When to be concerned about Flat Feet in Children
Flat feet (also called “pes planus”) are a common concern in children and can leave many parents wondering if it’s normal or if their child needs treatment. Simply put, flat feet occur when the arches of the feet are low, absent or hidden, making the entire sole of the foot touch the ground when standing. The estimated prevalence of flat feet remains is stated to be between 2-70% of the population, which is reflective of how broad the definition for flat feet is.
The biggest issue we see at our clinic, is to the untrained eye, flat feet are often confused with other conditions such as hypermobile or pronated feet which can impact how a child moves and which responds well to treatment.
A flexible flat foot should be symmetrical, pain free, and not impact movement.
What causes Flat Feet?
Many children are born with flexible flat feet, and this is a normal part of development. Around 97% of 18 month old children have flat feet, 54% of 3 year olds, 26% of 6 year olds and 4% of 10 year olds.
In children, there is a fat pad that sits in the arch of the foot which can give the appearance of a flat foot. As children grow, the fat pad is absorbed and the arch appears (Hooray!). In most children, the arches usually form by age 6–8.
When to Be Concerned
Although flat feet are often harmless, certain signs may indicate a need for assessment by a paediatric physiotherapist or podiatrist (or both!). These signs include:
Pain in the feet, ankles, or legs that is persistant or that comes and goes
Difficulty or coordination challenges when walking or running
Feet that turn inward or outward significantly
Feet that roll in when a child takes a step
Uneven shoe wear or frequent tripping
Flat feet that do not improve with age or that only affects one side of the body.
What does an assessment involve?
To determine whether a child requires treatment, we need to fully assess their movement and determine whether their flat feet is a concern or not. This may involve looking at:
Foot Structure - we will have a look at how the bones and joints in the foot move to see if there is any hypermobility or stiffness.
Muscle strength - Muscle strength in the foot is a good indicator of how the foot is functioning. If we find any weakness, we might provide you with some exercises.
Gait (walking and running pattern): We will assess how a child walks to see if there is any altered movement patterns or compensatory strategies.
Shoe Review: We often look at a child’s shoes to see if there is symmetrical wearing. This gives us a good idea on whether they have a typical walking pattern day to day
Hips and Knees: We will usually assess a childs hip rotation and knee extension. Sometimes children with a flat foot appearance can have hip issues that cause their legs to rotate outwards and some children may hyperextend their knee due to stability challenges or muscle tightness. It’s important we fully assess each child to ensure we can provide appropriate advice and treatment.
Strengthening exercises – improving foot, ankle, and lower leg muscles
Balance and coordination activities – encouraging proper gait and posture
Footwear guidance – supportive shoes that fit well
Orthotics – occasionally recommended for pain or severe cases
Early assessment is important if your child experiences pain, difficulty with activity, or if you notice your child’s flat feet are rigid, asymmetrical or appear concerning in any way.
Key Takeaway
Flat feet in children can be normal and common in developing children. They are far more common in younger children and become less common as children get older. Flat feet that are flexible and pain-free often don’t require treatment, but it’s important to determine that ‘flexible flat feet’ is an accurate diagnosis. If your child experiences pain or difficulty walking, a timely assessment by a paediatric physiotherapist and/or podiatrist can help guide treatment strategies to prevent pain and help kids move more comfortably.