Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Flat feet in children are extremely common and — in most cases — a completely normal developmental finding that requires no treatment. The arch develops gradually throughout childhood, with the majority of children achieving a normal arch by age 6–8. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki evaluates pediatric flat feet to distinguish between the normal developmental variant (flexible flatfoot) that needs monitoring only, and the pathological forms (rigid flatfoot, symptomatic flexible flatfoot, tarsal coalition) that benefit from intervention.
Normal Development vs. Pathological Flatfoot in Children
Flexible flat feet in children — the arch is present when the child is non-weight-bearing but flattens when standing — is a normal finding in children under 6 and common in children through age 8–10. The vast majority of these children develop a normal arch without intervention. Treatment is indicated only when: pain is present (especially with activity), the child refuses to participate in sports or physical activity due to foot discomfort, there is excessive tripping or falls, the gait appears significantly abnormal, or the flatfoot is rigid (no arch forms even on tiptoe). Tarsal coalition — an abnormal bony or fibrous connection between two tarsal bones — is an important cause of rigid flatfoot and should be suspected in adolescents with a rigid flatfoot, frequent “ankle sprains,” and reduced subtalar motion. CT scan or MRI confirms the diagnosis. Calcaneonavicular coalition and talocalcaneal coalition are the most common types.
Treatment Options
For asymptomatic flexible pediatric flatfoot: observation only — no orthotics, no special shoes required unless symptoms develop. The evidence does not support using orthotics to “correct” asymptomatic developmental flatfoot. For symptomatic flexible pediatric flatfoot (pain, activity limitation): custom orthotics with medial arch support are the first-line treatment and are highly effective at reducing symptoms — most children with symptomatic flexible flatfoot become asymptomatic with well-fitted orthotics. Physical therapy addresses calf tightness (tight gastrocnemius-soleus contributes to pronation). Supportive footwear with firm heel counters complements orthotic therapy. For tarsal coalition causing symptoms: conservative treatment (orthotics, activity modification, casting) for mild cases; surgical resection of the coalition for cases that fail conservative care, with good outcomes in adolescents before secondary arthritis develops.
Frequently Asked Questions
Should I get orthotics for my child’s flat feet?
Only if your child has symptoms — pain, activity limitation, abnormal gait, or rapid unexplained fatigue with walking. Asymptomatic flexible flatfoot in a child under 10 does not require orthotics. Research consistently shows that orthotics do not accelerate normal arch development. For children with symptomatic flatfoot, custom orthotics significantly reduce pain and improve function — but they do not “fix” the structural flatfoot. See a podiatrist to determine whether your child’s flatfoot warrants evaluation and whether orthotics are appropriate.
At what age should a child’s flat feet be evaluated?
Flat feet are normal in children under age 6 and common through age 10 — no evaluation is needed unless symptoms are present. Evaluation is recommended regardless of age if: the flatfoot is rigid (no arch forms when standing on tiptoe), the child has pain or refuses to walk/run, the flatfoot is in only one foot, or the flatfoot worsened suddenly. Adolescents with rigid flatfoot and reduced ankle/subtalar motion should be evaluated for tarsal coalition.
Do flat feet in children cause problems in adulthood?
Most children with flexible flat feet develop a normal arch and have no foot problems in adulthood. A subset remain flat-footed as adults but are asymptomatic — the majority of adult flat feet do not cause pain or functional limitation. The children most likely to have adult foot problems from flatfoot are those who had symptomatic flatfoot in childhood, those with rigid flatfoot or tarsal coalition, and those with systemic hypermobility syndromes (Ehlers-Danlos, Down syndrome). Posterior tibial tendon dysfunction (adult acquired flatfoot) is a separate condition that develops in previously normal adults.
Concerned about your child’s flat feet? Contact Balance Foot & Ankle in Southeast Michigan for pediatric podiatric evaluation with Dr. Biernacki.
Dr. Tom’s Recommended Products for Flat Feet & Arch Support
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
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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.
Frequently Asked Questions
Do flat feet need to be treated?
What is the best insole for flat feet?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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