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Flexible Flatfoot in Children

Flatfoot in children does not occur before a child reaches four or five years of age because the arches of the feet do not develop before the fourth or fifth year of life. Flexible flatfoot is said to occur when the arch of the foot disappears in a child who standing on the ground but reappears when the child is sitting down or standing on tip-toe.

Parents are often concerned by the appearance of this very common childhood affliction. Their concern that an abnormally low or absent arch in their child’s foot will lead to a deformity or disability in the future is almost always unfounded. Most children do not experience pain symptoms or interference when walking or participating in sports. Children typically outgrow flatfoot without experiencing discomfort or complications; it is only in later childhood that very flat feet may cause problems.


Flexible flatfoot in childhood occurs in both feet and is categorized as a variation of a normal foot because the muscles and joints continue to function as usual despite the lack of a highly developed arch. This lack of arch in early childhood is not a particularly alarming affliction however, as children are born without any significant arch formation. It is only as they grow and walk and begin executing weight-bearing activities that the soft tissue running through the bottom of the feet begin to tighten, which only then begins to shape the arches and promote visible arch development.

If the arches do not begin to develop after nine years of age and flatfoot continues into adolescence the child may begin to show the following symptoms:

  • Aching in the arch of the feet and legs
  • Fatigue in the feet and/or legs
  • Difficulty keeping up with peers during sports or recreational activities
  • Pain in a specific part of the foot and/or along the bottom of the foot

Flexible flatfoot may become increasingly severe if it continues into early adolescence and is left untreated, particularly in cases where the feet are very flat. If a child is experiencing pain symptoms in the foot at any age a medical professional should be consulted.


Obtaining a correct diagnosis will require the doctor to examine your child’s feet. This will help to confirm the diagnosis and rule out any other type of foot problem that would require immediate treatment. For instance, if your child has both flat feet and a tight Achilles tendon, or rigid flatfoot—which is much more serious than flexible flatfoot—then the ‘wait and see’ used in typical cases is not appropriate.

You should inform your doctor if there is a history of flatfoot in the family as this would strongly indicate an inherited condition. Your doctor will also need to be notified of any known neurological or muscular diseases that your child is suffering from.

It is common for doctors to inspect the wear patterns on your child’s shoe as it is highly indicative of the general way the foot is functioning in motion, so don’t be surprised if the question arises. Your doctor will likely also have your child sit, stand, lift the toes from the floor while standing, and stand on tiptoe in order to observe the foot in motion.

The doctor should also examine the child’s Achilles tendon (heel cord) for any signs of tightness, as this will affect treatment methods. He or she may also examine the bottom of the child’s foot for calluses, which often occur in both children and adults who have flat feet.

Conservative Treatment of Flatfoot in Children

Flexible flatfoot in children only requires treatment if the child is experiencing pain or discomfort.

If the pain results from physical activity and the child is experiencing fatigue in the foot, ankle, and/or leg the following exercise may help to relieve discomfort by stretching the Achilles tendon:

Heel Cord Stretch:

  • Face a wall that is clear of debris or wall hangings
  • Lean forward and brace your hands the wall
  • Bring your left foot forward and place it ahead of the right foot, bending the knee in the left leg
  • Deepen the stretch if necessary by deepening the bend in your knee
  • Hold for 15-30 seconds, making sure that both heels stay flat on the floor and that the right foot is facing forward and not out to the side
  • Repeat 2-3 times
  • Switch sides and repeat

Another effective conservative treatment is the introduction and use of orthotic devices. The following option may provide relief:

Shoe Inserts: If your child’s discomfort does not alleviate over time your doctor may prescribe the use of shoe inserts. You may choose between soft, firm, and hard molded arch supports depending on the child’s preference and the degree of support needed. Shoe inserts may not only reduce the severity of the child’s pain but increase the lifespan of their footwear, which tend to wear unevenly unless orthotics devices are used.

If the child’s discomfort is severe your doctor may prescribe physical therapy or a cast, particularly if your child suffers from both flexible flatfoot and tight Achilles tendons (heel cords), but in most cases these steps are not necessary.

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Surgical Treatment of Flatfoot in Children

It more rarely occurs that surgical intervention is necessary to help correct flatfoot in a child if the foot remains flat into adolescence and causes chronic, persistent pain. It also happens that in a small percentage of children flexible flatfoot is not outgrown but becomes rigid flatfoot instead. Should this occur your child will need further medical attention and additional treatments will likely be introduced.

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