Pediatric Flat Feet
Symptoms, Causes and Treatment of Children's Flat Feet
What Are Flat Feet in Children?
Pediatric flat feet is a condition where the arch on the inside of a child’s foot is flattened or absent, causing the entire sole to make contact with the ground when standing. Also known as pes planus or fallen arches, this occurs when the foot’s natural arch either hasn’t yet developed or has collapsed. In children with flat feet, the characteristic curve along the inner foot appears diminished or completely flat, which is why the whole foot presses against the floor during weight-bearing activities.
While many kids with flat feet have no pain or limitations, others may experience foot, ankle, leg, or heel pain, fatigue with activity, or difficulty keeping up with sports and play. Flat feet can also affect how a child walks or runs.
The key difference is whether flat feet are flexible and pain-free or stiff and symptomatic. A pediatric foot and ankle specialist can determine if your child’s flat feet are part of normal development or if treatment is needed to prevent discomfort and long-term problems.
Trusted Pediatric Foot & Ankle Care • Thousands of children treated by Dr. Mikkel Jarman, DPM, FACFAS
Fixable vs rigid flat feet in kids
Flexible flat feet and rigid flat feet are two distinct types of pediatric flat feet that differ in their characteristics and implications. Flexible flat feet, the most common and typically benign form, appear flat when the child stands but show a visible arch when sitting, on tiptoe, or when the foot is not bearing weight. This occurs because the ligaments and tissues are looser, allowing the arch to collapse under body weight but return when pressure is released.
In contrast, rigid flat feet remain flat in all positions, whether standing or sitting, indicating a structural abnormality such as tarsal coalition (fused bones), tight tendons, or other bone and joint issues. While flexible flat feet are usually painless, rigid flat feet are more likely to cause pain, limit mobility, and necessitate medical intervention such as orthotics, special shoes or even surgery to address the underlying structural problem and prevent long-term complications.
- Flexible flat feet (arch appears when standing on tiptoes)
- Rigid flat feet (arch does not form)
Age specific guidance
Flat Feet in Infants & Toddlers
- Flat feet are common due to soft tissue and baby fat pads
- Most arches begin forming between ages 2–4
- Early evaluation helps identify rare but important concerns
Flat Feet in School-Age Children
- Flat feet are often the culprit for frequent fatigue or walking irregularities
- Complaints of leg pain, heel pain, or avoiding activity are red flags
- Early treatment is often simple and very effective
Flat Feet in Teens
- Pain during sports or daily activity is not “normal”
- Untreated flat feet may lead to ankle, knee, or back pain
- Orthotics and targeted care can prevent lifelong problems
Causes & Symptoms
How Does a Child Get Flat Feet?
Children develop flat feet through a combination of factors, with the most common being simply a normal part of early development, babies are born with flat feet because the arches haven’t formed yet, and these typically develop naturally as children grow and become more active between ages 2 and 6. However, some children have flat feet due to genetic factors passed down from parents, while others may develop the condition from loose ligaments and joints that cause the arch to collapse when standing (flexible flat feet). Less commonly, flat feet can result from conditions such as tarsal coalition (abnormal connections between foot bones), tight Achilles tendons, neurological or muscular conditions like cerebral palsy, or injuries to the foot or ankle. In many cases, pediatric flat feet are hereditary and run in families, making it more likely for a child to have flat feet if one or both parents do.
We help parents answer questions like:
- Is my child’s flat foot normal—or a problem?
- Will this affect walking, running, or sports?
- Could flat feet cause pain now or later?
- Does my child need orthotics—or just monitoring?
Our role is to give you clear answers, not guesswork.
Common Symptoms of Pediatric Flat Feet
Most of the time, a child with flat feet experiences no symptoms beyond the actual appearance of the foot. In this case, the condition is considered asymptomatic. Most people recognize the appearance of flat feet. Namely, the foot lies flat on the ground, with little to no arch visible. When standing behind the child, you likely can see the outer toes but not the big toe.
Children with symptomatic flat feet may display one or more of the following symptoms:
- An outward tilt at the heel
- Changes to gait or awkwardness when walking
- Difficulty moving the foot from side to side or up and down
- Feeling pain or tenderness anywhere from the foot to the knee
- Pain or difficulty when wearing shoes
- Withdrawing from physical activities
If your child experiences any of these symptoms, schedule an appointment with a pediatric podiatrist.
Signs your child should be evaluated
When Flat Feet Should Be Checked by a Specialist
- Foot, ankle, knee, or leg pain
- Frequent tripping or poor balance
- Fatigue with walking or sports
- Shoes wearing out unevenly
- Feet turning in or out
- Feet turning in or out
- Avoiding physical activity
- Heel pain (including Sever’s disease)
If You’re Worried About Your Child’s Feet, You’re Not Alone. A professional evaluation provides peace of mind.
How Flat Feet Are Evaluated
Your Child's Visit - What to expect
Our pediatric flat foot evaluations are:
- Gentle and child-friendly
- Based on age, activity level, and symptoms
- Focused on function—not just appearance
The visit may include:
- Gait and posture analysis
- Foot alignment evaluation
- Muscle flexibility and strength testing
- Digital X-ray Imaging, when necessary
Parents are fully involved in the discussion and decision-making. Our goal is to ensure at the end of appointment you have the following:
- An accurate diagnosis of your child’s foot condition, or at least a list of possible differentials
- Understanding of this diagnosis
- Understanding of ALL available treatment options
It is often encouraged to record this initial encounter as the amount of information can feel overwhelming.
