It is common for young children to have a foot deformity called infantile bent flatfoot, which is harmless and usually goes away on its own by school age.
What is infantile bent flatfoot?
Infantile buckling flatfoot is the name given to a harmless foot deformity that is common in children, in which the heel is bent outward in the shape of an X and at the same time the arch of the foot appears flattened, as in flatfoot. This anomaly occurs in most children and has to do with the growth of the skeleton, which is why it is also referred to as physiological bent flat foot. The deformity becomes noticeable only after a child has started walking. However, the natural gait is not hindered by it. In most cases, the child’s bent and fallen arches regress on their own by the time the child starts school. Treatment is only needed if the gait is severely affected and the deformity has not normalized sufficiently by age 7.
Causes
Thus, the main cause of infantile bent flatfoot is to be found in the physiological growth of a child. The main reason is the holding apparatus of the foot, which is different from that of an adult. Due to their anatomy, children have to turn their foot a little inward when walking and try to counteract this inward rotation by bending the foot. This causes the foot to buckle at the ankle and the arch to flatten. This is also the reason why children often have knock knees. But other, non-developmental causes may also be a possibility:
- Instability of tendons and ligaments
- A weak musculature
- Severe overweight (obesity)
- X- or O-legs
- Paralysis especially of the posterior tibial muscle.
- Diseases of the bones
Typical symptoms and signs
- The heel is bent outward, at the ankle
- X-position of the foot (bent foot).
- The foot surface is flattened (similar to the flat foot), the flat foot lies majority on the ground
- X-legs
Diagnosis and course
A child’s bent flat foot can be recognized purely externally by the X-position of the ankle and the arch of the foot resting on the ground. Significantly, the deformity does not appear until after the child learns to walk. This phenomenon is rarely painful, does not affect the natural gait at all and usually disappears by itself at the latest at school age. Only in the case of severe symptoms should a possible other cause be clarified, e.g. a congenital flat foot or malformations / adhesions in the area of the foot bone parts. The pediatrician usually makes the diagnosis by examining the child’s foot, looking at the arch of the foot for flattening. To determine if it is the physiological infantile bent flat foot, he performs further tests:
- Appraisal, whether the arch of the foot straightens in the tiptoe stand
- Mobility of the ankle, should be possible without pain
- Podogram (footprint) to see if the foot shows a normal infantile silhouette.
Only if there are severe restrictions of movement or pain, an X-ray examination is performed to rule out other causes. If necessary, the condition is checked again at certain intervals.
Complications
In most cases, the bent flat foot does not lead to any particular complications or discomfort. This usually disappears by school age, so there is no subsequent damage or limitation in adulthood. Those affected suffer from a malposition of the feet. This can lead to teasing or bullying, especially in children, and thus trigger depression or other psychological complaints. It is not uncommon for patients to appear irritable as a result and suffer from a greatly reduced sense of self-worth. Furthermore, the so-called knock-knees also occur. The deformity can lead to further restrictions in movement, so that the child may no longer be able to perform certain sports without further ado. This can also disturb the child’s development. In most cases, no treatment of this condition is necessary and the symptoms disappear on their own. If necessary, the diet and lifestyle must be changed.Various therapies and exercises can also alleviate the symptoms. As a rule, no particular complications occur. The life expectancy of the patient is also not reduced by the bent flat foot.
When should you go to the doctor?
Parents who notice a foot deformity in their child should consult the pediatrician or an orthopedist promptly. Typical signs such as a flattened arch or knock-knees indicate a child’s bent flat foot, which in any case requires medical clarification. If the malposition is corrected at an early stage, permanent damage can be avoided. A visit to the doctor is necessary at the latest when the child complains of pain or other complaints. Thus, with gait difficulties and nerve disorders, but also with mental suffering as a result of the foot malposition, a specialist should be consulted. If the child’s bent flat foot takes a severe course, an individual therapy must be worked out together with an orthopedist, which is adapted to the type and severity of the complaints. Regular visits to the doctor are necessary during treatment, as the position of the feet changes during growth and the therapy may need to be adjusted. Parents of affected children should regularly consult with the doctor and pay attention to any noticeable symptoms in the child.
