The term flatfoot is not a medical term, which is often used to describe a foot with a flattened or lowered arch.  The arches of normal feet can be of varying height, so it is possible to have a relatively normal foot with a low arch.  A normal foot with a low arch rarely requires treatment.

Pes plano valgus is a medical term that refers to an abnormal foot due to a flattened arch, a rolled-in appearance of the ankle, and a heel that appears to be rolled out from under the ankle.

When sitting, a person with pes plano valgus may have a reasonably well-formed arch.  However, when the person stands, the arch flattens, the ankle rolls in, and the heel rolls out (everts).  This complex set of position changes between sitting and standing is called pronation of the foot.  A pes plano valgus foot is often maximally pronated.

Pes plano valgus is usually flexible, meaning that the joints of the foot and ankle are mobile.

Usually, parents don’t become aware of their child’s pes plano valgus until they start walking, or even later.

The cause of pes plano valgus in the majority of children and adolescents is hereditary factors, such as bone and joint alignment, ligament laxity (hyperflexible joints), or a tight calf muscle.  While being overweight does not necessarily cause pes plano valgus, it can contribute to these feet being symptomatic (painful).

Pes plano valgus is not always symptomatic (painful).  However, pes plano valgus is often associated with some symptoms.  In younger children, related complaints may be tired feet or legs, wanting to be held after being on their feet for a short duration, or reluctance to play or be active on their feet.  In older children and adolescents, there may be complaints of sports-related knee, shin, heel, ankle, or arch pains.

It is often a recommendation to initiate non-surgical treatment measures in a child that:

  1. has symptomatic (painful) pes plano valgus
  2. in cases where symptoms may be minor or absent, but the foot alignment abnormality is significant, surgery is not commonly recommended.

It should be kept in mind that the goals of non-surgical treatment of pes plano valgus are:

  1.  the elimination and/or prevention of symptoms
  2. improving activity level (functional capacity).  Non-surgical measures, even custom foot orthotics, should not be expected to create a permanent structural correction of the foot.

Primary Non-Surgical Treatment Options:

  • Appropriate footwear:  the shoes must be supportive.  Choose shoes that have a sturdy heel counter.  High-top shoes and boots provide even more support than standard footwear.  Avoid sandals and barefoot.  Replace shoes that show signs of break-down in the sole or heel.
  • Your foot specialists may recommend replacing the insoles that come with shoes with a custom orthotic insert that provides superior arch support.  Prefabricated orthotics may be considered as a first-line approach in children.  Custom orthotics are recommended when a satisfactory response is not obtained with prefabricated orthotics.

Perform calf stretching exercises for 30-60 seconds on each leg at least two times per day.  In many cases, tight calf muscle may be present