Flat Feet

What are flat feet?

Flat feet — or pes planus, pes valgus, overpronation — are exactly what the name implies, the feet are flatter on the bottom and allow the entire sole of the foot to touch the floor when standing.

Flat feet are normal in babies and toddlers because the arches in their feet haven’t yet developed. The foot arch develops throughout childhood for most individuals, however some will never develop arches in their feet. Flat foot can also develop in adulthood, but that is not the same pathology that is referred as “flexible flat feet”. Arches can fall due to age, wear and tear on the body, or from an injury.

Flat feet are a common condition, often runs in families and is usually painless. In some cases, flat feet can affect the body’s alignment, which can cause knee and ankle discomfort.

If the flat feet are not causing pain, no treatment is necessary.

Causes

The causes of flat feet are varied. Some inherit the condition from their parents as an isolated trait, this is particularly true for children with hypermobility or “double jointed”. Others develop flat feet as part of another genetic condition. Still others develop the condition over time.

Certain factors can increase the risk of developing flat feet over time including:

  • Obesity
  • Diabetes
  • Rheumatoid arthritis
  • Foot or ankle injuries
  • Aging

Signs and symptoms

Most people with flat feet have no complaints or symptoms of the condition. However, some people may experience:

  • Foot pain, specifically in the heel or arch area
  • Foot pain that increases with activity
  • Ankle swelling
  • Tight heel cords

If your child has foot pain, talk to your child’s doctor.

Testing and diagnosis

Children with flat feet are often diagnosed by their pediatricians. If your child is not experiencing any pain or other symptoms, no further testing is usually needed.

Children who have symptoms should be examined by experts in pediatric foot conditions. At Children’s Hospital of Philadelphia, a trained pediatric orthopedic physician will perform a complete medical history, physical examination and visual evaluation of your child. Doctors will ask your child to describe the pain — dull, sharp, sudden, burning — and whether there are any activities that ease the pain or worsen it.

The doctor may observe your child walking, standing or running — regularly and on their toes — to better understand the mechanics of your child’s feet. Clinicians may ask you to bring your child’s everyday shoes to the appointment so they can evaluate the wear patterns and pinpoint what may be causing their pain.

If your child is experiencing significant foot pain, doctors may also order imaging tests such as:

  • X-rays, which produce images of bones.
  • EOS imaging, an imaging technology that creates 3-dimensional models from two flat images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.
  • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to examine bones and produces cross-sectional images ("slices") of the body.
  • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs, soft tissues, muscles, ligaments and other structures within the body. Your child is exposed to no radiation during an MRI.

Treatments

 If your child’s flat feet are not causing pain, no further treatment is usually necessary.

Non-surgical treatment

For children who are experiencing pain associated with their flat feet, doctors may recommend a variety of non-surgical treatments to relieve the pain, including:

  • Arch supports — Your child’s doctor may recommend arch support orthotic devices that fit inside your child’s shoes to relieve pain and reduce symptoms. These devices are available over-the-counter or can be custom-designed to mold to the contours of your child’s feet. 
  • Supportive shoes — Encourage your child to wear structurally supportive shoes instead of sandals, flip-flops and shoes without arch support.
  • Stretching exercises — Exercises to stretch the Achilles tendon may help some children with flat feet.
  • Physical therapy — Flat feet can lead to overuse injuries in some active children and runners. A video analysis of how your child runs may help identify problems with form and physical therapists can work with your child to correct it.
  • Rest — Encourage children to rest and allow their bodies time to recuperate. Avoid high-impact activities such as jumping and running – and instead encourage your child to participate in low-impact activities such as walking, swimming and biking.
  • Medications — Over-the-counter pain relievers may reduce pain and discomfort for children who experience it.
  • Weight loss — If your child is overweight and has flat feet, a doctor may recommend structured weight loss to relive some of the stress on the child’s feet.

Surgery

Surgery is not usually needed for flexible flat feet, but if your child has a related foot or leg problem, such as a torn tendon, accessory or extra bone, fusion between bones in the foot and other conditions, surgery may be recommended.

Follow-up care

Most children with flat feet will not need long-term follow-up care. However, if your child’s flat feet begin to cause pain, your child should see a pediatric orthopedic physician.

At Children's Hospital of Philadelphia, we offer a wealth of ongoing support and services for your child and family at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with you to provide the most current, comprehensive and specialized care possible for your child. We recognize your child's pediatrician as an important part of the clinical team and provide regular updates on your child's progress.

Outlook

The vast majority of children with flat feet will go on to live normal, healthy lives. Some children may experience intermittent foot pain, but using arch supports, wearing supportive shoes, stretching and resting when needed can ease this.

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