Overpronation (flat feet) in children: causes, signs and treatment

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Overpronation, also called flatfoot or flexible flatfoot, is relatively common in children and often goes away on its own. Treatment may be needed if your child is not growing up with flat feet or complaining of foot pain.

Here’s what you need to know about recognizing, monitoring, and treating overpronation in children.

When you walk, your feet naturally move from side to side. This directional movement is called pronation and determines how well your feet absorb the shock and impact of your movements.

Your feet are supposed to stay aligned in a fairly straight stance as you walk, although a slight inward or outward roll – up to around 15% either way – is typical.

There are three types of pronation:

  • Normal (or neutral). Your feet stay mostly straight, except for a small percentage of rolling inward or outward.
  • Underpronation. Your feet roll outward more than 15%. This is also called supination.
  • Overpronation. Your feet roll inward more than 15%.

Having underpronated or overpronated feet is usually not too serious, but it can lead to other health issues if left untreated. These can include shin splints, bunions, or pain.

Flat feet are often evident in young children. This is partly because their arches are not yet fully developed.

According to the American Academy of Orthopedic Surgeons (AAOS), children are not born with arches. Instead, arches develop as children begin to walk, and the muscles along the soles of the feet strengthen and tighten. In fact, according to the AAOS, some children don’t develop arches until age 5 or older.

In 2006 study, researchers found that 44% of preschoolers observed had flexible flat feet. The children included in the study were between 3 and 6 years old. Younger children had a higher percentage of flat feet than older children, and boys were more likely to have flat feet than girls.

Because flexible flatfoot is part of many children’s natural development, it’s typical to see your child grow out of overpronation without any intervention.

However, it is important to monitor your child’s foot development. Treatment may be needed if they experience movement irregularities or pain due to flat feet.

Very young children usually have no symptoms other than visibly flat feet.

This means that when you look at the insides of your child’s feet when they are standing, there may not be much space or arch shape between the soles of their feet and the ground. You may also notice that when you look at the back of your child’s ankles while standing, they appear to be turned slightly towards each other.

However, if your child does not grow with their flat foot as they get older, they may begin to complain of certain symptoms. Any foot pain, frequent discomfort, or unusual walking style (gait) is a sign that it’s time to make an appointment with your child’s doctor.

According to the Children’s Hospital of Philadelphia, symptoms of overpronation can include:

  • arch pain
  • heel pain
  • foot pain that gets worse with physical activity
  • tightness in the foot, especially the heel cord along the back of the ankle (Achilles tendon)

Your child may also have other common signs of overpronation, including:

  • frequent corns or calluses on the feet
  • knee or back pain
  • hammer toes

If you have noticed that your child has flat feet, you can talk to their doctor about it at their next visit. This is not an urgent problem unless your child is in pain or discomfort. If so, make an appointment to have your child’s feet checked.

Many pediatricians are qualified to identify overpronation in children, although your child’s doctor may also refer you to a podiatrist (foot specialist) for an expert opinion.

According to the AAOS, during a physical examination for flatfoot, a healthcare professional may:

  • ask about family medical history
  • inspect your child’s feet
  • look at the wear patterns on their shoes
  • watch them as they perform basic movements (walking, running, standing on their tiptoes)

If your child’s doctor needs more information, they may order diagnostic tests to better see the structure of your child’s foot. This may include X-rays, CT scans, or even an MRI.

If your child’s overpronation isn’t bothering him, you probably don’t have to do anything to “fix” it.

Some research 2010 advises against treating children with asymptomatic flatfoot, arguing that the condition resolves on its own without any intervention in most cases.

But if your child is a candidate for flatfoot treatment because they have symptoms, there are several different options you can discuss with their doctor. While surgery is sometimes necessary for adults and adolescents, the AAOS reports that young children are almost never referred for flatfoot surgery.

Most likely, you will be encouraged to try one or more non-surgical treatments to help treat your child’s overpronation.

Let’s review some of these options.

Elongation

Heel cord stretching is one of the most popular types of treatment for flat feet. This involves gently stretching the Achilles tendon three times on each leg each day or when your child’s feet hurt. It is a simple approach that is generally safe for children, for research 2010.

There are several other easy-to-perform stretches that can help correct incorrect gait and strengthen your arch muscles. You may need to do them alongside your child at first, to make sure they learn the correct form and posture.

Support shoes

Flat shoes can make foot pain worse if you have overpronation. Making sure your child has shoes with a cushioned footbed and extra arch support can help reduce foot pain.

Although children are particularly attached to their favorite pair of shoes, it is important that they do not continue to use shoes that are too old or worn out. Check out the AAOS recommendations for choosing the right shoes.

Orthotics

If you can’t find shoes that offer enough support, you can add orthotics to your child’s regular shoes for extra relief. These inserts are designed to fit the contours of your child’s feet and are sold over-the-counter or available custom-made.

The AAOS says that in most cases, OTC supports work just as well – and are much cheaper – than custom orthotics.

Parents should make every effort to select or order orthotics as recommended by a podiatrist or physician. Ensuring children’s feet are correctly measured and fitted for the correct insert can improve efficiency and reduce the chance of irritation.

Painkillers safe for children

If your child complains of sore feet, ask their doctor about the safe use of a pain reliever, such as acetaminophen or ibuprofen, to help in the short term, according to Children’s Health of Orange County.

Make sure to always keep medications out of the reach of children or locked away. Children should only take medication under adult supervision and as directed by the doctor.

Children with sore feet may also benefit from putting ice or heat on their feet at the end of the day or using a manual foot massage roller to release some of the muscle tension.

physical therapy

If you can’t figure out what your child needs for their flat foot pain, a physical therapist can give advice on footwear and stretching. Physiotherapists specialize in identifying and treating a wide variety of musculoskeletal problems, whether caused by injury or chronic disease.

Even one or two sessions with a physical therapist can allow you and your child to successfully treat their overpronation at home.

The therapist will likely give your child stretches to do daily. Some children may need adult supervision to complete their routine, while others may be able to handle it on their own after guidance and practice.

Overpronation, or flexible flatfoot, is quite common in children under 5 because their arches are not yet fully developed. Once they start walking, most children naturally develop an arch and continue to have typical pronation.

If your child is over five and still has a flat foot – or if their flat foot is causing pain, discomfort, or an unusual walking style – be sure to make an appointment with your child’s doctor to have his feet checked.

Conservative treatments such as ice, stretching, or orthopedic inserts may be needed.

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