rigid arch supports, often made of hard plastic, can cause more pain than children have without them.

In rare cases, flatfoot is not helped by more conservative treatment and children need surgery to relieve their pain.

In almost all cases that require surgery, the child is at least 8 years old and their Achilles tendon is short. Surgery involves lengthening the short Achilles tendon, as well as correcting the flatfoot deformity.

The doctor lengthens the heel bone (calcaneus) using a bone graft inserted on the outer side/edge of the middle of the foot. This procedure is called calcaneal-lengthening osteotomy.