Children's Hospital Colorado

Flatfoot in Children

What is flatfoot?

Most babies are born with almost no arch in their feet. Within 2 to 3 years of age, after toddlers have been walking for a while, the arch develops. If the arch does not form fully or it goes away when standing or bearing weight, this is known as "flatfoot."

Flatfoot is a condition that occurs when the arch seems to shrink or disappear, making the foot look flat. There are two types of flat footedness, known as flexible flatfoot and rigid flatfoot.

What is flexible flatfoot?

Flexible flatfoot is a normal variant and usually does not require treatment, nor does it cause pain, disability or other symptoms. Most children eventually outgrow flexible flatfoot without any problems.

What is rigid flatfoot?

Rigid flatfoot is much less common and usually causes other symptoms like pain and disability. Rigid flatfoot often occurs in kids with problems with the bones in their feet.

What causes flat footedness?

A foot's arch is dependent on three things: The anatomy of the bones, the muscles and tendons of the foot and the ligaments. Young children's ligaments are generally loose (known as "ligamentous laxity") and therefore when they stand, the ligaments cannot support the arch. As children age, however, the ligaments tighten up. By about age 5, most kids with flatfeet will develop a normal arch.

Some children continue to have flat feet throughout life, which is not a cause for concern as long as they are not in pain.

What are symptoms of flatfoot?

This condition is typically painless. It should not interfere with walking or playing sports. A person with flexible flatfoot should have normal muscle function and joint mobility. When the child is sitting or not bearing weight on the feet, a slight arch may be visible.

How is flatfoot diagnosed?

Flatfoot is diagnosed by a clinical exam from your primary care doctor or at Children's Hospital Colorado.

Kids with flexible flatfeet will have a normal appearing arch when they are sitting; when they stand the arch flattens. If they stand on their tiptoes, the arch will re-form.

If the foot is stiff or if the arch does not appear with standing on the toes, your child's doctor may use X-rays to evaluate the anatomy of the bones.

How is flatfoot treated?

Flexible flatfoot typically does not require treatment; most children will develop an arch as they grow. If your child remains flatfooted, it is completely normal as long as he or she does not have pain with activity and the foot is not stiff.

Treatment may be required if your child has flatfeet with tight heel cords or has activity-related pain or weakness in the foot, ankle or leg.

If your child has a tight Achilles tendon, he or she will be treated with stretching exercises or possibly some stretching casts. This gets rid of most symptoms.

If your child continues to have pain, an arch support may be prescribed. The arch support does not create an arch, it merely treats the pain symptoms.

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