Flat feet (Pes planus)

What are flat feet?

Flat feet do not have a normal arch. When your child is standing, the whole foot touches the ground.

Flat feet are not always a problem. Before age 3, all children have flat feet. The arch at the inside of the foot does not begin to develop until about 3 years of age.

After age 3 your child could have one of two kinds of flat feet: flexible flat feet or rigid flat feet.

• Flexible flat feet: Most children with flat feet have flexibility in their feet. When a child stands on a flexible flat foot, the arch will fall and be flat. The arch returns when the big toe is raised. Children with flexible flat feet sometimes walk with their toes pointed inward to help keep their balance. The flat foot and the intoeing cause rapid wear on the soles of the child's shoes. However the child will not have any foot pain.
• Rigid flat feet: As a child gets older, flat feet may become more rigid or inflexible. If this happens, your child will probably have foot pain.

What is the cause?

There are many reasons that older children may have flat feet. Problems with ligaments, muscles, joints, bones and the nervous system can all contribute to flat feet.

Children with conditions such as Down, Marfan, and Ehlers-Danlos syndromes are more likely to have flat feet.

What is the treatment?

Young children with flexible (painless) flat feet need no special treatment. Children with flexible flat feet may walk barefoot without hurting their feet.

If your child is having pain from flat feet, your health care provider will probably refer your child to an orthopedic (bone) doctor. Depending on the cause, a variety of treatments might help.

• Special shoes or shoe inserts: Special shoes or inserts may help relieve the pain for some children. Shoes or inserts, however, do not correct any misshapen bones of the foot. That is why it is important to have an orthopedic doctor check your child's feet. Children with flexible (painless) flat feet do not benefit from wearing special shoes, shoe inserts, heel wedges or any other devices.
• Exercises: Stretching the muscles of the leg may be helpful. Have your child sit down with his legs straight out in front of him. Have your child stretch the calve (lower leg) muscles by keeping his heels in place while stretching his feet and toes upwards. Your child can also stretch his calves by standing 1 to 2 feet from a wall. Have your child lean forward and touch the wall, while keeping his heels on the ground. Ask your health care provider whether stretching exercises will help your child. Muscle strengthening exercises do not help flat feet.
• Surgery: Surgery can help children who have painful flat feet or whose feet are causing major problems with walking. Because the foot is made of many bones, ligaments and muscles, there are many different types of operations. Surgery may help some but not all symptoms. Surgery is often delayed until a child has finished (or almost finished) growing.

When should I call my child's health care provider?

Call during office hours if:

• Your child often has foot pain.
• You are concerned about the shape of your child's foot or how your child walks.