Question
QUESTION: I am so happy to find this site.  My child is 10.  I had noticed years ago that her feet "flat" and very narrow.  I mention it to the pediatrician a while back and he said to watch it.  Then recently suggested inserts in her shoes.  That was great.  She is extremely difficult to SHOE!  Nothing fits her feet.  And everything is uncomfortable (some of this is over dramatized for mom's benefit).  But she can't put inserts in every shoe.  When she gets to be a teen, she'll want to wear prettier shoes.  Do the inserts correct or just correct when wearing them?  Should she have surgery.  Sadly, I am leary that the foot specialist will say she needs it when she doesn't. I know this issue will cause all kinds of pain in the future and I would like to help her avert all that if I can.

ANSWER: Generally speaking, it sounds like your child needs orthotics (also known as orthoses).
An orthotic is a custom prescription device that can only be made by a lab with a prescription from a podiatrist or other qualified physician.Forget the shoe store and other over the counter products.
Please worry more about function than fashion. If the orthotic is to help it needs to be worn in her daily activity shoes and needs to be able to address the problem. Sometimes you need 2 pair.
"Flat feet" may not need to be treated--if the doctor deems it not to be a problem.
Although I take my daughter to the pediatrician-I would never ask her an orthopedic question---their training is not sufficient to recognize these problems.
Get a good diagnosis from a podiatrist or orthopedist who specializes in child orthopedics. If surgery is recommended-get a second opinion to confirm
Hope this helps!
Dr George Tsatsos


---------- FOLLOW-UP ----------

QUESTION: Thanks.  I am more concerned with future knee/back pain.  I assume the orthotics are only raise her arch while using them? And guess that she'd had to do that from now on.   And that surgery is the only way to get a permanent arch, am I correct?  Thanks again for the reply.

Answer
Does anyone in your family have low arches with knee or back pain?
If not-then I wouldn't worry about your daughter yet.
As a surgeon---I enjoy to do surgery----but my PRIMARY RESPONSIBILITY is to do no harm. In other words make sure that the surgery has more benefits than detriments.
If your daughter can participate in the activities that she enjoys without pain or tripping problems and does not wear out her shoes in a fashion that suggest a problem---then try orthotics and hold off on surgery.
Remember a good orthotic is made by prescription after a thorough gait analysis. This is not an arch support. A well made orthotic has the ability to change the mechanics of the foot in motion and therefore has a better chance to influence bone growth.

Hope this answer helps more!

Dr George Tsatsos

Not med advice-Just info for all