Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Type | Arch on Tiptoe? | Peroneal Spasm? | Cause | Imaging |
|---|---|---|---|---|
| Physiologic Flexible Flatfoot | Yes — arch reconstitutes | No | Ligamentous laxity; developmental; familial | Usually not needed; weight-bearing X-ray if surgical planning |
| Flexible Flatfoot + Tight Achilles | Yes — but limited dorsiflexion (<5°) | No | Gastrocnemius tightness drives compensatory pronation | X-ray; Silfverskiöld test for equinus |
| Tarsal Coalition (Rigid) | No — arch does not reconstitute | Yes — classic finding | Congenital bony/fibrous bar between tarsal bones | CT (CN coalition); MRI (TC middle facet; fibrous coalitions) |
| Congenital Vertical Talus | No — rocker-bottom deformity | Variable | Congenital; associated syndromes (spina bifida, arthrogryposis) | X-ray plantarflexion lateral: talus-1st MT angle; forced dorsiflexion view |
| Neurologic Flatfoot (spastic) | No — rigid | Variable (spasticity-driven) | Cerebral palsy; myelomeningocele; posterior tibial spasm | MRI brain/spine; EMG if indicated; weight-bearing X-rays |
| Treatment | Age Range | Indication | Expected Outcome | Notes |
|---|---|---|---|---|
| Observation | Under 8 years; asymptomatic | Flexible painless flatfoot; normal development | 80% develop arch spontaneously by age 8–10 | Reassure family; no intervention needed |
| Custom Orthotics (UCBL or semi-rigid) | Any age; symptomatic | Activity-related pain; fatigue; shin splints from overpronation | 60–70% symptom control; does NOT accelerate arch formation | Evidence shows orthotics do not change arch development outcome |
| Gastrocnemius Stretching | Any age with tight Achilles | Limited dorsiflexion driving pronation | Improves dorsiflexion 5–10° with compliance; reduces pronation | Wall stretch × 3 sets × 30 sec daily; combined with orthotics |
| Subtalar Arthroereisis (HyProCure) | 8–16 years | Symptomatic flexible flatfoot; failed orthotics 12+ months | 75–85% good-excellent; removes if needed | Sinus tarsi stent; removable; 4–6 week boot recovery |
| Calcaneal Lengthening Osteotomy | 10–18 years | Severe flexible flatfoot with forefoot abduction; failed arthroereisis | 80–90% structural correction | Lateral column lengthening; 6–8 weeks NWB; bone graft needed |
| Tarsal Coalition Resection | 8–16 years (before OA) | Symptomatic rigid flatfoot; coalition <50% joint | 75–90% CN; 60–75% TC | Fat graft interposition prevents recurrence |
Watch: Reverse Flat Feet & Overpronation FAST [FIX Knee, Hip & Back Pain] — MichiganFootDoctors YouTube
Foot pain isn't resolving?
Same-week appointments at Howell & Bloomfield Hills
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Flat feet in children are extraordinarily common — and in the vast majority of cases, completely normal. The arch develops gradually through childhood; most children under 6 appear flat-footed due to natural ligamentous laxity and fat pad fullness in the arch area. The critical question is not whether the foot is flat, but whether the flatfoot is flexible (arch forms with toe rise — benign), painful (requires treatment), or rigid (arch does not form with toe rise — evaluate for tarsal coalition or vertical talus). At Balance Foot & Ankle PLLC, Dr. Tom Biernacki provides expert pediatric flatfoot evaluation and parent education.
When Is Flat Foot Normal?
Under age 6: flat feet are physiologically normal and require no treatment. Ages 6–10: arch should be developing. Persistent flatfoot in this age range is evaluated for symptoms and gait impact. Over age 10: flexible flatfoot without symptoms and without progressive gait problems does not require treatment — observation only. Treat the child, not the X-ray. Asymptomatic flexible flatfoot with normal activity tolerance does not require orthotics or intervention regardless of severity of flatness.
When to Treat Pediatric Flatfoot
Indications for custom orthotics: Pain with activity, foot fatigue, or shoe wear abnormality in flexible flatfoot. Gait abnormality — in-toeing, excessive pronation affecting knee and hip mechanics. Progressive deformity with worsening appearance. Sever’s disease with associated flatfoot biomechanics. Rigid flatfoot (always requires evaluation): Flatfoot that does not correct with toe rise. Tarsal coalition (fibrous or bony bridge between calcaneus and talus or navicular) — diagnosed with CT scan. Congenital vertical talus — diagnosed with X-ray. Accessory navicular with symptomatic prominence.
