A couple of weeks ago, I had a mom come into my office with this same concern. Her 9 year old son, “Timmy” was experiencing no pains anywhere in his lower limb. When he ran and played with his friends there was no concern. But when his mom watched him walk and run she had noticed that his ankles rolled in and knew that this didn’t look right. So there they were sitting in my office wanting me to complete and assessment on Timmy’s lower limb. This is what I found:
- Functional pes planus
- Forefoot alignment was in varus
- Hypermobile ankle and subtalar joint
- Arch height normal
- Bilateral genu valgum (knocked knees)
- Bilateral tibial varus
- Arch height flattened - pes planus
- Bilateral valgus rear foot
- Central rearfoot heel strike
- Moderately pronated midstance that was prolonged into the 1st MTP joint
- Failure of the subtalar joint to resupination during toe-off
Once my assessment was completed I had told Timmy’s mother that Timmy had an asymptomatic flexible flat foot. Asymptomatic meaning no pain with his flat feet. Because of there being no pain at this time but there was a concern, I did suggest a pair of custom made foot orthotics. There is controversy over children wearing custom orthotics when pain in not present however, when I parent is concerned of their child’s foot, custom orthotics are typically the route they do choose to go down.
I casted Timmy for a pair of custom orthotics and had him come back in a week to pick them up. Upon his follow up a couple of weeks after wearing his new orthotics, it was his mother that told me she had noticed a big improvement in the way Timmy was walking in general. She felt he was out running and playing for a longer period of time. He looked straighter and had even mentioned to me that he looks taller when he is wearing his shoes and custom orthotics.
In this case, custom orthotics did work for Timmy even though pain in his lower limb was never an issue but biomechanically improvements were noticed.