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

Pediatric flatfoot — a low or absent medial longitudinal arch in a child or adolescent — is among the most common reasons parents seek podiatric evaluation for their children. The critical clinical distinction is between physiological flexible flatfoot (a normal variant in young children that often resolves spontaneously) and pathological flatfoot (rigid, symptomatic, or associated with a specific underlying cause requiring treatment). Most pediatric flatfoot does not require treatment — but the minority that does requires timely diagnosis to prevent permanent structural changes.

Normal Development and Flexible vs. Rigid Assessment

Normal arch development: the arch is flat in all infants (the fat pad obscures the arch); the arch typically develops between ages 3–7 as intrinsic foot muscles strengthen and body fat redistributes; 20% of adults have flexible flatfoot with no pain or functional limitation. Flexible flatfoot assessment: the arch is absent or reduced during weight-bearing but REAPPEARS on tiptoe or when the great toe is dorsiflexed (Jack test / Hubscher maneuver) — this arch reconstitution confirms that the passive arch support structures (plantar fascia, plantar ligaments) are intact; the hindfoot inverts normally on tiptoe; no rigid deformity. Rigid flatfoot: the arch does NOT reappear on tiptoe; hindfoot remains in valgus on tiptoe; limited subtalar motion; suggests tarsal coalition (the most common cause of rigid flatfoot in adolescents — fusion of calcaneonavicular or talocalcaneal joints), vertical talus, or inflammatory arthritis. Symptoms warranting treatment: pain with walking or sports participation; fatigue and activity avoidance; shoe wear abnormalities; rigid flatfoot at any age.

Treatment

Asymptomatic flexible flatfoot in children under 8: observe — the overwhelming majority will develop a normal arch; shoe modifications and insoles have not been shown to accelerate arch development or prevent adult flatfoot. Symptomatic flexible flatfoot: custom orthotics (UCBL-style) control hindfoot valgus and reduce fatigue; gastrocnemius stretching; activity modification during growth spurts when symptoms peak; calcaneonavicular bar resection for tarsal coalition causing rigid flatfoot in adolescents before arthritic changes develop. Idiopathic flatfoot in adolescents with pain refractory to orthotics: subtalar arthroereisis (a removable titanium implant placed in the sinus tarsi that limits hindfoot eversion) — a reversible procedure that supports the subtalar joint; calcaneal osteotomy for older adolescents with fixed valgus deformity. Dr. Biernacki at Balance Foot & Ankle evaluates pediatric flatfoot with weight-bearing examination and X-ray, and distinguishes flexible from rigid flatfoot requiring treatment. Call (810) 206-1402 at our Bloomfield Hills or Howell office for your child’s foot evaluation.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Pediatric Flatfoot Treatment in Michigan

Flat feet in children can be a normal developmental finding or indicate a structural problem requiring treatment. Our podiatrists specialize in distinguishing flexible from rigid flatfoot and creating age-appropriate treatment plans to support healthy foot development.

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

Clinical References

1. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4(2):107-121.
2. Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg. 2004;43(6):341-373.
3. Pfeiffer M, Kotz R, Ledl T, et al. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634-639.