Flat Feet in Children: Understanding Arch Development

A ProVital Physiotherapy Guide

What are Flat Feet?

Flat feet (pes planus) occur when the arch of the foot is either low or absent. In young children, this is common and often part of normal development.

Normal Arch Development

Birth to Age 2-3:

Babies are usually born with flat feet due to a fat pad in the medial arch area. This is normal.

Age 3-6:

Arches begin forming as foot muscles and ligaments develop with standing, walking, and running.

Age 6+:

Most children will have visible arches. Persistent flat feet beyond this may need assessment.

Types of Flat Feet in Children

1. Flexible Flat Feet (Most Common)

• Arch appears when standing on tiptoes or sitting.

• Usually painless and improves with age.

2. Rigid Flat Feet (Less Common)

• Arch remains flat in all positions.

• May cause pain, stiffness.

• Requires medical assessment.

Causes of Persistent Flat Feet

• Genetics

• Ligament laxity (common in hypermobile children)

• Obesity

• Neuromuscular disorders (e.g., cerebral palsy)

• Tarsal coalition (fusion of foot bones)

When to Seek Physiotherapy?

• Foot or leg pain

• Difficulty walking, running, or fatigue

• Uneven shoe wear

• Tripping frequently

• Rigid or stiff feet

Physiotherapy Approach

• Arch-strengthening exercises (e.g., toe curls, towel scrunches)

• Calf and Achilles stretches

• Balance and proprioception training

• Gait retraining

• Advice on proper footwear

Orthotic use should be assessed individually — not all cases require insoles.

ProVital Note:

For any nutrition or weight-related management of flat feet (e.g., in cases of obesity), kindly consult a qualified nutritionist or dietitian.

ProVital ; Physio Provider, Better Together

References :

1.Evans, A. M., & Rome, K. (2011). A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. European Journal of Physical and Rehabilitation Medicine, 47(1), 69-89.

2.Pfeiffer, M., et al. (2006). Prevalence of flat foot in preschool-aged children. Pediatrics, 118(2), 634-639.

3.Uden, H., & Scharfbillig, R. (2017). The typically developing paediatric foot: how flat should it be? A systematic review. Journal of Foot and Ankle Research, 10(1), 37.