How the arch of the foot is formed
A child is born with flat feet, and this is normal: the longitudinal arch is hidden under a fatty pad, and the ligaments and joint capsules are very elastic. As you begin to walk, the muscles of the lower leg and foot gradually become stronger, coordination improves, and the arch begins to appear. In most children, it is formed by school age, and the final picture emerges even later. Therefore, a foot print in a three-year-old child that looks completely flat is not in itself a reason for treatment - age, complaints and mobility of the foot decide.
- A newborn has a physiologically flat foot
- The fat pad hides the arch
- Ligaments in children are more elastic than in adults
- The arch forms as muscles grow and strengthen.
- For most, the picture returns to normal by school age.
Flexible and rigid shapes
This is the main division that determines tactics. With a flexible form, the arch is absent when the foot is supported, but appears when the child stands on his toes or when the foot is not loaded - this means that the structure of the joint is preserved, and most often only observation is required. Rigid means that the foot is rigid and does not change shape under any circumstances: this indicates an anatomical cause, such as fusion of the tarsal bones or vertical position of the talus, and requires examination. Pain, stiffness and one-sidedness are considered an alarming combination.
- Flexible shape - the arch appears when you rise on your toes
- Rigid shape - the foot is rigid in any position
- Stiffness requires x-rays and in-depth examination
- One-sided deformation is always alarming
- Pain is more important than the appearance of the foot
Causes and risk factors
Most often we are talking about a developmental variant in combination with a hereditary feature of the structure of connective tissue: in children with hypermobility of the joints, the feet flatten more noticeably. Excess weight contributes to the load on the arches. A separate group consists of children with neurological diseases in which muscle tone is impaired, as well as with systemic connective tissue disorders. Bone abnormalities, such as tarsal fusions, are uncommon but cause a stiff, painful foot and usually present during school age or adolescence.
- Hereditary joint hypermobility
- Overweight
- Weakness of the leg and foot muscles
- Neurological diseases with impaired tone
- Fusion of the tarsal bones
- Shortening of the Achilles tendon
- Systemic connective tissue diseases
Survey
The doctor examines the child standing, while walking, on his toes and without weight, assesses the position of the heels behind him, the mobility of the joints of the foot, the length of the Achilles tendon and muscle strength. The calf raise test is a simple and informative test that distinguishes a flexible form from a rigid one. Additionally, gait, shoe wear and the presence of calluses are assessed. Plantography helps document dynamics. X-rays of the feet with weight-bearing are not prescribed for everyone: they are needed for pain, rigid deformity, unilateral changes and before a decision about surgery. Children without complaints with flexible feet do not require additional examinations.
- Examination of feet while standing, walking and on toes
- Calf raise test
- Achilles tendon length assessment
- Plantography for dynamics
- X-ray of feet for pain and stiffness
- Neurological examination for weakness and clumsiness
What really helps
For flexible, pain-free feet, the key is time, movement and muscle strengthening. Walking barefoot on uneven surfaces is useful: sand, grass, pebbles, orthopedic mats, as well as raising your toes, picking up small objects with your toes, and walking on the outer edge of the foot. Shoes should be light, flexible, with a fixed heel and a fairly wide toe; A healthy child does not need hard “orthopedic” shoes and interferes with muscle function. Insoles do not form an arch, but reduce pain and fatigue, so they are prescribed for complaints. Losing weight significantly lightens the load. Surgical treatment is rarely used - in cases of severe rigid deformity with pain.
- Walking barefoot on uneven surfaces
- Exercises: calf raises, grasping objects with fingers
- Lightweight, flexible shoe with a fixed heel
- Refusal from hard shoes without indications
- Insoles for pain and fatigue, as prescribed by a doctor
- Losing weight if you are overweight
- Stretching the calf muscles for shortening the Achilles tendon
- Surgery only for rigid, painful deformity