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Flexible Flat Foot

Pes planus, or a flexible flat foot, is when the arch seems to disappear when the foot comes in contact with the ground. As the arch disappears, the ankle rolls inward. This ankle position is called pronation. Flexible flat foot is often diagnosed by specialists in the Institute for Sports Medicine.


A flexible flat foot is a developmental variation which is extremely common in children. Almost all babies have flat feet. More than four out of every 10 children aged three to six years old have flat feet. A flexible flat foot will often improve or resolve as a child gets older and the muscles and ligaments in the arch mature and tighten. By age six, one in four children have flexible flat foot and the about one in seven people will still have flat feet by the time they reach adulthood. A flexible flat foot can run in families. Rigid, inflexible flat feet are much less common and can be due to bone or nerve problems.


The diagnosis of flat foot can be made with a physical examination by your doctor. X-rays generally are not needed. With flexible flat foot, the arch seems to lower or disappear with standing, but reappears when the child stands on his tip-toes; this is one maneuver which can help the physician distinguish between flexible and rigid flat foot.


Most children with flat feet do not have any problem with pain in the feet or legs. In fact, children with high arches are more likely to have foot pain. Parents may notice that they cannot see their child’s arches or that their ankles seem to roll inward when they are walking.

Some children with flexible flat feet do have pain over the arch or bottom surface of the foot when walking or running. Pain felt in the knee or legs and limping due to pain after strenuous activity are much less common; when these symptoms are present, other causes should be considered.


Flexible flat feet generally do not require any treatment at all. Special shoes, shoe inserts and exercises do not lead to flat foot correction. For children younger than eight, physicians tend to recommend observation only. Doctors may recommend orthotics (shoe inserts) for middle- or high school-aged children with pain which seems to be due to flat feet. Orthotics provide support to the arch of the foot and decrease the amount of pronation (ankles rolling inward).

It is important to remember that shoe inserts will not change the shape of the foot or lead to the development of the arch as your child gets older. Inserts only provide added support and comfort.

Surgery to place an implant into the foot is not recommended for children and adolescents. Reconstructive surgery of the foot is very complex and requires a long recovery period; this procedure is reserved for the rare cases of severe, painful flat feet that don’t respond to conservative measures such as shoe inserts, stretching and strengthening. We recommend consulting an orthopaedic provider with extensive experience treating children, adolescents and young adults before considering this type of surgery.

Long-term Effects

If your child ends up having flat feet as an adult, this condition is unlikely to affect their ability to perform normal activities or play sports.

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