Among the many questions surrounding the pediatric flat foot, is the possible whole body affects of the pathology. The discussion regarding when and if to treat will become more clear as we have more evidence to help formulate an answer. An article by Lin from the Journal of Pediatric Orthopedics in 2001, evaluated children with flat feet to determine if their activity levels were different than children wtihout flat feet. The designation of "flat foot" was based on longitudinal arch height. Interestingly, they found that the younger children tended to have a higher propensity for flat feet. In addition they found that the presence of flat feet correlated with lower performance of certain tasks. The tasks included: squatting and standing, standing on toe, toe-walking, heel-walking, one-leg standing, and one-leg hopping. The tasks performance was based on repetition of tasks over a 30 second interval. The other significant finding was that more severe flat feet correlated with a higher ligmentaous laxity index.
One of the important conclusions from the authors was consideration of the role of muscle strength in the flexible flat foot. Perhaps early intervention with a combination of orthotics, shoes and exercises may reverse at least a portion of the flat foot deformity. I am hopeful that this group will follow-up with a study that focuses on this question. In many of the pediatric articles that I have read recently, early intervention may be the key to preventing many medical problems, maybe the pediatric flexible flat foot is one of those problems.