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.
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.
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.
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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
What are flat feet in children?
Pediatric flat feet — also called pes planus or fallen arches — is when the arch on the inside of the foot is flattened or absent, so the whole sole makes contact with the ground while standing. Standing behind a child with flat feet, you'll typically see the outer toes but not the big toe.
Is it normal for young children to have flat feet?
Yes, very often. Babies are born with flat feet because the arch hasn't formed yet, and most arches begin developing naturally between ages 2 and 6. Flat feet in infants and toddlers are usually just a normal part of development — but an early evaluation can still help rule out the rarer, more significant causes.
What's the difference between flexible and rigid flat feet?
Flexible flat feet are the most common and typically benign form — the foot looks flat when standing, but a visible arch appears when the child sits, stands on tiptoe, or takes weight off the foot. This happens because looser ligaments let the arch collapse under body weight and return once pressure is released.
Rigid flat feet stay flat in every position, standing or sitting, which points to a structural cause such as tarsal coalition (fused bones), tight tendons, or another bone or joint issue. Rigid flat feet are more likely to cause pain and limited mobility and are more likely to need treatment such as orthotics, special shoes, or surgery.
What causes flat feet in children?
Most flat feet are simply part of normal development as the arch forms between ages 2 and 6. Genetics also play a large role — flat feet are often hereditary and run in families. Loose ligaments and joints can allow the arch to collapse under weight (flexible flat feet), while less commonly, flat feet can be related to tarsal coalition, tight Achilles tendons, neurological or muscular conditions like cerebral palsy, or a foot or ankle injury.
What symptoms should I watch for?
Most children with flat feet have no symptoms beyond the appearance of the foot itself. When symptoms are present, they can include an outward tilt at the heel, changes to gait or an awkward walk, difficulty moving the foot side to side or up and down, pain or tenderness anywhere from the foot to the knee, pain or difficulty wearing shoes, or a child withdrawing from physical activity.
When should my child's flat feet be evaluated 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 noticeably in or out
- Avoiding physical activity
- Heel pain, including Sever's disease
Pain during sports or daily activity is never just "normal" for flat feet and is worth having checked.
Will my child's flat feet affect walking, running, or sports?
Many children with flexible flat feet participate in sports and activity without any issues. But in school-age kids, flat feet can sometimes be behind frequent fatigue or walking irregularities, and in teens, untreated flat feet can contribute to ankle, knee, or back pain over time. If activity is affected, that's a sign it's worth an evaluation rather than something to just watch.
Does my child need orthotics, or just monitoring?
It depends on the child's age, whether the flat feet are flexible or rigid, and whether symptoms are present. Many cases are simply monitored as the arch continues to develop, while others are effectively and permanently treated with custom orthotics — medically prescribed shoe inserts molded to your child's foot, with the specific type chosen based on age. An evaluation is the best way to know which approach fits your child.
Is surgery ever needed for pediatric flat feet?
Surgery isn't the first option, but for cases where conservative treatment isn't effective, it can be a viable and often highly effective option. Procedures range from traditional flatfoot reconstruction to HyProCure, joint fusion, ligament reconstruction, or tendon repair and transfer. The right procedure depends on identifying the underlying cause of your child's flat feet first.
What happens during a flat feet evaluation?
Evaluations are gentle, child-friendly, and based on your child's age, activity level, and symptoms — the focus is on function, not just appearance. A visit may include gait and posture analysis, a foot alignment evaluation, muscle flexibility and strength testing, and digital X-ray imaging when necessary. Parents are fully involved in the discussion, and the goal is to leave with a clear diagnosis and a full understanding of all treatment options.
Your Child’s Feet Are Built for Life. We Help Keep Them That Way.
