Flexible Flatfoot

Flexible flatfoot is a common condition in children where the arch of the foot looks flat when standing but reappears when the child is sitting, lying down, or standing on their toes. It is a normal part of development for many children and often improves as they grow. In the majority of cases, flexible flatfoot does not cause pain or problems. When symptoms do occur, simple treatments can usually help keep children comfortable and active.

What Causes Flexible Flatfoot in Children?

Flexible flatfoot happens because the ligaments and muscles in a child’s foot are still developing. Common factors include:

• Naturally flexible ligaments
• Underdeveloped foot muscles
• Family history of flat feet
• Growth and development patterns
• Generalized joint looseness (hypermobility)

In young children, flat feet are very common and usually improve as the arch develops with age.

What Are the Symptoms?

Most children with flexible flatfoot have no symptoms at all. When symptoms do occur, they may include:

• Foot or ankle pain after activity
• Tired or achy feet
• Pain in the heels, arches, or ankles
• Clumsiness or frequent tripping
• Uneven shoe wear

Pain is more common in older children or very active kids.

When Should My Child See a Specialist?

You should consider seeing a pediatric orthopedic specialist if:

• Your child has foot pain or fatigue
• The flatfoot is only on one side
• The foot is stiff or cannot be moved easily
• Your child has trouble keeping up with activities
• The flatfoot does not improve with growth

These signs may suggest a different or more serious condition.

How Is Flexible Flatfoot Diagnosed?

Diagnosis begins with a physical exam and observation of your child’s feet while standing, walking, and standing on their toes. The provider checks:

• Whether the arch reappears when your child is not bearing weight
• Foot flexibility
• Alignment of the ankles and legs

Imaging tests are usually not necessary unless the foot is painful, stiff, or has an unusual appearance.

How Is Flexible Flatfoot Treated?

Treatment depends on whether your child has symptoms. Treatment goals include:

• Relieving pain
• Supporting comfortable movement
• Allowing normal foot development
• Keeping your child active

Most children with flexible flatfoot do not need treatment.

Nonsurgical Options

If symptoms are present, nonsurgical treatment may include:

• Supportive shoes with good arch support
• Shoe inserts or orthotics
• Stretching exercises, especially for tight calf muscles
• Physical therapy in some cases
• Activity modification during painful periods

Surgical Options

Surgery is rarely needed for flexible flatfoot. It may be considered only if:

• The pain is severe and long-lasting
• Nonsurgical treatments have failed
• The condition interferes with daily activities

Surgical options are tailored to the child’s anatomy and symptoms. Surgery is typically done only after the growth plates have closed.

What Are the Risks of Surgery?

If surgery is ever required, risks may include:

• Infection
• Stiffness
• Continued pain
• Need for additional procedures

What Does Recovery From Treatment Involve?

Most children treated nonsurgically continue normal activities.

If surgery is needed, recovery may include:

• Temporary casting or bracing
• Physical therapy
• Gradual return to activity

How Long Does Recovery Take?

For nonsurgical care, improvement is often seen within weeks to months.

After surgery, the initial recovery period typically lasts 6–8 weeks, with continued improvement occurring over several months. Weight-bearing activities are reintroduced slowly.

What Is the Outlook for My Child?

The outlook for children with flexible flatfoot is excellent. Most children develop normal arches over time. Even those who keep flat feet usually remain active and pain-free with proper support.