In January, I took him to get his foot measured at the local Brown's Shoe Center. $32 and priceless comfort later, he's in a pair of navy blue New Balance toddler shoes, size 5, extra wide. I should've known better. Wide AND thick feet run in the family, i.e. Bill.
Flat Foot & Weak Ankle
Any child can have a flat foot but it is more common for kids with Down syndrome due to loose ligaments at the ankle (ligament laxity) and low muscle tone (hypotonia). Ligament laxity causes joint instability. I can imagine that gravity compounds this problem by allowing the ankle to roll inward once a child starts walking. My understanding of flatfeet is that it is only a problem if the condition is severe, where one is walking on the inside of the heel, and it causes foot or leg pain. The feet may be turned outward when walking instead of straight ahead.
At Matthew's physical therapy (PT) session this week, I learned that he is flat-footed. Isn't it too young to say for sure though? I thought the arch of the foot doesn't generally appear until the age of 2 or 3 (or 4?). Apparently, his therapist could already tell. I don't have her experience and trained eye so I trust her observations. 70%-80% of the kids who have Down syndrome that she has worked with required ankle braces (in severe cases) or physician-prescribed plastic foot supports called orthotics. Matthew's ankles weren't rolling inward excessively enough to need orthotics.
There are several ways to test whether an arch is being developed. One that I know of is by creating a footprint of your child’s damp foot on colored paper. Another is to walk (barefoot of course) on sand. Then check whether the foot arch leaves a noticeable gap. We'll do this when Matthew is walking independently. He still walks with two-hand support these days and sometimes with one-hand support very gingerly.
Ways To Strengthen The Ankles & Develop The Arch
Matthew's PT suggested a few exercises/ activities to help develop tendons, muscles, and ligaments. Of course, I don't think these exercises are a guarantee that an arch will develop, but if it will improve muscle tone in the legs and feet, I'm all for it.
- Walk barefoot on soft uneven surfaces - Sand on the beach is a good example but since we don't live anywhere near a beach, we can create soft uneven surfaces indoors using blankets and pillows or a bed mattress on the floor. Walking barefoot on the grass is also an option for us.
- Walk with shoes on both level and uneven hard terrains, such as the driveway, gravel road, or rocks.
- Pushing a weighted toy/ object - This requires him to push off more with his feet to move forward. A laundry basket half filled with clothes is perfect! Matthew enjoys pushing our laundry basket and fusses when I say it's time to stop.
- Activities where he needs to tiptoe and maintain the position for a few seconds at a time. He's getting tall enough to hold on to the top of our sturdy dining table. Perhaps a good motivator is having a toy on the edge of the table, just slightly out of reach so he has to tiptoe to get it.
Custom shoes, arch supports, or braces prevent flat feet from worsening and alleviate pain (only in cases of severe flatfeet) but they don't help develop an arch or correct a problem. Whether Matthew may need orthotics or not remains to be seen. He'll probably need arch supports and hopefully, the off-the-shelf kinds will work just fine. Orthotics aren't as affordable but we won't hesitate to get them if that's what Matthew will need in the future.
In the meantime, his New Balance shoes are just fine. Target, my favorite store, hasn't failed me completely. I recently found a pair of Circo brand sandals ($13) with adjustable velcro straps near the toes and the ankle. This helps compensate for his wide, thick feet. I also found a pair of slippers ($7), which are great for when he's playing at his water table.