Concerns about gait and leg alignment in children are common. It's hard to tell when to worry and when to just be reassured. We asked pediatric orthopedic surgeon David Roberts, MD, of NorthShore Orthopaedic & Spine Institute, to break down four of the most common gait and leg alignment concerns in children and when you need to do something.

In this second of a four-part series, we look at flat feet.

Flexible flatfoot is a common condition seen in children. Both feet are affected, so this is commonly described as having “flat feet.” In this condition, the arch of the foot flattens when the child stands, due to the flexibility of the foot joints. The arch reappears when the child stands on tiptoes or sits with the feet hanging down. 

Parents often worry about flat feet, and whether treatments such as inserts or orthotics are needed. The good news is that most children outgrow this with time, and treatment is not necessary if the child does not have symptoms.

The foot arch forms by age 5-10 in most children with normal growth.  For more than 80% of young children with flat feet, the condition will eventually resolve and a normal arch will develop by early adolescence.  Studies have shown that wearing inserts, orthotics or corrective shoes does not make it more likely for an arch to develop, or make arch development occur at a faster rate.   

Whether to worry depends on the child’s symptoms. For a child with no symptoms, no treatment is needed. With time and growth, the arch will usually develop on its own.

However, flat feet can cause foot pain or discomfort in the medial arch, especially with long walks or strenuous physical activity. This usually responds to properly fitted and good-quality shoes, calf stretching at home or with a physical therapist, and arch support or orthotics. 

If pain persists despite this, surgery can be considered, and occasionally is necessary for severe flat feet in older children or adolescents with refractory symptoms. Some flexible flat feet will become stiff and rigid over time, and this requires further evaluation to see if other problems are present (e.g. tarsal coalition).

We suggest seeing a doctor about your child’s flat feet, if it is:

• Painful – causing foot pain, trouble with shoe wear, or limiting participation in physical activities
• Severe – e.g. concerning to your pediatrician, more than what is typically seen
• Stiff and rigid – the foot does not correct with toe rise or sitting with the feet free, or has lost flexibility over time