What exercises are recommended for pediatric flatfoot?

Exercise Recommendations for Pediatric Flatfoot

For children with pediatric flatfoot, an 8-12 week foot-ankle exercise program supervised by a trained healthcare professional is recommended, focusing on strengthening and stretching exercises to improve foot function and reduce risk factors for complications.

Understanding Pediatric Flatfoot

Pediatric flatfoot is a common condition characterized by the partial or complete collapse of the medial longitudinal arch of the foot. It's important to recognize that:

• Most children are born with flexible flatfeet, and the normal arch typically develops during the first decade of life 1
• Approximately 45% of preschool children and 15% of older children (average age 10 years) have flatfeet 2
• Most flexible flatfeet are asymptomatic and do not require treatment 3, 2

Assessment and Classification

Before prescribing exercises, proper assessment is essential:

1. Determine if the flatfoot is flexible or rigid:

   • Flexible flatfoot: The arch appears when the child stands on tiptoes or sits
   • Rigid flatfoot: The arch remains flat regardless of position (may indicate pathology)

2. Check for symptoms:

   • Pain location (medial midfoot, sinus tarsi)
   • Functional limitations
   • Presence of tight heel cord (Achilles tendon contracture)

Exercise Recommendations

For Asymptomatic Flexible Flatfoot:

• No specific intervention required - these are normal variants of foot shape 1, 3
• Allow normal barefoot walking indoors to promote natural foot muscle development 4
• Avoid unnecessary treatment with orthotics or corrective shoes 1

For Symptomatic Flexible Flatfoot:

1. Supervised Exercise Program:

   • 8-12 week foot-ankle exercise program under supervision of a trained healthcare professional 4
   • Continue performing exercises after the supervised program 4

2. Specific Exercises:

   • Foot and ankle strengthening exercises:

     • Toe curls and spreads
     • Towel scrunches with toes
     • Marble pickup with toes
     • Heel raises (standing on edge of step)

   • Stretching exercises (especially important with tight heel cords):

     • Achilles tendon stretches
     • Plantar fascia stretches
     • Calf muscle stretches

   • Balance and proprioceptive exercises:

     • Single-leg standing
     • Balance board activities
     • Walking on different surfaces

3. Functional Exercises:

   • Gait training
   • Coordination exercises
   • Age-appropriate strength training for lower extremities

Physical Activity Guidelines

In addition to specific foot exercises, general physical activity is beneficial:

• Children should participate in 60 minutes of moderate to vigorous-intensity aerobic activity daily 4
• Include muscle-strengthening and bone-strengthening activities at least 3 days per week 4
• For children with flatfoot, activities that promote foot strength and flexibility are particularly beneficial

Important Considerations

• Avoid exercises that cause pain or discomfort
• Monitor progress with regular assessment
• Modify exercises as the child improves
• Children with pre-ulcerative lesions should not participate in exercises that mechanically load the foot 4
• For rigid flatfoot or pathological conditions, consult with a specialist before implementing an exercise program

When to Consider Additional Interventions

• If symptoms persist despite exercise program
• If there's significant pain that interferes with normal activities
• If there's a contracture of the heel cord that doesn't respond to stretching
• If the flatfoot is rigid or associated with other pathologies

Conclusion

Most pediatric flatfeet are asymptomatic and resolve naturally with age. For symptomatic cases, an 8-12 week supervised exercise program focusing on foot and ankle strengthening, stretching (especially for tight heel cords), and balance training is recommended. Surgery is rarely indicated and should be reserved only for cases with persistent localized symptoms despite conservative care.