Diagnosing And Treating Flexible Flatfoot In Children

Children with a condition known as flexible flatfoot have little arch in the feet when they stand. However, the arch reappears when the child sits. Since flexible flatfoot is caused by loose ligaments and not a bone deformity, most children walk normally. Eventually, most children develop an arch and outgrow the condition.

Although children do not normally experience pain with flexible flatfoot, if the condition continues into the teen years or your child has pain along the bottom of the foot, talk to your primary care provider. Your physician may refer your child to a foot and ankle doctor for further evaluation.


Let the doctor know if there is a history of flatfeet in your family, as the trait often is inherited. The doctor will examine your child's feet as he or she stands, sits, and stands on tiptoes. Since calluses can be a sign of flatfeet, the doctor also will check the bottom of your child's feet. The doctor may ask to examine your child's shoes to look for uneven wear patterns.

As part of the physical exam, the doctor will check your child's Achilles tendon (heel cord) for tightness. If the doctor diagnoses your child with flatfeet, he or she may then order X-rays to make certain there are no bone deformities.


The American Academy of Pediatrics reports that children with flatfeet typically develop arches by age 6. While treatment usually isn't necessary, if feet are stiff or a child experiences pain with flexible flatfoot, there are options that can help.

Proper Shoes

Buy your child shoes that provide good arch and heel support. Shoes that have stiff soles with strong heel counters help align the foot. Choose a shoe for your child with rigid soles that flex only at the forefoot and wedge heels to help prevent over pronation.

Physical Therapy

A physical therapist can use manual manipulation and instruct your child on how to do stretching exercises on  his or her own to lengthen the heel cord. Because a tight Achilles tendon limits the foot's range of motion, it can cause discomfort. However, stretching exercise can help relieve pain in the foot, ankle, or leg following physical activity. The physical therapist may also use ultrasound therapy to relieve pain, increase blood flow to the area, and loosen up tissues so that tight muscles and joints respond better to stretching exercises.


A pediatric orthopedist may recommend that your child wear night splints or casts to loosen tight heel cords. When stretching exercises aren't successful, casting provides a constant stretch.


In some cases, surgery may be necessary if pain becomes continuous and the condition does not improve as your child grows. Although flexible flatfoot is a common type of flatfoot, if the condition worsens, the tendons and ligaments of the arch can stretch and tear, causing more problems. Your child's doctor may recommend surgery to lengthen a tight Achilles tendon to correct flexible flatfoot if other treatments fail to relieve persistent pain.

Symptoms that a child may eventually experience if flexible flatfeet become rigid include:

  • Over-pronation (the ankle rolls in)

  • Achy feet and legs

  • Bunions or hammertoes

  • Pain in the heel, arch, ankle, along the shin bone, or along the outside of the foot

Flatfeet can lead to low back pain and pain in the hips and knees if the condition follows a child into adulthood.