You looked down at your child's feet in the school-shoe shop and noticed there is no arch. Or a grandparent, a coach or a shoe fitter mentioned it, and now you are wondering whether your child needs orthotics, special shoes or a podiatrist. Here is the reassuring, evidence-based answer: for most young children, a flat foot is a normal stage of development, not a problem.
The trick is knowing which flat feet are the normal kind and which are the exception. That distinction is simple, it takes about ten seconds to check at home, and it is exactly what this article walks you through.
In this article
What does a flat foot in a child actually mean?
A flat foot, or pes planus, simply means the arch on the inside of the foot sits low or touches the ground when the child stands. In toddlers and preschoolers this is expected. Young feet carry a pad of fat under the arch, the ligaments are naturally loose, and the muscles and bones that build and hold an arch are still developing. The arch typically appears gradually through the primary-school years as the foot matures.
So a flat foot at three is not a diagnosis. It is a description of a foot that is doing what young feet do. What matters is whether the foot is flexible and pain-free, or rigid, painful and affecting how your child moves.
If you would like a professional eye on it, our podiatry in Mount Gravatt team sees children's feet every week and can usually tell you in one appointment whether anything needs doing at all.
How common are flat feet in young children?
It falls with age
In the same study, flat feet were found in 54% of 3 year olds but only 24% of 6 year olds. Boys were affected about twice as often as girls, and the authors concluded that a large majority of the treatments prescribed were unnecessary.
Those figures come from a study published in the journal Pediatrics, and a later systematic review of the typically developing child's foot found the same trend: the young foot is flat, and the arch develops through childhood. In other words, if your four year old has flat feet, they are in the majority, and most of their classmates will grow an arch over the next few years without anyone doing anything.
Not sure what you are looking at? A children's foot assessment at ACE Sports Medicine in Upper Mount Gravatt can settle the question and save you buying supports your child may not need.
The tiptoe test: flexible or rigid?
This is the single most useful thing you can do at home. Ask your child to stand barefoot on a hard floor, then rise up onto their tiptoes. In a flexible flat foot, an arch appears as they rise and the heel swings slightly inwards. You can also lift their big toe upwards while they stand: in a flexible foot, the arch lifts with it.
A flexible flat foot that is painless is the normal developmental kind. A foot that stays flat on tiptoes, feels stiff when you gently move it, or is painful, is a rigid flat foot, and that is the version that deserves a proper assessment because it can be caused by the way the bones in the foot have formed.
Does my child need orthotics or special shoes?
For a painless, flexible flat foot in a young child, the current evidence does not support routine orthotics, arch supports or corrective shoes. Supports do not change how the foot will develop, and the Pediatrics study specifically noted how often children in their sample were being treated unnecessarily. What children's feet need most is room to move: shoes that fit well, bend at the ball of the foot, and are not so structured that the foot cannot do its own work.
Orthotics and footwear changes do have a place. They are considered when a flat foot is causing pain, when a child tires easily or avoids activity because of their feet, when the feet are wearing shoes unevenly and quickly, or when the flat foot is rigid. In those cases a support is a tool to reduce symptoms while the underlying issue is addressed, not a cure for the shape of the foot.
What actually helps?
For most children, time and activity. Barefoot play on safe surfaces, climbing, running on grass and sand, and the simple act of growing all help the arch develop. Keeping a healthy weight matters too: overweight children in the Pediatrics study were about three times as likely to have flat feet.
For the child whose flat feet are causing symptoms, a podiatrist can assess the whole lower limb, check the flexibility of the foot and ankle, look at how your child walks and runs, and put together a plan. That may include calf and foot strengthening games, footwear advice, and in some cases a temporary in-shoe support. Many children with symptomatic flat feet improve well with this kind of targeted, conservative care, and a good assessment is just as valuable when the answer is "nothing needs doing".
When should you seek help?
Painless, flexible flat feet in a child under about eight rarely need treatment. The exceptions are worth acting on early.
Consider getting assessed if
Your child complains of foot, ankle, knee or leg pain; they limp, trip often or ask to be carried more than you would expect; the flat foot is on one side only or appeared suddenly; the foot stays flat on tiptoes or feels stiff; the arch has not started to appear by around age eight; or the feet look very different from each other. If your child has a known neurological or joint condition, any foot change deserves review.
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Helping You Perform at Your Best
Our podiatry team at ACE Sports Medicine in Upper Mount Gravatt assesses children's feet for families across Brisbane's southside, from the school-shoe question through to the child whose feet are holding them back from sport. Most of the time the news is good. When it is not, early, conservative care makes a real difference.