Flat Feet in Children: What Parents Really Need to Know
Why Your Child’s Feet Look Flat
If you’ve ever noticed your child’s arches disappear when they stand, you are not alone. Flat feet in kids is one of the most common concerns parents bring up in my office. The technical term is pediatric flatfoot, and most of the time it’s simply a normal part of growth. Children are born with very little arch, and the fat pad on the bottom of the foot makes the arch look even flatter. As ligaments tighten and bones mature, arches typically develop around ages 7 to 10.¹ ²
The key point for parents: flat feet are often normal in kids, especially if they’re flexible and pain-free.
What Is Flexible Flatfoot?
Flatfoot simply means the arch of the foot is lower than average. In children, the most common type is flexible flatfoot, where:
The arch looks flat when standing
The arch reappears when the child tiptoes or sits with feet dangling
This is different from rigid flatfoot, which is much less common. In rigid cases, the arch never appears, even when the child rises onto tiptoe. That’s often a red flag for more serious problems like tarsal coalition (abnormal connections between bones) or neuromuscular conditions.³ ⁴
Flexible flatfoot is usually a developmental variant, not a disease.
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When to Worry
Flat feet don’t usually need treatment. But there are situations where parents should pay closer attention:
Pain: Foot or ankle pain with activity is not normal
Stiffness: If your child cannot rise on tiptoe or has limited ankle motion
Limping or fatigue: Kids who tire faster than peers or avoid sports may need evaluation
Uneven shoe wear: Rapid breakdown of the inside edge of shoes may indicate excessive pronation
In these cases, it’s worth having a podiatric evaluation to rule out more significant conditions.⁵
How We Diagnose It
A pediatric foot exam is straightforward and usually does not require imaging. Key parts of the exam include:
Gait observation: Watching how your child walks and runs
Heel rise test: Asking your child to stand on tiptoe. If the arch reappears, the flatfoot is flexible
Joint motion: Assessing ankle and subtalar flexibility
X-rays or MRI are only needed if there is pain, stiffness, or suspicion of rigid flatfoot.⁶ ⁷
Treatment Options
Most kids with flexible flatfoot need nothing more than reassurance. But for children with pain or difficulty in activity, treatment is aimed at comfort and function rather than “fixing” the foot.
1. No Symptoms: Observation Only
Regular monitoring during checkups
Reassurance to parents that flat feet alone are not harmful
2. Mild Symptoms
Supportive footwear with a firm heel counter
Over-the-counter arch supports or cushioned inserts
Calf stretches if tightness is present
3. Persistent or Moderate Symptoms
Physical therapy to strengthen intrinsic foot muscles and improve mechanics
Custom orthotics when pain interferes with sports or daily activity
Activity modification during flare-ups
4. Severe or Rigid Cases
Imaging to check for underlying pathology
Rarely, surgery in adolescents only when there persistent pain and/or structural deformity
ABOVE: Before and After of a standard pediatric flatfoot correction. Showing a Cotton osteotomy, Evans osteotomy, Posterior tibial tendon tightening with removal of accessory bone, and an achilles tendon lengthening
The American College of Foot and Ankle Surgeons (ACFAS) and AOFAS clinical consensus statements both emphasize that orthotics and supportive care reduce symptoms, but surgery is reserved for severe, painful deformities that don’t respond to conservative management.⁸ ⁹
The Role of Shoes
Parents often ask, “What shoes are best for flat feet?” The truth is that shoes alone don’t create or correct an arch, but they can reduce pain and fatigue.
Features to look for:
Firm heel counter: Prevents excessive inward rolling
Supportive midsole: Provides cushioning and mild arch support
Appropriate fit: Wide toe box to allow natural foot development
Avoid overly stiff or “corrective” shoes unless recommended by a physician. Research shows that forcing arch correction in otherwise asymptomatic kids is not necessary.¹⁰
Recovery and Timeline
Flatfoot is often a developmental stage rather than a permanent condition. Here’s what to expect:
Ages 1–5: Flatfoot is normal due to ligament laxity and fat pads
Ages 6–9: Arches often begin to appear as muscles strengthen
Ages 10+: Persistent flatfoot is still common and often normal, especially if flexible and pain-free
If treatment is needed, most kids improve within 3 to 6 months of conservative care like shoes, inserts, and stretching.¹¹
Special Reassurance for Parents
This is where I spend the most time in clinic: helping parents breathe easier. Flat feet are often framed as a problem that must be “fixed.” In reality, most kids with flexible flatfoot grow up to be active adults without limitations.
