Children’s Flat Feet and Orthotics: When Treatment Is Actually Needed

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Flat feet are among the most common concerns parents bring to podiatrists — and most of the time, the answer is reassuring. The vast majority of children with flat feet have a completely normal variation of foot anatomy that requires no treatment. But a subset of children with flat feet do benefit from orthotics, and knowing the difference is where expert evaluation matters.

Normal Development of the Arch

All infants are born with flat feet. The arch develops through childhood as muscles strengthen, ligaments tighten, and the tarsal bones ossify. Most children develop a visible arch by age 5–6. Some children have a flexible flat foot (the arch appears when standing on tiptoe or when seated — only flattening under weight-bearing load) which is a normal anatomic variant. Flexible flat feet in a child who is active, pain-free, and developing normally virtually never require treatment.

When to See a Podiatrist

A podiatric evaluation is warranted when a child with flat feet has any of the following:

• Foot or ankle pain — arch pain, heel pain, or ankle pain during or after activity
• Calf or knee pain — overpronation from flat feet can transmit abnormal forces up the kinetic chain
• Activity limitation — if the child avoids physical activities due to foot discomfort or fatigue
• Asymmetric flat feet — flat foot on one side but not the other warrants evaluation for underlying cause
• Rigid flat feet — if the arch does not appear when the child stands on tiptoe, a tarsal coalition (abnormal bony connection between tarsal bones) may be present and requires imaging
• Associated conditions — Ehlers-Danlos syndrome, Down syndrome, cerebral palsy, and muscular dystrophy can cause pathological flat feet requiring treatment
• Excessive shoe wear — disproportionate medial shoe wear or rapid shoe breakdown can indicate significant overpronation

Do Custom Orthotics Help Children with Flat Feet?

For flexible flat feet with no symptoms, there is no evidence that orthotics change the long-term outcome or accelerate arch development. However, for children with symptomatic flat feet — those experiencing pain, fatigue, activity limitation, or associated knee/hip pain — custom orthotics reduce pathological pronation forces, relieve symptoms, and allow full participation in sports and activities. Most children with symptomatic flexible flat feet respond very well to custom orthotics.

Orthotics for Children: What to Expect

At Balance Foot & Ankle, Dr. Biernacki uses 3D digital foot scanning to create custom orthotics for pediatric patients. Children’s orthotics are typically replaced every 1–2 years as feet grow. The orthotic is a functional device — not a corrective one — that controls motion and distributes pressure during the activity phase. Most insured children with documented symptomatic flat feet qualify for insurance coverage.

Tarsal Coalition: The Flat Foot That Needs More Than Orthotics

Tarsal coalition is a congenital fusion of two tarsal bones (most commonly calcaneonavicular or talocalcaneal coalition) that causes rigid flat foot, peroneal spasm, and activity-related pain — typically presenting in adolescence as bone ossification increases rigidity. Diagnosis requires CT scan. Treatment ranges from immobilization and orthotics for mild cases to surgical coalition resection (for simple cases) or subtalar arthrodesis for complex cases.

Children’s Flat Feet — When Do Kids Need Orthotics?

Worried about your child’s flat feet? Our podiatrists evaluate pediatric foot development and determine when treatment is needed versus normal growth patterns.

Learn About Our Pediatric Foot Care Services → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Pfeiffer M, et al. Prevalence of flat foot in preschool-aged children. Pediatrics, 2006;118(2):634-639.
2. Evans AM, Rome K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. European Journal of Physical and Rehabilitation Medicine, 2011;47(1):69-89.
3. Mosca VS. Flexible flatfoot in children and adolescents. Journal of Children’s Orthopaedics, 2010;4(2):107-121.

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.