Do flat feet in children need treatment?

What are flexible flat feet?

Flat feet mean the arch on the inner side of the foot is low or absent when standing. In flexible flat feet, the arch appears when the child stands on tiptoe or sits with the foot hanging, and the foot moves normally.

Almost all babies and toddlers have flat-looking feet because of fat pads and ligament laxity. The arch usually develops gradually during childhood. A Cochrane review reports that paediatric flat feet are common in primary care, with a reported prevalence of about 15 per cent, and only a minority cause pain or limit walking 1.

Do insoles or special shoes help children without symptoms?

The Cochrane review included 16 trials with 1,058 children aged 11 months to 19 years with flexible flat feet 1. In children without symptoms, one trial of 106 participants found that custom-made foot orthoses resulted in little or no difference in the proportion of children without pain at one year compared with shoes alone, based on low-quality evidence 1.

Prefabricated orthoses also showed little or no difference compared with shoes in the same trial 1. The certainty of the evidence overall was very low to low, so routine insoles for children without symptoms are not usually recommended.

When do flat feet need assessment?

Assessment is advisable if a child has foot, ankle or leg pain, tires quickly when walking, has a stiff foot where the arch does not appear on tiptoe, has flat feet on one side only, or if the problem appears or worsens after early childhood.

Flat feet together with frequent tripping, delayed walking, low muscle tone, joint hypermobility, or conditions such as juvenile idiopathic arthritis also warrant assessment.

What can cause rigid flat feet?

Rigid flat feet, where the arch does not form with tiptoeing, may be caused by conditions such as tarsal coalition, in which two foot bones are joined, a tight Achilles tendon, or neurological and muscular conditions. These are less common than flexible flat feet but may require specific treatment.

Pain in the midfoot or ankle during adolescence with a stiff foot should be assessed, sometimes with X-rays or other imaging.

What helps children with painful flexible flat feet?

For children with symptoms, options may include supportive footwear, foot orthoses, calf stretching if the calf is tight and exercises to strengthen the foot and lower leg muscles. The Cochrane review found limited, low-certainty evidence in symptomatic groups, such as children with juvenile idiopathic arthritis 1.

Weight management, activity adjustment and treatment of related conditions can also reduce symptoms. Surgery is rarely considered and only for persistent pain that does not respond to other treatment.

How can I check my child’s feet at home?

Ask your child to stand on tiptoe. In flexible flat feet, an arch usually appears and the heel turns slightly inward. Also look at whether both feet look similar, whether shoes wear down evenly and whether your child complains of pain or tires quickly when walking or running.

These simple checks do not replace an assessment, but they help you decide when to seek advice. A stiff foot where no arch appears on tiptoe, pain, or flat feet on one side only are reasons to see a health professional.

What can parents do?

Encourage active play, walking and running on varied surfaces and barefoot time indoors, which supports foot muscle development. Choose comfortable, well-fitting shoes with a firm heel counter for outdoor activities.

Watch for pain, fatigue or changes in walking and seek advice if concerns arise.

Frequently asked questions