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Quick reference medical handouts used by Pediatric offices

Flat Feet in Children

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What are flat feet?

Flat feet is a condition in which the foot doesn't have a normal arch. It may affect one foot or both feet. At first, all babies' feet look flat because an arch hasn't formed yet. Arches should form by the time your child is 2 or 3 years old. Flat feet, even in older children, usually do not cause any problems.

What causes flat feet?

Flat feet.......
  • Is painless.
  • Does not interfere with walking or sports participation.
  • Corrects itself over time without surgery or other treatment

Most flat feet are caused by loose joint connections and baby fat between the foot bones. These conditions make the arch fall when your child stands up. This is why you sometimes hear flat feet called "fallen arches." The feet may look like they have arches when your child is sitting or when the big toe is bent backward, but the arch flattens when the child puts weight on the foot.

Should I take my child to the doctor?

If your child complains of foot or ankle pain, take him or her to the doctor. Flat feet in an older child may cause pain in the heel or arch, or may cause pain when the child is walking and running. Your doctor will look at your child's feet to make sure that the pain isn't caused by a problem in the hip or the knee. Rarely, flat feet can be caused by foot bones that are joined together. In this case, the bones can't move, and the foot hurts. Your child may need to have x-rays, but your doctor probably can tell you what the problem is just by looking at your child's feet.

There are three symptoms that indicate you should have your flat-footed child seen by a doctor:

• No arch when the child sits or stands on tiptoes

• Persistent pain around the arch of the foot

• Frequent toe walking, often due to foot pain

Will my child need special shoes or inserts?

Probably not. Your child's foot development will be the same whether arch supports are worn or not. High-top or special orthopedic shoes, "cookies" or wedges are only useful to keep the shoe on your child's foot. If your child has foot pain, your doctor may recommend a heel cup or a shoe insert.

Will some activities make flat feet worse?

No. You don't need to limit your child's activities. If flat feet become painful from overuse, your doctor may recommend rest. Wearing a certain style of shoe, walking barefoot, running, doing foot exercises or jumping will not make flat feet worse or better.

Many children treated for flat foot shouldn’t be. That’s the finding of an Austrian study of 835 children three to six years old. Forty-four percent of the 411 girls and 424 boys were diagnosed with “flexible flat foot.” That may seem like a lot of children, but it’s important to understand there are two types of flat feet.

The most common type of flat foot, and the type that over 99% of these children had, is “flexible flat foot” (FFF). Children with FFF have flexibility in their feet. When they stand, the arch of their foot disappears and the bottom of the foot appears flat. The arch reappears when their big toe is raised or when they are off their feet This form of flat feet is painless. The other type of flat footedness, “rigid flat feet” (RFF), is more serious. The feet of these children are rigid and less flexible, the arch doesn’t reappear and their feet may be painful. These children benefit from arch supports.

Interestingly, the number of children with flat foot declines with age. This study found 54% of three year olds showed at least one flat foot. The percentage dropped to 24% for the six year olds. Over 99% of all the children diagnosed with flat feet had the flexible type. Yet, 10% of all the children diagnosed with flat foot had arch supports – a treatment needed only in children with RFF.

Many orthopedists believe the best treatment for children with any type of flat footedness is sneakers with flexible soles. Since arch supports are uncomfortable and sometimes difficult to use properly, it’s best to avoid them unless diagnosed with RFF. Arch supports, when not needed, may actually interfere with proper foot development.

posted 04-22-07 on


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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