Flat feet in children

What are flat feet in children, and how common are they?

Flat feet in children (developmental flat foot) means the arch along the inside of the foot is low or missing when your child stands¹. Most are flexible: the arch shows when the foot is off the ground, such as when sitting, or when your child stands on tiptoe¹.

Flexible flat foot is usually a normal part of growth, not a disease². A rigid (stiff) flat foot, where the arch doesn't come back, is rare and may have an underlying cause².

Children are born with flexible flat feet and build an arch over the first decade of life, so a flat foot is expected at certain ages³. It's very common in young children and becomes less common with age³. Some children never develop an arch, and for them flat feet are simply their normal shape¹.

What causes flat feet in children, and who gets them?

Mostly it's normal growth. Children's joints and ligaments are looser than adults', their feet carry extra fatty tissue, and their muscle control is still maturing⁴. Often there's no obvious cause, and flat feet sometimes run in families⁵.

Very loose joints (hypermobility) and being overweight are linked with flat feet that last⁶⁷. These are links, not proven causes, and findings on weight are mixed⁸. If you're concerned about your child's weight, a health professional can help.

What do flat feet look like, and how are they diagnosed?

When your child stands, the arch disappears, the middle of the foot sags towards the ground and the heel tilts outwards⁹. Flexible flat feet usually cause no symptoms¹⁰. Some children do get sore or tired feet, legs or ankles (especially after activity), uneven wear on the inside of the shoe heel, or more tripping and falling¹¹.

A doctor can diagnose flat feet from your child's symptoms and an examination of the feet standing, sitting and walking. X-rays are sometimes ordered¹⁰. The key check is whether the arch comes back when the foot is off the ground¹².

What can I do about my child's flat feet?

Most children with a flexible, painless flat foot need no treatment, just reassurance and watching how it develops¹³. No treatment is needed if the arch comes back on tiptoe or when the foot isn't bearing weight¹⁴. Arches usually develop somewhere between 3 and 10 years of age⁵.

It isn't clear yet whether insoles, exercises or special shoes change how the arch develops. Keep an eye on how your child's feet look and feel, and see your GP or a podiatrist if anything changes.

What helps if my child's flat foot is painful or isn't settling?

If pain or limited activity continues, see your GP or a podiatrist rather than waiting. A rigid or painful flat foot in a child older than 3 years that limits activities such as running or jumping is a reason for referral to a public hospital service¹⁵. So are toe walking with an abnormal spine examination, asymmetry, enlarged calf muscles, or signs of cerebral palsy¹⁵. What comes next depends on that assessment.

Will my child grow out of flat feet?

For most children the outlook is good: the arch develops by itself during the first decade, and few children have symptoms¹⁶. Only a minority have a flat foot that lasts or gets worse, and pain is uncommon⁷.

Being overweight and very loose joints are linked with flat feet that last⁷⁶. Beyond about age ten, a flat foot can become stiffer⁷. If your child is around that age and the flat foot persists or becomes painful, see your GP or a podiatrist.