Common myths to bust:
Myth: Flat feet always cause arthritis.
Reality: Many flatfooted children remain pain-free lifelong.¹²
Myth: All flat feet require orthotics.
Reality: Only kids with pain or activity limitation may benefit.
Myth: Flat feet automatically need surgery.
Reality: Surgery is extremely rare and only for severe, painful cases.
Parents should focus more on how their child functions than how their feet look.
Prevention and Long-Term Outlook
There is no way to “prevent” flatfoot, since it’s often a normal variation. But parents can promote healthy development by:
Encouraging regular physical activity
Keeping children at a healthy weight
Choosing supportive, well-fitted shoes for sports
Checking in with a foot specialist if pain develops
The long-term outlook is excellent. Most children with flexible flatfoot live fully active lives without limitation.
Resource Box: Trusted Pediatric Flatfoot Information
- AOFAS: Flatfoot in Children – Clear overview from the American Orthopaedic Foot & Ankle Society.
- APMA: Children's Feet – Tips from the American Podiatric Medical Association on kids’ foot health.
- Journal of Foot & Ankle Surgery – Peer-reviewed research and consensus statements on pediatric flatfoot.
Frequently Asked Questions about Flat Feet in Children
Is flatfoot in children normal?
Yes. Most children have flat feet until around age 7–10, and many remain flatfooted into adulthood without ever developing problems.
When should I worry about my child’s flat feet?
If your child has pain, stiffness, limping, or avoids activities because of their feet, a podiatric evaluation is recommended.
Do flat feet always need treatment?
No. If there are no symptoms, no treatment is needed. Supportive shoes or orthotics are used only when children have pain or difficulty with activities.
Can flat feet cause problems later in life?
Not necessarily. Many people with flat feet live active, pain-free lives. Research shows flat feet alone do not guarantee arthritis or disability.
Does my child need surgery for flat feet?
Surgery is very rare. It is considered only for older children or teens with severe pain and deformity that does not improve with conservative care.
References
Evans AM, Rome K. Non-surgical interventions for flexible pediatric flat feet. J Foot Ankle Res. 2011.
Sullivan JA. Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg. 1999.
Harris EJ. The natural history and pathophysiology of flexible flatfoot. Clin Podiatr Med Surg. 2010.
Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010.
Pfeiffer M, et al. Prevalence of flatfoot in preschool-aged children. Pediatrics. 2006.
Wenger DR, et al. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. 1989.
Banwell HA, et al. Foot orthoses for flexible flatfeet in children and adults: a systematic review. Br J Sports Med. 2014.
ACFAS Clinical Consensus Statement: Pediatric Flatfoot. J Foot Ankle Surg. 2018.
AOFAS Position Statement: Management of Pediatric Flatfoot. AOFAS.org.
Whitford D, Esterman A. A randomized controlled trial of two types of in-shoe orthoses in children with flexible flat feet. Foot Ankle Int. 2007.
Kulcu DG, et al. Flatfoot in children: relationship with pain and disability. Arch Orthop Trauma Surg. 2007.
Drefus LC, et al. The long-term functional outcomes of untreated pediatric flatfoot. J Pediatr Orthop. 2019.
Disclaimer: This article is for educational purposes only and should not replace individualized medical care. If your child has persistent pain, consult a podiatrist or pediatric orthopedist.
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- Achilles Tendinopathy: Your Complete Guide – Kids with flat feet sometimes develop tight calves, which can stress the Achilles tendon. Learn how to spot and treat this common issue.
- Sesamoiditis: What It Is and How to Heal – Flatfoot mechanics can overload the ball of the foot, leading to pain under the big toe joint. This post explains sesamoid injuries and recovery.
