Flat feet: which children need surgery? | Children's Charity

Flat feet: which children need surgery?

First published on 14 May 2012

Updated on 4 August 2016

What did the project achieve?

“My research has improved understanding of the consequences of having flexible flat feet during childhood,” says Mr Alpesh Kothari of the University of Oxford.

When children have flexible flat feet, the arches of their feet are lost when standing, meaning the foot presses almost completely flat against the ground. While many children have no noticeable symptoms, some experience pain, stiffness and other problems.

“My studies of nearly 100 children show that having flexible flat feet reduces health-related quality of life in some children,” says Mr Kothari. “Children with flexible flat feet may walk more slowly, can have abnormal foot and ankle motion, and are more likely to experience knee, hip and back pain. What’s more having flat feet is linked to changes in the shape of the joint below the ankle (the subtalar joint).”

“These findings may help when identifying which children with flexible flat feet need treatment and will help me work towards my ultimate goal of finding the best ways to improve those children’s symptoms and quality of life,” adds Mr Kothari. “Next steps are to investigate treatment options, including physiotherapy and surgery, and I hope to set up a clinical trial to find out whether shoe insoles improve symptoms, and whether expensive custom-made insoles are any better than off-the-shelf insoles.”

This research was completed on 31 July 2015

Research Training Fellowship*: Mr Alpesh Kothari

Estimates suggest nearly one in five children is flat footed.1 The majority of these children find their feet cause no noticeable problems. However, some develop considerable disability. Mr Alpesh Kothari, of the University of Oxford, is looking for objective ways to predict which children will develop disability. This could help guide surgeons when deciding whether a child would benefit from an operation to recreate the arches of his or her feet.

What is the problem and who does it affect?

The most common reason why children are referred to specialist orthopaedic clinics is that they have flat feet. Essentially, this means the arches of their feet are lost when standing.

While most children with flat feet are fine, others go on to experience on-going pain and disability. "Problems can range from some pain around the foot and ankle when walking long distances, to difficulty even walking short distances," says Mr Kothari. "Children with more severe problems can find it difficult to participate in many recreational activities with their peers, which puts them at risk of feeling left out and isolated. Further down the line flat footedness can lead to other problems like foot and ankle arthritis, bunions and nerve entrapment, and may be linked with knee, hip and back problems."

Surgery to recreate the foot arch can help. However, there are risks, including infections, damage to nerves and blood vessels, problems with metalwork, recurrent deformity and stiffness.

"At the moment, surgeons have no robust way to predict which children are likely to develop disabilities and which children will be fine," says Mr Kothari. "This makes it difficult to decide whether or not a child would benefit from early surgery."

What is the project trying to achieve?

"I am investigating why flat feet lead to disability in some children and not in others," explains Mr Kothari. He is studying 100 children aged between nine and 15. Half of the children have flat feet.

Mr Kothari is assessing several things:

  • the structure of the children’s feet – using MRI scans, for example
  • how the children’s feet, legs and pelvis move when they are walking
  • how forces are exerted through the sole of the children’s feet
  • whether the children have any symptoms or disabilities that they think are related to their feet.

"I hope to establish new diagnostic guidelines that can help to predict whether a child with flat feet is likely to develop disabilities," says Mr Kothari. "I also hope to find out whether flat feet lead to problems in the knees, hips and lower back. All this information will help when deciding which children need surgery."

What are the researchers’ credentials?

"I hope to become an academic paediatric orthopaedic surgeon – helping children on a day-to-day basis in my clinical practice and improving future care through research," explains Mr Kothari. "I feel a huge sense of responsibility to use this funding wisely to make a difference to the lives of children and their families."

Project LeaderMr Alpesh Kothari MA BMBCh MSc MRCS
Project team
  • Mr Tim Theologis PhD FRCS
  • Dr Amy Zavatsky MA DPhil
LocationDepartment of Paediatric Orthopaedics, Nuffield Orthopaedic Centre, University of Oxford
Other locations
  • Department of Engineering, University of Oxford
Duration2 years
Grant awarded14 February 2012
Start date8 May 2012
End date31 July 2015
Grant amount£183,004.00
Grant codeGN2019

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  1. Craxford AD et al. Plantar pressures and gait parameters: a study of foot shape and limb rotations in children. J Pediatr Orthop 1984; 4: 477-81.

*Research Training Fellowships:

Each year, Action Medical Research awards these prestigious grants to help the brightest and best doctors and scientists develop their career in medical research.

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