Flat feet is when the whole foot is in contact with the floor in standing, rather than the inner (medial) arch of the foot being raised. Flattened arches can lead to knee and hip pain and balance difficulties. Children under the age of five or six normally have no visible medial arch because it is hidden by a ‘fat pad’. This fat pad is gradually absorbed as the child begins to stand and Walk.


Physiotherapy treatment will help improve your childs foot position, reduce pain and allow your child to continue with the activities at home or school that they enjoy.



  • Shortened Achilles tendon (the thick tendon at the back of the heel). A child will usually pronate (turns inward) their foot while walking and running in order to get their heel down.
  • Laxity (Looseness) in the Achilles tendon can lead to increased movement of the ankle joint and therefore the foot pronates and flattens more often.
  • Muscle weakness – weakness of the deep abdominal muscles and the hip muscles causes a change in posture around the hips and over pronation of the feet.

Your doctor will perform a physical examination of your child’s foot and observe the child in standing and sitting positions. If an arch form when the child stands on his toes, then the flatfoot is flexible and no further tests or treatment are necessary. If pain is associated with the condition, or if the arch does not form on standing on toes, then X-rays are ordered to assess the severity of the deformity. A computed tomography (CT) scan is done if tarsal coalition is suspected and if tendon injury is presumed a magnetic resonance imaging (MRI) is recommended.


If your child does not exhibit any symptoms your doctor may monitor your child’s condition as they grow to assess for any changes. If, however, your child has symptoms, your doctor may suggest some of the following non-surgical treatments.

  • Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time.
  • Orthotic devices: Your surgeon may advise on the use of custom made orthotic devices that are worn inside the shoes to support the arch of the foot.
  • Physical Therapy: Stretching exercises of the heel can provide pain relief.
  • Medications: Pain relieving medications such as NSAID’s can help to reduce pain and inflammation.
  • Shoe modification: Using a well‐fitting, supportive shoe can help relieve aching pain caused by flatfoot.
Surgery is rarely needed to treat

pediatric flatfoot,

however, if conservative treatment options fail to relieve your child’s symptoms then surgery may be necessary to resolve the problem. Depending on your child’s condition, various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.