Flat Feet in Children vs. Adults: When to Treat and When to Watch

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

Understanding Flat Feet Across the Lifespan

Flat feet — technically called pes planus — is one of the most common foot presentations seen in podiatric practice. Yet the implications of flat feet are entirely different depending on the patient’s age, symptom status, and underlying cause. The approach to a 3-year-old with flat feet is completely different from the approach to a 35-year-old with progressive arch collapse.

Flat Feet in Infants and Toddlers: Almost Always Normal

All infants are born with flat feet. The arch develops gradually as children begin walking, as the foot bones ossify, and as the ligaments tighten with weight-bearing activity. Most children develop a visible arch by age 6–7. Until that point, flat feet in children are considered physiologic — a normal developmental stage, not a pathology.

A toddler or preschooler with flat feet who is walking normally, showing no pain, and keeping pace with peers developmentally does not require orthotics or intervention. Premature intervention with arch supports in toddlers does not speed up arch development and is generally not recommended by pediatric podiatrists.

When Flat Feet in Children Warrant Attention

Flags that indicate a flat-footed child should be evaluated by a podiatrist include: persistent flat feet beyond age 7–8 without arch formation, pain in the arch, heel, or ankle, abnormal gait (toe walking, in-toeing, significant out-toeing), rapid fatigue with walking or refusal to participate in physical activity, asymmetry (one foot more flat than the other), and rigidity (a flat foot that does NOT form an arch when the child stands on tiptoe — a rigid flatfoot has a different cause than flexible flatfoot).

Rigid flatfoot in a child is always worth investigating. It may indicate tarsal coalition (an abnormal fusion of tarsal bones), vertical talus, or other structural anomaly that may require surgical treatment.

Flexible Flatfoot in Older Children and Adolescents

Flexible flatfoot — where an arch appears on tiptoe but disappears with full weight-bearing — is the most common form in children and adolescents. If symptomatic (causing arch pain, heel pain, or shin pain), custom orthotics are highly effective at reducing discomfort and improving mechanics. Orthotics do not “create” an arch permanently but do provide functional support during growth.

Athletic children with symptomatic flatfoot often experience significant improvement in pain and performance with custom orthotics — the device compensates for the lack of passive bony support by providing external arch support during activity.

Adult Flat Feet: Two Different Problems

Adults present with two distinct types of flat feet. The first is longstanding flexible flatfoot that was present since childhood and has been asymptomatic for years but is now causing problems — often triggered by weight gain, increased activity, or new footwear. The second and more urgent is adult acquired flatfoot, which develops progressively in adulthood due to posterior tibial tendon dysfunction (PTTD).

In adult acquired flatfoot, the posterior tibial tendon — the main arch-supporting tendon — gradually fails under load. The arch collapses, the heel rolls outward, and the forefoot abducts. This is a progressive condition that, without treatment, leads to arthritic changes in the subtalar and midfoot joints. Stage I disease (tendon inflammation with intact arch) responds to orthotics and physical therapy. Stage II (arch collapse without arthritis) may require reconstructive surgery. Stages III and IV (with fixed deformity and arthritis) typically require fusion procedures.

Custom Orthotics for Flat Feet

Custom orthotics fabricated from a neutral cast are the most evidence-supported non-surgical treatment for both flexible flatfoot (children and adults) and early-stage PTTD. They support the medial arch, reduce torsional stress on the posterior tibial tendon, improve alignment, and distribute pressure more evenly across the foot.

Over-the-counter arch supports provide some benefit for mild cases, but do not match the precision of custom devices for moderate-to-severe flatfoot or for patients with complex arch anatomy.

Evaluation at Balance Foot & Ankle

Dr. Tom evaluates flat feet with weight-bearing X-rays to assess arch height, talar coverage angle, and calcaneal pitch. For suspected PTTD, MRI provides critical information about tendon integrity. Both pediatric and adult flatfoot patients are seen at the Howell and Bloomfield Township locations. Call (810) 206-1402 or book online for a comprehensive evaluation.

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Flat Feet Treatment for All Ages

Flat feet affect both children and adults differently, and knowing when treatment is needed can prevent long-term complications. At Balance Foot & Ankle, we provide age-appropriate flatfoot evaluation and treatment.

Learn About Our Flatfoot Treatment Options → | 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. Lee MS, et al. “Diagnosis and Treatment of Adult Flatfoot.” Journal of Foot and Ankle Surgery. 2005;44(2):78-113.
3. Harris EJ, et al. “Diagnosis and Treatment of Pediatric Flatfoot.” Journal of Foot and Ankle Surgery. 2004;43(6):341-373.

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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.