Medicine Information

Flatfeet in Children: When Are They A Problem?

There are high arch feet and low arch feet and many different foot types in between. Many individuals have flatfeet, but do not have foot problems. All of us are born with flatfeet and some of the greatest athletes have flatfeet. But, flatfeet are a problem when the arch completely collapses in combination with excess inward rotation in the foot. This type of flatfoot causes excess stress on the joints, ligaments and tendons in the foot and ankle. If not treated appropriately, tendon and joint problems will develop.

Flatfeet are normal in infants and the arch will not start to develop until between four and eight years of age. Up until this time, all children will have flatfeet. Many children under the age of 4 may have excessively flatfeet and excess rotation in their feet. How do you tell the difference? The following list may indicate that your toddler's flatfeet are a problem:

1. Your child is over 15 months of age and has not started walking.

2. Your child started walking around 12 months but seems to prefer crawling.

3. Your child is between the ages of 2-4 and complains of foot pain or leg pain. In many instances, this leg pain is confused with growing pains.

4. The wear on your child's shoe is uneven.

5. Your child's arch is touching the ground and the ankles look like they are rolling in, bringing the knees together.

For toddlers, the typical treatment is a kiddie orthotic. This is a pre-made orthotic which comes in different sizes. It will fit into any of your child's shoes and should be comfortable for them. This will help stabilize their foot while they are walking. In severe cases, or in children ages 3 and 4, a custom made orthotic may be necessary. A custom made orthotic is a device that involves taking a mold of the foot, typically done with plaster, but sometimes done with foam. A device is made with specific corrections for your child's foot and looks like a plastic insert. This insert can slip into the shoe and can be switched from shoe to shoe.

Children can wear the same insert for up to 2 shoe sizes, then a new pair must be made. Although the insert will not change the way the foot develops, it will support the foot and allow for a more normal walking pattern. In some cases, children only need the orthotic during the first few years, and after the arch develops, the orthotic is no longer needed. In most cases, children will not "outgrow" their flatfeet.

As the arch develops between 4 and 8 years of age, the child's body goes through numerous changes. The bones grow in length while the leg and thigh bones are rotating. During these years it may be difficult to determine if the flatfeet will become a problem or not. One of best indicators of a problem is pain. Children should not have pain in their feet. They should be able to run around with their friends or in an organized sport without any pain. If your child is having foot, ankle or leg pain, make sure they see a podiatrist.

Young children between eight and thirteen years may have flatfeet, but not complain of any pain. This is a common occurrence in this age group, especially if the children are not competitive in any sports. Look for the following:

1. The arch touches the floor and the ankles and feet rotate in.

2. The knees are very close together (knock-knees).

3. Shoes are worn out within 3 months.

4. Wear pattern on the shoe is toward the inside (big toe side).

5. Your child's gait is bouncy or looks awkward.

6. Your child seems slower than his or her friends or shows a lack of interest in sporting activities despite being athletic.

If your child shows any of these signs it is necessary to visit a podiatrist to be evaluated. In many cases, small problems that are developing in this age group can lead to more severe problems down the road. Generalized ankle pain is the most common complaint in children this age with flatfeet. Typically, they will be able to run and play sports, but find that they have a deep, achy pain in and around their ankle when they are done. Children this age have a very difficult time expressing the type of pain they are experiencing and when they experience it. Writing down when the pain happens and where is occurs will help your doctor during the visit.

Over fourteen years of age, the growth slows in girls and over the next few years the growth plates in the feet fuse. Boys will have continued growth until 16 to 18 years of age. Children in this age group will typically complain of pain. The most common problem in children with flatfeet in this age group is tendonitis. The pain is either at the back of the heel, or at the inside of the arch. Sometimes the foot and ankle are stiff and sore in the morning, when first stepping down. Walking up and down stairs or hills, squatting or walking on uneven surfaces will cause more pain in these tendons.

Treatment of tendonitis involves rest, ice and immobilization for a minimum of two weeks, but two months can be a common recovery time. When these conditions develop as a result of flatfeet, it is necessary to be fit with orthotics to prevent the problem from occurring again. Not every foot needs a custom made orthotic. There are many prefabricated orthotics that work well. A prefabricated orthotic is not the same as an insert. An insert slips into the shoe and will provide comfort, cushion and a little support. In some cases, inserts purchased at the drugstore will help alleviate some arch or heel pain and give relief to sore, tired feet. But, an insert is not an orthotic. Orthotics are devices which fit into the shoe and aid in foot function.

The most important difference is an orthotic controls abnormal motion and corrects foot function, while an insert will only provide cushion and comfort. Pre-fabricated orthotics can be found at your local sports store and will help many individuals with flatfeet. They are much cheaper than custom-made orthotics, but they will wear out in 1-2 years. A custom-made orthotic is custom to each foot and corrections are built-in to help the foot function. They are designed to keep stress off the ligaments and tendons in the arch and designed to distribute the pressure evenly while walking. The cover material on the custom-made orthotic may need to be changed every one to two years, but the orthotic itself will last ten years. As expected, custom-made orthotics are much more expensive than prefabricated orthotics or inserts.

In summary, all infants have flatfeet, but more severe flatfeet in this group can become a problem. The arch develops between four and eight years of age and predicting long term foot problems in this group can be difficult. Many children, teenagers and adults have flatfeet, yet no foot problems. Therefore, not all flatfeet need to be treated. But, children with foot, ankle or leg pain and flatfeet should be evaluated by a podiatrist. For children with flatfeet and foot pain, custom made orthotics are essential to treatment of the foot problem and for prevention of problems in the future.

Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book visit For more information on orthotics visit

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