Custom Orthotics for Children
When orthotics are indicated, Dr. Biernacki prescribes growing-foot orthotics appropriate to the child’s size and activity. Children’s orthotics require replacement as the foot grows — typically every 1–2 years. The goal is symptom management and gait normalization — not to “create” an arch, as orthotics do not alter arch development in the long term.
Dr. Tom's Product Recommendations
New Balance Kids 860v13 Stability Running Shoe
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Stability youth running shoe with medial support — provides better arch support for active children with symptomatic flexible flatfoot than neutral shoes.
Dr. Tom says: “My podiatrist recommended these for my 9-year-old with flat feet and activity-related foot pain — significant improvement in after-school foot complaints.”
Pediatric flexible flatfoot, youth running shoe, medial support, growing foot stability
Replace every 6 months or 300 miles for growing active children
Disclosure: We earn a commission at no extra cost to you.
Powerstep Kids Orthotic Insole
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Youth arch support orthotic — provides medial arch and heel support for children with symptomatic flexible flatfoot. An OTC option while awaiting custom orthotic evaluation.
Dr. Tom says: “My pediatrician recommended arch support insoles for my daughter’s flat feet and foot pain and these made a noticeable difference.”
Pediatric flatfoot, youth arch support, flexible flatfoot symptom management, OTC orthotic
Growing children’s feet need size updates every 6-12 months
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Most childhood flatfoot is physiologically normal and self-resolving — reassurance is appropriate
- Custom orthotics effectively manage symptomatic flexible flatfoot with pain or gait abnormality
- Rigid flatfoot (tarsal coalition) identified early prevents years of unnecessary pain
- Evidence-based approach: treat the child, not the X-ray or the appearance
❌ Cons / Risks
- Custom orthotics require replacement every 1-2 years as children’s feet grow
- Orthotics do not permanently alter arch development — symptom management only
- Rigid flatfoot (coalition) may require surgery during adolescence
Dr. Tom Biernacki’s Recommendation
The most common scenario I see is a parent worried about their 4-year-old’s flat feet — and I get to reassure them that it’s completely normal and that most kids develop an arch by age 6-8. The cases that require real attention are: flat feet causing actual pain and activity limitation, significant gait problems affecting development, and rigid flat feet that don’t correct with toe rise. For those, we have excellent treatment options.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Should I be worried about my child’s flat feet?
In most cases, no. Physiological flat feet in children under 8 are normal. If your child has flat feet but runs, plays sports, and has no foot pain, observation is appropriate — no treatment needed. If your child has foot or leg pain, avoids activity, or has shoes wearing abnormally, evaluation is warranted. Dr. Biernacki will determine if treatment is indicated.
Do flat feet need to be treated in children?
Not in most cases. Asymptomatic flexible flatfoot — regardless of severity — does not require treatment. Custom orthotics are indicated when flatfoot causes pain, abnormal gait, or associated conditions like Sever’s disease. There is no evidence that treating asymptomatic flatfoot with orthotics improves long-term outcomes.
What is tarsal coalition?
Tarsal coalition is an abnormal fibrous or bony connection between two foot bones — most commonly the calcaneus and navicular (calcaneonavicular coalition) or the talus and calcaneus (talocalcaneal coalition). It causes a rigid, painful flat foot typically first noticed in adolescence. Diagnosis requires CT scan. Treatment: initial immobilization; surgical resection for persistent pain; arthrodesis for advanced degeneration.
At what age should I bring my child to a podiatrist for flat feet?
If your child has flat feet and is: under 6 with no symptoms — no evaluation needed. Ages 6-10 with symptoms (pain, fatigue, gait abnormality) — evaluation appropriate. Any age with rigid flatfoot (arch does not form on tiptoe) — prompt evaluation. Shoes wearing abnormally on the medial side regardless of age — evaluation appropriate. Dr. Biernacki provides efficient pediatric evaluations with parent education.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your flat feet, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
OrthoInfo – AAOS: Adult Flatfoot
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
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.