Flat foot (pes planus): refers to a low or absent arch of the foot. In children, this is very common and usually normal.
Most infants and young children naturally have flat feet because their arches are still developing. In the majority of cases, the arch forms gradually between ages 3 and 8.
Types of Flat Foot:
1- Flexible Flat Foot (Most Common)
• Arch appears when sitting or standing on tiptoes
• Flattens during standing
• Usually painless
• Typically, does not require treatment
2- Rigid Flat Foot (Less Common)
• Arch does not appear even on tiptoes
• Foot may feel stiff
• May require further medical evaluation
Is Flat Foot a Problem?
In most children: No.
Research shows that painless flexible flat foot:
• Is a normal developmental variation
• Does not limit sports participation
• Does not require routine orthotics
Many children — and even elite athletes — have flat feet without issues.
When Should Parents Be Concerned?
Consult a healthcare professional if your child has:
• Persistent foot or ankle pain
• One foot much flatter than the other
• A stiff foot that does not form an arch on tiptoes
• Frequent tripping or difficulty walking
Does My Child Need Orthotics?
Current evidence shows:
• Orthotics are not necessary for painless flat feet
• They may help reduce pain in symptomatic children
• They do not permanently create an arch
Treatment should focus on symptoms, not appearance.
Role of Physical Therapy:
If a child has pain or fatigue, physical therapy may include:
• Strengthening foot and hip muscles
• Balance and coordination training
• Functional movement exercises
References:
Evans, A. M. (2008). The flat-footed child—To treat or not to treat: What is the clinician to do? Journal of the American Podiatric Medical Association, 98(5), 386–393. https://doi.org/10.7547/0980386
Harris, R. I., & Beath, T. (1948). Army foot survey: An investigation of foot ailments in Canadian soldiers. National Research Council of Canada.
Mosca, V. S. (2010). Flexible flatfoot in children and adolescents. Journal of Children’s Orthopaedics, 4(2), 107–121. https://doi.org/10.1007/s11832-010-0239-9
Uden, H., Scharfbillig, R., & Causby, R. (2017). The typically developing paediatric foot: How flat should it be? A systematic review. Journal of Foot and Ankle Research, 10(1), 37. https://doi.org/10.1186/s13047-017-0218-1
Whitford, D., & Esterman, A. (2007). A randomized controlled trial of two types of in-shoe orthoses in children with flexible flatfoot. Pediatrics, 119(3), e634–e640. https://doi.org/10.1542/peds.2006-1309