Kids and Flat Feet: When to Worry

A concerned parent brings their child in because they noticed the feet look flat — no visible arch when standing. "Is this normal?" they ask. "Will it cause problems later?"

The short answer: flat feet in children are extremely common and usually normal. But not always. Knowing the difference between the kind that resolves naturally and the kind that needs attention can save your child from unnecessary worry — or catch a real problem early.

Flat Feet Are Normal in Young Children

All babies and most toddlers have flat feet. This is completely expected. The arch of the foot develops gradually through childhood as the muscles, tendons, and ligaments strengthen and the fat pad under the arch thins out. Most children develop a visible arch between ages 3 and 6, though some take longer.

The key test: have your child stand on tiptoe. If the arch appears when they rise onto their toes, they have a flexible flat foot — the arch is there, it just flattens under load. This is the most common type in children and is almost always benign.

When Flat Feet Might Be a Concern

Flat feet warrant evaluation if any of the following are present:

• Pain: Your child complains of foot pain, arch pain, heel pain, or leg pain — especially during or after physical activity. Flat feet in children should not be painful.
• Fatigue: Your child avoids physical activity, tires quickly during sports, or asks to be carried more than seems appropriate for their age.
• No arch on tiptoe: If the arch doesn't appear when standing on tiptoe, this suggests a rigid flat foot, which can indicate a structural issue like tarsal coalition (bones in the foot that are abnormally fused).
• Uneven shoe wear: Shoes that wear down dramatically on the inner edge indicate significant overpronation that may be stressing the ankle and knee.
• One foot only: Flat foot on one side but not the other deserves evaluation.
• Getting worse: An arch that was present and is collapsing over time, especially in an older child or adolescent.

What We Look For

Evaluation involves watching the child walk and run (gait analysis), examining foot flexibility and joint range of motion, checking for tenderness, and assessing the alignment of the foot, ankle, and leg. X-rays are occasionally needed but not routine — the clinical exam tells us most of what we need to know.

We're looking to distinguish between a flexible flat foot that will resolve or remain painlessly flat (the vast majority), a flexible flat foot that's causing symptoms because of excessive pronation, and a rigid flat foot that may require further workup.

Treatment When Needed

Most children with flat feet need nothing at all — reassurance for the parents and monitoring over time. For children with symptomatic flat feet (pain, fatigue, or functional limitations), treatment typically starts with supportive shoes — firm heel counter, good arch support, and avoid overly flexible shoes. Custom orthotics designed for the child's specific foot shape can control excessive pronation, reduce pain, and support healthy development of the arch.

Surgery is rarely needed and is reserved for rigid flat feet with structural abnormalities or symptomatic flat feet that don't respond to conservative treatment. When it is necessary, the procedures are well-established with excellent outcomes.

The Bottom Line

Flat feet in young children are normal. Flat feet that cause pain, limit activity, or don't improve with age deserve a professional look. If you're unsure where your child falls, a quick evaluation gives you a clear answer and peace of mind. Call (760) 728-4800 to schedule — we see patients of all ages, including kids.