Introduction to biomechanics


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Flatfeet in Children: When Are They A Problem?

There are high arch feet and low arch feetnecessary to visit a podiatrist to be
and many different foot types in between.evaluated. In many cases, small problems that
Many individuals have flatfeet, but do notare developing in this age group can lead to
have foot problems. All of us are born withmore severe problems down the road.
flatfeet and some of the greatest athletesGeneralized ankle pain is the most common
have flatfeet. But, flatfeet are a problemcomplaint in children this age with flatfeet.
when the arch completely collapses inTypically, they will be able to run and play
combination with excess inward rotation insports, but find that they have a deep, achy
the foot. This type of flatfoot causes excesspain in and around their ankle when they are
stress on the joints, ligaments and tendonsdone. Children this age have a very difficult
in the foot and ankle. If not treatedtime expressing the type of pain they are
appropriately, tendon and joint problems willexperiencing and when they experience it.
develop.Flatfeet are normal in infants andWriting down when the pain happens and where
the arch will not start to develop untilis occurs will help your doctor during the
between four and eight years of age. Up untilvisit.Over fourteen years of age, the growth
this time, all children will have flatfeet.slows in girls and over the next few years
Many children under the age of 4 may havethe growth plates in the feet fuse. Boys will
excessively flatfeet and excess rotation inhave continued growth until 16 to 18 years of
their feet. How do you tell the difference?age. Children in this age group will
The following list may indicate that yourtypically complain of pain. The most common
toddler's flatfeet are a problem:1. Yourproblem in children with flatfeet in this age
child is over 15 months of age and has notgroup is tendonitis. The pain is either at
started walking.2. Your child started walkingthe back of the heel, or at the inside of the
around 12 months but seems to preferarch. Sometimes the foot and ankle are stiff
crawling.3. Your child is between the ages ofand sore in the morning, when first stepping
2-4 and complains of foot pain or leg pain.down. Walking up and down stairs or hills,
In many instances, this leg pain is confusedsquatting or walking on uneven surfaces will
with growing pains.4. The wear on yourcause more pain in these tendons.Treatment of
child's shoe is uneven.5. Your child's archtendonitis involves rest, ice and
is touching the ground and the ankles lookimmobilization for a minimum of two weeks,
like they are rolling in, bringing the kneesbut two months can be a common recovery time.
together.For toddlers, the typical treatmentWhen these conditions develop as a result of
is a kiddie orthotic. This is a pre-madeflatfeet, it is necessary to be fit with
orthotic which comes in different sizes. Itorthotics to prevent the problem from
will fit into any of your child's shoes andoccurring again. Not every foot needs a
should be comfortable for them. This willcustom made orthotic. There are many
help stabilize their foot while they areprefabricated orthotics that work well. A
walking. In severe cases, or in children agesprefabricated orthotic is not the same as an
3 and 4, a custom made orthotic may beinsert. An insert slips into the shoe and
necessary. A custom made orthotic is a devicewill provide comfort, cushion and a little
that involves taking a mold of the foot,support. In some cases, inserts purchased at
typically done with plaster, but sometimesthe drugstore will help alleviate some arch
done with foam. A device is made withor heel pain and give relief to sore, tired
specific corrections for your child's footfeet. But, an insert is not an orthotic.
and looks like a plastic insert. This insertOrthotics are devices which fit into the shoe
can slip into the shoe and can be switchedand aid in foot function.The most important
from shoe to shoe.Children can wear the samedifference is an orthotic controls abnormal
insert for up to 2 shoe sizes, then a newmotion and corrects foot function, while an
pair must be made. Although the insert willinsert will only provide cushion and comfort.
not change the way the foot develops, it willPre-fabricated orthotics can be found at your
support the foot and allow for a more normallocal sports store and will help many
walking pattern. In some cases, children onlyindividuals with flatfeet. They are much
need the orthotic during the first few years,cheaper than custom-made orthotics, but they
and after the arch develops, the orthotic iswill wear out in 1-2 years. A custom-made
no longer needed. In most cases, childrenorthotic is custom to each foot and
will not "outgrow" their flatfeet.As the archcorrections are built-in to help the foot
develops between 4 and 8 years of age, thefunction. They are designed to keep stress
child's body goes through numerous changes.off the ligaments and tendons in the arch and
The bones grow in length while the leg anddesigned to distribute the pressure evenly
thigh bones are rotating. During these yearswhile walking. The cover material on the
it may be difficult to determine if thecustom-made orthotic may need to be changed
flatfeet will become a problem or not. One ofevery one to two years, but the orthotic
best indicators of a problem is pain.itself will last ten years. As expected,
Children should not have pain in their feet.custom-made orthotics are much more expensive
They should be able to run around with theirthan prefabricated orthotics or inserts.In
friends or in an organized sport without anysummary, all infants have flatfeet, but more
pain. If your child is having foot, ankle orsevere flatfeet in this group can become a
leg pain, make sure they see aproblem. The arch develops between four and
podiatrist.Young children between eight andeight years of age and predicting long term
thirteen years may have flatfeet, but notfoot problems in this group can be difficult.
complain of any pain. This is a commonMany children, teenagers and adults have
occurrence in this age group, especially ifflatfeet, yet no foot problems. Therefore,
the children are not competitive in anynot all flatfeet need to be treated. But,
sports. Look for the following:1. The archchildren with foot, ankle or leg pain and
touches the floor and the ankles and feetflatfeet should be evaluated by a podiatrist.
rotate in.2. The knees are very closeFor children with flatfeet and foot pain,
together (knock-knees).3. Shoes are worn outcustom made orthotics are essential to
within 3 months.4. Wear pattern on the shoetreatment of the foot problem and for
is toward the inside (big toe side).5. Yourprevention of problems in the
child's gait is bouncy or looks awkward.6.future.Christine Dobrowolski is a podiatrist
Your child seems slower than his or herand the author of Those Aching Feet: Your
friends or shows a lack of interest inGuide to Diagnosis and Treatment of Common
sporting activities despite being athletic.IfFoot Problems. To learn more about Dr.
your child shows any of these signs it is



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