Assessment: clinical examination includes the Jack's test (great toe dorsiflexion test — if the arch reconstitutes, the foot is flexible), tip-toe standing (if the heel corrects to varus, the posterior tibial tendon is functioning), and assessment for tightness of the Achilles tendon. Imaging: weight-bearing X-rays if pathology is suspected. Treatment: observation for flexible asymptomatic flatfoot. Stretching and physiotherapy for symptomatic flexible flatfoot with tight Achilles. Custom orthotics for symptomatic feet. Subtalar arthroereisis (a spacer implant in the sinus tarsi) for persistent symptomatic flexible flatfoot in selected cases. Surgical reconstruction (calcaneal osteotomy, tendon transfer, spring ligament repair) for rigid or progressive flatfoot.
Assessment is recommended for children with painful flat feet, progressive deformity, rigid flatfoot, shoe wear problems, or flatfoot associated with an underlying condition (cerebral palsy, Down syndrome, tarsal coalition).
Observation (the majority of children with flat feet need no treatment), Achilles stretching, supportive footwear, and activity encouragement. Custom orthotics for symptomatic flexible flatfoot.
Weight-bearing X-rays. CT if tarsal coalition is suspected. Assessment of Achilles tightness and subtalar motion.
Most children with flat feet do not need treatment — the arch often develops by age six to eight. For those who do, treatment aims to create a comfortable, functional foot. Orthotics relieve symptoms; surgery is reserved for persistent symptomatic or pathological flatfoot.
Over-treatmentCommon
The most common 'risk' — treating a normal variant that would have resolved spontaneously.
Orthotic dependencyCommon
Children may become reliant on orthotics unnecessarily.
Subtalar arthroereisis complicationsUncommon
The implant may cause sinus tarsi pain, shift position, or need removal.
Surgical complicationsUncommon
Standard surgical risks if reconstruction is needed.
No anaesthesia for clinical assessment. General anaesthesia for surgical procedures.
For observation: no restrictions. For orthotics: wear as guided. For surgery: weight-bearing restrictions for six to eight weeks depending on the procedure.
Clinical review every six to twelve months during growth. X-rays only when clinically indicated.
Will my child grow out of flat feet?
Most children with flexible, painless flat feet develop a normal arch by age six to eight. No treatment is needed in the majority.
Do flat feet need orthotics?
Most do not. Orthotics are recommended for children with symptomatic flat feet — pain, fatigue, or difficulty with activities. There is no evidence that orthotics change the natural development of the arch in asymptomatic children.
When should I be concerned?
Concern is warranted for rigid (non-flexible) flatfoot, painful flatfoot, progressive deformity, flatfoot with tight Achilles tendon, or flatfoot associated with neurological conditions.