Flatfoot, also known as “fallen arches” or Pes planus, is a deformity in children, in which the arch that runs lengthwise, along the sole of the foot, has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the ages of 3 and 5 years. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment, unless pain is involved. Rigid pediatric flatfoot, however, can cause joint pain in the leg when walking or an aching pain in the feet, and usually requires intervention.

Causes and risk factors

Pediatric flatfoot is a common condition that can run in families. It is often caused by loose connections between joints and excess baby fat deposits between foot bones, which make the entire foot touch the floor when the child stands up. A rare condition called tarsal coalition can also cause flatfoot. In this condition, two or more bones of the foot join together abnormally, causing stiff and painful flatfeet.

Signs and symptoms

Children with flatfoot deformity may have one or more of the following signs and symptoms:

  • Inside arch of the foot is flattened.
  • Heel bone may be turned outward.
  • The inner aspect of the foot may appear bowed out.
  • Pain may present in the foot, leg, knee, hip or lower back.
  • Pain may present in the heels, causing difficulty with walking/running.
  • Discomfort may be felt in wearing shoes.
  • Inability to bear weight on the affected foot.
  • Feet may get tired or achy with prolonged standing or walking.


Your doctor will perform a physical examination of your child’s foot and observe the child in standing and sitting positions. If an arch forms 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 ordered if tarsal coalition is suspected, and if tendon injury is presumed, a magnetic resonance imaging (MRI) is recommended.

Conservative treatment

If your child does not exhibit any symptoms, your doctor may monitor your child’s condition as he/she grows 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 the use of custom-made orthotic devices worn inside shoes, to support the arches of the feet.
  • Physical therapy: Stretching exercises of the heel can provide pain relief.
  • Medications: Pain-relieving medications such as NSAIDs can help reduce pain and inflammation.
  • Shoe modification: Using a well‐fitting and 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.