Flat Feet In Children: Causes, Problem And Solutions

Flat foot (medically referred to as pes planus) is a foot condition characterized by lack of an arch on the inside of the foot. Flat feet in children often cause a lot of anxiety among parents.

The condition occurs the feet fail do develop a normal arch. It is quite normal among children below six years old. Flat feet can be very painful and may affect your child’s athletic ability.

Flat Feet in Children Causes

The main cause of flat feet is loose tendons – the tissues that hold the feet joints together. In infants and toddlers, these tissues are yet to tighten up to form an arch, until when they attain the age of 2 or 3.

However, in rare cases, the arch may fail to form resulting in pain and loss of balance when the child is standing or walking.

In other cases, a flat foot may develop in a child due to a ruptured tendon, a condition known as tibialis posterior tendon, or arthritis. I results into stiffness and distortion of the joints of the foot causing intense pain and immobility.

An injury to the feet or illness may also harm the feet tendons and result in flat feet, even to a child who has already formed arches. However, this type of flat feet is known to occur only on one side of the child’s feet. (http://www.nlm.nih.gov/medlineplus/ency/article/001262.htm).

Rarely, flat fleet in children is also caused by tarsal coalition – an abnormality that occurs in the womb during fetal development. Tarsal development is a condition where a joint or two or more bones are fused together (http://www.nhs.uk/Conditions/flatfeet/Pages/Introduction.aspx).

In some children, the feet tend to roll in too much more than the normal (over-pronates), especially noticeable when they stand or walk. This condition is often caused by lax (loose) ligaments either in the subtalar joint (heel joint) or at the base of the big toe.

This over pronation in the mid-foot makes the heel and the front-foot to point outwards more than normal. The best way to tell when a child has an over-pronated foot is to have the child stand on tip-toe.

Nervous system complications (conditions affecting the brain and spinal cord) such as spina bifida, muscular dystrophy and cerebral palsy are also known to cause flat feet.

As the children grow up, their feet muscles progressively become stiffer and weaker and lose their flexibility.

Another common cause of flat feet is weak core muscles around the hips that results in a change in posture and over pronation of the feet.


Most children with flat feet often experience an ache around the arch and ankle, down the outer side of their feet, and around the calf, knee, hip or back. Others have their condition so pronounced that they begin to experience pain or inability to stand, walk or run.

Those whose feet are over-pronated tend to wear out their shoes very quickly. The children may also develop ligamentous laxity, which is probably determined genetically.

Other symptoms include ankle weakness and stiffness, and swollen arch especially after long periods of standing or playing sports.


Prior to treatment, the doctor or physiotherapist will examine your kid’s feet, muscle strength, posture and walking pattern, and check whether the pain is as a result of flat feet or it is just a symptom of other underlying conditions in the leg.

During the examination, if the arch fails to form with toe-standing, and there is pain, the following tests may be recommended:

  • X-ray of the foot
  • CT scan to look at the bones in the foot
  • MRI scan to look at the tendons in the foot

Depending on the examination results, the physiotherapist may:

  • Offer advice on the best footwear for the child
  • Recommend insoles to help in the development of the child’s foot and posture
  • Provide exercises to help stretch and/or strengthen the kid’s feet muscles
  •  Provide fun activities to help your child build up their foot muscles
  • Refer the child to an orthotic or podiatrist either for further check-up or for surgery

Treatment options for flat feet in children include:

An arch-support (orthotic) – supposed to be put in the child’s shoes. Orthoics are available at the store, but you can also have it custom-made. The insoles will also stop the child’s feet from rolling inwards when he/she walks or runs.

The kid may be required to wear special flat feet in children shoes that fit properly. The child may need to wear shoes that are wider than normal. In cases where the flat feet is due to a condition of the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed.

For over-pronated feet, stretching and muscle strengthening exercises may be required to help tighten the Achilles tendon.

If the condition is due to a ruptured tendon (tibialis posterior tendon) or arthritis, it can be treated by an insole together with painkillers.

When is surgery needed?

In some rare cases, the child may need surgery especially if the flat feet is caused by a congenital abnormality such as tarsal coalition. The fused bones will need surgery to be separated and the foot straightened.

The latest surgical procedure is a minimally invasive technique where a small plug is inserted into a small cavity of the foot to help provide more stability.

The implant also changes the architecture of the foot, as well as the maturation and development of the bone.

However, possible complications are bound to arise after surgery.

They include:

  • Infection
  • Failure of the separated bones to heal
  • Loss of ankle movement
  • Unending pain and foot deformity

Do they need orthotics?

The use of orthotics depends on the age of the child. Children below the age of six still have flexible feet that can be easily corrected. However, if the child is above age six, the flat foot can be considered permanent, requiring long-term use of orthotics.

Generally, orthotics are very effective in treating flat feet in children. An orthotic can be placed directly into a standard, sports or athletic shoe. There is evidence that early use of orthotics can help encourage normal arch development.