Flat Feet

Almost all babies are born with flat feet, or flatfoot, which continues into childhood. Babies and children have flexible bones and joints, causing their feet to flatten when they stand. Babies also have a fat pad on their inner feet, so it can be hard sometimes to see their arch.

Most children outgrow flatfoot as their feet become less flexible, and they develop arches before age six. Only one or two out of every 10 children will continue to have flat feet into adulthood.

Flatfoot, sometimes called pronated foot, is a common condition where the arch in the middle of the foot disappears when a person stands up. This is also known as fallen arches. There are three types of flatfoot:

• Flexible flatfoot. Most children with flatfoot have this type, and it affects both feet. It is not painful and does not need treatment.
• Flexible flatfoot with a short Achilles tendon. This rarely happens to young children. It also affects both feet. It can cause pain and disability, eventually leading to arthritis.
• Rigid flatfoot. This is the least common type of flatfoot. It affects people who have problems with the bones in their feet, and about one in four has pain and disability. It may affect one or both feet.

Children with flat feet are also prone to bunions, which are different from the bunions adults get. Bunions in childhood (juvenile bunions) are due to inherited bone issues that cause the big toe joint to be incorrectly aligned.

With flexible flatfoot, an arch in the foot can be seen when your child stands on their toes or lets their foot hang. With rigid flatfoot, no arch is visible. If children have pain because of flat feet, it is usually just in one area of the foot instead of a generalized pain.

Talk to your child’s pediatrician if your child has foot pain, a stiff foot, limited motion from side to side or up and down, or pressure sores on the inner foot. Your pediatrician may refer your child to a pediatric orthopedic [or-tho-PEE-dik] surgeon.

Babies are often born with flat feet. It is a normal condition because their joints and bones are flexible. As they get older, the joints become less flexible, and arches develop. Flat feet are only a problem if they cause pain or limit your child’s mobility.

An orthopedist [or-THO-PEE-dist], a doctor who specializes in bones, will examine your child’s feet. The orthopedist will look at your child’s feet when they stand, let their feet dangle, or stand on their toes. The orthopedist will also look at the joints in your child’s foot and ankle and see how flexible the foot and ankle are.

If your child’s feet hurt, the doctor may want to take x-rays pictures to find out more about the cause.

Nonsurgical treatments are typical for the various types of flatfoot.

• Flexible flatfoot that doesn’t cause pain does not need treatment.
• If your child has aching in their feet or legs after activity, they may need to wear shoes with arch support (such as athletic shoes) or use over-the-counter arch support insoles in their shoes.
• If your child has flexible flatfoot with a short Achilles tendon, the orthopedist may do (or teach your child how to do) stretching exercises to help stretch and lengthen the tendon.

Occasionally, surgery is needed for children over age 8 who have flat feet. The surgeon can lengthen your child’s Achilles tendon if it is too short, as well as correct the flatfoot. Surgery for juvenile bunion is not recommended until your child is fully grown, usually by about age 17. Waiting is necessary to avoid harming the growth plate in your child’s foot.

Most children are born with flatfoot, which is a natural condition and can’t be prevented. However, if your child develops flat feet or bunions as they get older, you may be able to keep it from getting worse by having your child wear shoes with more arch support or that don’t rub the bunion and hurt it. You can also have them use toe spacers, splints, and orthotics to help keep their foot in the proper position. Follow your pediatrician’s recommendations.

Your child might need to switch activities if they participate in something that places a lot of stress on the feet, such as dance or ballet.

Flat feet in childhood is normal, but most kids outgrow it as their joints become less flexible and they develop arches in their feet. However, if your child has foot pain or their mobility is limited, they need treatment.

Most of the time, flat feet can be treated without surgery, such as with insoles that offer arch support or stretching exercises. Surgery can correct a child’s flat feet and lengthen their Achilles tendon if other treatments aren’t working.