Treating Pediatric Flat Feet
How we treat flat feet in children
Treatment is individualized and always begins conservatively.
Possible options include:
- Observation and monitoring (when appropriate)
- Custom orthotics (Andy Device Orthotics)
- Supportive footwear guidance
- Stretching and strengthening exercises
- Activity modification
Surgery is rarely needed and only considered after all conservative options are exhausted.
At Pediatric Foot and Ankle, we offer a range of treatment protocols for flat feet in children, the gold standard is custom orthotics as the primary protocol. After 12 years of private practice and treating thousands of children with flat foot pain. We exclusively use the Andy Device orthotic as it has proved the test of time and has the power to eradicate flat foot in young children.
- Devices that are designed specifically for each individual child
- Provide the necessary support, stability
- Help the foot function correctly
- Found to resolve around 90% of cases without the need for surgery.
Age -specific guidance on Best Treatment for Children's Flat Feet
As mentioned above, surgery may be recommended for certain cases of flat feet in children, but more often than not, custom orthotics will effectively and permanently treat the condition. Custom orthotics are medically prescribed shoe inserts fabricated from a mold of the child’s foot, and the child’s age will determine the best type of orthotic device.
Is surgery ever required?
Pediatric Flat Feet Surgery
There are some cases where conservative treatment options are ineffective. In such cases, surgery becomes a viable and often highly effective option.
Flatfoot reconstruction surgery includes a number of procedures to correct dysfunction and issues caused by flat feet.
- Traditional flat foot reconstruction
- HyProCure
- Joint fusion
- Ligament reconstruction
- Tendon repair and transfer
To determine which procedure is needed, your Dr. Mikkel Jarman will first determine the underlying cause of your child’s flat feet.
Success stories
Click Any Card To See The Full Story & Video
Mackenzie's Story
Meet Hector - How HyProCure Surgery Corrected Hyperpronation
Flat Feet Corrected with HyProCure Surgery Mike's Story
Flat Feet Correction with HyProCure Surgery Zachary's Story
Why parent's choose dr. jarman
A Specialist Who Focuses on Growing Feet
- Dedicated pediatric foot & ankle care
- Experience treating infants through teens
- Evidence-based, conservative approach
- Clear communication with parents
- Friendly, kid-centered office environment
Your child’s feet are still growing, expert care matters.
Pediatric Flat Feet FAQ's
Flat feet are common in infants and toddlers up to age 3-4 as the arch develops. If flat feet persist beyond age 5-6, it may be a concern requiring evaluation.
Typically flat feet are normal in young kids and not harmful. Beyond age 5, persistent flat feet could cause problems like foot pain, improper gait, or increased injury risk during sports if not well supported.
Flat feet can be caused by loose ligaments, low muscle tone, excess body weight, or bone abnormalities present at birth. Sometimes the cause is unknown. Family history can play a role.
There are no definitive ways to prevent normal development of flat feet in infants and toddlers. Maintaining a healthy weight, proper footwear, and activity modifications can help manage flat feet in older children.
While many parents wonder if their child will outgrow flat feet, it’s important to understand that flat feet are a structural part of a person’s anatomy that doesn’t simply disappear with age. What actually happens during childhood development is that the arch of the foot becomes more prominent and defined as the muscles, ligaments, and bones strengthen between ages 2 and 6, giving the appearance that flat feet have been “outgrown.” However, the underlying foot structure remains—children who have truly flat feet will maintain this foot type into adulthood, as it’s part of their inherited skeletal and biomechanical makeup
While flat feet can potentially lead to pain and complications later in life due to altered biomechanics and increased stress on the feet, ankles, knees, and lower back, proactive orthotic management during childhood can significantly prevent these future problems. When left unsupported, flat feet may cause the body to compensate with poor alignment patterns that can result in arthritis, plantar fasciitis, Achilles tendonitis, shin splints, and chronic joint pain as adults. However, by implementing custom orthotics early on, we help redistribute pressure evenly across the foot, maintain proper alignment throughout the lower extremity, and reduce abnormal wear and tear on joints and soft tissues.
Early intervention with orthotic management isn’t about changing your child’s foot structure—it’s about supporting their natural anatomy in a way that promotes optimal function and prevents the compensatory issues that can develop over a lifetime of walking on unsupported flat feet.
Yes, orthotics are completely safe for children when properly prescribed and fitted by a pediatric foot and ankle specialist. Custom orthotics are specifically designed to support your child’s developing feet without restricting natural growth or movement, providing comfort and stability as they grow.
Flat feet should be evaluated and potentially treated when a child experiences pain, difficulty with activities, or shows signs of rigid flat feet, regardless of age, though we typically begin monitoring arch development around age 3-4. If a child has flexible flat feet without symptoms, we generally observe their development until around age 6-8, at which point intervention with orthotics may be recommended if the flat foot structure is causing biomechanical concerns or if we want to prevent future complications.
Yes, flat feet can affect sports performance by reducing stability, causing faster fatigue, and creating inefficient movement patterns that may limit speed, agility, and endurance during athletic activities. However, with proper orthotic support, most children with flat feet can participate fully in sports without limitations, as orthotics optimize alignment and improve overall function during high-impact activities.
