Flat Feet in Children

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

Flat feet (where the inner arch of the foot is low or absent when standing) are very common in children and are usually a normal variation rather than a problem. Almost all young children have flat feet, and the arch develops naturally over the first decade of life. The great majority of children with flat feet have no pain and need no treatment.

Flexible versus rigid flat feet

The key distinction is between flexible and rigid flat feet:

●      Flexible flat feet – the arch appears when the child stands on tiptoe or when the foot is not bearing weight, and disappears again on standing. This is the common, normal type.

●      Rigid flat feet – the foot stays flat regardless of position, and may be stiff or painful. This is uncommon and can indicate an underlying condition (such as bones that are joined together, a tarsal coalition) that warrants assessment.

When to seek assessment

Assessment is worthwhile if a child’s flat feet are:

●      Painful, or causing the child to tire or avoid activity

●      Rigid (do not correct on tiptoes) or stiff

●      Present on only one side, or associated with an in-turning or out-turning heel that does not correct

●      Associated with other concerns such as delayed milestones or a neurological condition

Treatment

For the common, painless, flexible flat foot, no treatment is needed – arch supports and special shoes do not change the shape of a growing foot and are not routinely recommended. Where a child has symptoms, simple measures such as supportive footwear, calf stretching, activity modification and, sometimes, an orthotic for comfort are used. Surgery is reserved for the small number of children with a painful, rigid deformity or an underlying structural cause that does not respond to non-operative care.

Summary

Flat feet in children are usually normal, painless and flexible, and need only reassurance – arch supports are not required for the typical flexible flat foot. Assessment is aimed at the uncommon child whose feet are painful, rigid or asymmetric.