Treatment and therapy
In most cases, there is no need for treatment in infantile bent flatfoot because the arch of the foot develops on its own as a result of growth and the deformity recedes. Even if the arch of the foot remains somewhat flattened after growth, this is usually not a problem in adulthood. The best therapy is to let children walk barefoot a lot, especially on natural ground, playful foot gymnastics exercises, gripping exercises with the toes and the toe stand. In case of discomfort, insoles can be prescribed as well as physiotherapy exercises. In obese children, nutritional counseling and diet are also indicated to prevent further discomfort. In particularly severe cases, there are two surgical methods for correction: soft tissue surgery to improve the pull of the muscles that straighten the arch of the foot, and bony surgery for connections to neurological disorders.
Outlook and prognosis
In most cases, the prognosis for patients with infantile bent flatfoot is favorable. Particularly in mild to moderate cases, the deformity corrects itself before children reach school age. Pain does not usually occur in these cases. In more severe cases, the disease can take a protracted course, in which case pain symptoms cannot be ruled out. If left untreated, the deformity can last for years and still lead to problems in adulthood. A pronounced bent and flat foot over many years can lead to problems with the statics of the musculoskeletal system. Resulting knee malpositions, such as knock knees or bow legs, can lead not only to pain in the knee joints but also to hip problems or back pain in the lumbar region. In the case of treatment of a severe form of the bent flat foot, a treatment period of several (usually 2-3) years can be assumed. In this case, however, the outlook for the patient is positive again; in the majority of cases, the bent low arch regresses within the period of time mentioned. Also, any pain that may be present usually subsides shortly after the start of treatment, thus enabling a pain-free gait.
Prevention
You can’t actually prevent a child’s bent flat foot, because it’s part of a child’s natural growth. However, if children can walk barefoot a lot mainly on natural ground and wear shoes that are comfortable and well adapted to the foot, you can already contribute a lot to a healthy development.
Aftercare
After the cast is removed, it is critical to maintain the improved correction with good follow-up care to prevent recurrences. A splint should be worn for the first three months after treatment. After that, it is used only at night until five years of age. This brace is a rod whose length measures the same distance as between the child’s shoulders. The ends of this rod are attached to the shoes at a 60 degree angle. For children with a bent-lowered foot, it is a 30 degree angle. The child will usually become accustomed to walking with the brace during follow-up treatment.Since these special shoes can cause blisters and sores, the correct fitting and wearing of them should be discussed with the treating physician. Follow-up surgery is required in rare cases if difficulties occur while wearing the splint. Infantile bent flat foot should be corrected only with a thorough understanding of the anatomy and motion of the healthy foot. Before considering surgery, contact centers and clinics that are knowledgeable about nonsurgical corrections.
Here’s what you can do yourself
Infantile bent flatfoot usually disappears on its own in children over the years, usually while they are still in preschool. Therefore, the condition is usually not a cause for concern, but it should be watched closely. Since infantile bent flatfoot is not accompanied by pain and children can move normally, the quality of life of those affected is not noticeably limited. Nevertheless, there are some factors that favor the infantile bent flatfoot and under certain circumstances contribute to the fact that it does not regress sufficiently. In order to improve the well-being of the affected children, existing excess weight should be reduced. In addition, the physiotherapist recommends adequate exercises for the children to do regularly at home to strengthen muscles and tendons. It is particularly beneficial for the progression of the disease of pediatric flatfoot if the children walk barefoot as often as possible. This strengthens the foot as well as the legs and counteracts the deformity. By strengthening the muscles when walking barefoot, the children’s bent and fallen arches often disappear more quickly. If the doctor prescribes shoe inserts or special orthopedic shoes for the foot deformity, they should be worn as prescribed to help the natural regression of the Child’s Knee-Lower Foot.
