Flat Feet

Flat Feet

What are flat feet?

Flat feet, also known as pes planus, are when the arch along the inside of the foot appears low or comes close to the floor when a child is standing.

The heel may also lean slightly outwards.

Flat feet are very common in babies and young children. Young children's feet are naturally more flexible, and the shape of the foot continues to develop as they grow.

The arch usually develops gradually throughout childhood, although the timing varies between children. Some children continue to have flexible flat feet as they get older.

Importantly, flat feet do not automatically mean that something is wrong.

If a child's feet are flexible, comfortable and do not affect their walking, running, play or sport, treatment is often not needed.

What causes flat feet in children?

In many children, flat feet are simply part of normal development.

Flat feet can also run in families and may be associated with naturally flexible joints and ligaments.

Other factors that can contribute to a flatter foot or affect how the foot functions include:

• Generalised joint hypermobility

• Tight calf muscles or Achilles tendons

• Differences in the development or structure of the foot bones

• Previous foot or ankle injury

• Muscle weakness

• Conditions affecting the muscles or nerves

• Neurological conditions such as cerebral palsy or spina bifida

• Some inherited connective tissue conditions

A tight Achilles tendon does not necessarily cause flat feet, but reduced ankle flexibility can affect how the foot moves and may contribute to discomfort or altered movement in some children.

What are the different types of flat feet?

Flexible flat feet

Flexible flat feet are the most common type in children.

The arch may be visible when the child is:

• Sitting

• Lying down

• Standing without weight through the foot

• Standing on their tiptoes

The arch then lowers or disappears when the child stands and puts weight through the foot.

Flexible flat feet are often present in both feet and are usually painless.

If the child is walking, running and playing normally without pain, treatment is generally not required.

Rigid flat feet

With rigid flat feet, the arch remains flat even when the foot is not bearing weight or when the child stands on tiptoes.

The foot may also feel stiff and can be painful.

Rigid flat feet are less common and can sometimes be associated with structural conditions such as a tarsal coalition.

A child with a rigid, painful or significantly restricted foot should be assessed by an appropriate healthcare professional.

Flat feet associated with another condition

Some children have flatter feet because of an underlying condition affecting their muscles, joints, nerves, bones or connective tissues.

For these children, physiotherapy may form part of a wider rehabilitation programme alongside other healthcare professionals.

Who can develop flat feet?

Flat feet can occur at any age, but they are particularly common during infancy and early childhood.

As children grow, their feet, muscles, ligaments and movement patterns continue to develop.

Some children will continue to have flat feet into later childhood and adulthood. This does not necessarily cause a problem.

The most important question is not simply “Does my child have flat feet?”, but “Are their feet causing symptoms or affecting what they can do?”

What symptoms can flat feet cause?

Most children with flexible flat feet do not experience any symptoms.

When problems are present, a child may experience:

• Pain or aching in the foot, arch or ankle

• Tired or uncomfortable feet after prolonged walking or standing

• Calf or Achilles tendon tightness

• Reduced endurance during physical activity

• Difficulty keeping up with friends

• Reduced balance or coordination

• Frequent tripping

• Changes in their walking or running pattern

• Limping

• Avoiding activities they would normally enjoy

For example, a young child may have visibly flat feet but still run, jump and play without pain or difficulty. In this situation, the appearance of their feet alone may not require treatment.

An older child may experience aching in their feet or ankles after a long walk or during sport. If weakness, stiffness, reduced ankle movement or changes in lower-limb movement are contributing to these symptoms, physiotherapy may be helpful.

When should my child have their flat feet assessed?

Flat feet do not usually require assessment simply because the arch looks low.

It is worth seeking professional advice from a GP, physiotherapist, podiatrist or other appropriate healthcare professional if your child has:

• Persistent or worsening foot or ankle pain

• A stiff or painful foot

• Difficulty walking, running or participating in activities

• A noticeable limp

• Frequent falls or tripping

• Significant weakness

• A noticeable difference between the two feet

• A foot that remains flat and does not develop an arch when standing on tiptoes

• Flat feet that develop or become significantly worse after previously having a normal arch

An assessment can help determine whether the flat foot is simply part of normal development or whether something else may be contributing to the child's symptoms.

Can physiotherapy help children with flat feet?

Yes, physiotherapy can help when flat feet are causing pain, stiffness, weakness or difficulty with movement and participation.

Physiotherapy is not usually needed simply to make a child's arch look higher.

Instead, we focus on how the child's feet function and what they are able to do.

At Positive Steps, the physiotherapist will discuss the child's symptoms, activities and goals with them and their family before assessing their movement.

What might be assessed?

Depending on the child's needs, this may include:

• Foot and ankle posture

• Foot and ankle movement

• Calf and Achilles tendon flexibility

• Foot, ankle and lower-limb strength

• Balance and coordination

• Hip and knee movement

• Standing posture

• Walking and running

• Squatting

• Jumping and landing

• Functional activities relevant to the child's everyday life or sport

We will also consider whether the child's presentation suggests that further medical, orthopaedic or podiatry assessment may be appropriate.

How can physiotherapy help?

Treatment is individualised and may include:

Foot, ankle and lower-limb strengthening

Exercises can help improve strength and control through the foot, ankle and wider lower limb where weakness is contributing to symptoms.

Calf and ankle flexibility

Where reduced ankle movement or calf tightness is contributing to symptoms, appropriate stretching and mobility exercises may be included.

Balance and coordination

Balance activities can help children develop control through their feet and lower limbs.

These may be incorporated into play, sport or functional activities to make them meaningful and enjoyable.

Walking and running

If a child has developed changes in the way they walk or run, physiotherapy can assess their movement and work on strategies to improve comfort, control and confidence.

Strength and conditioning for sport

For older children and teenagers who participate in sport, physiotherapy can help develop the strength and movement control needed for running, jumping, landing and changing direction.

Activity and participation

We can help families understand how to manage activity when symptoms are present, while supporting children to remain involved in the activities they enjoy wherever possible.

Footwear and insoles

Comfortable, well-fitting footwear can be important for children with foot pain.

Depending on the child's presentation, we may discuss footwear, heel cushioning or insoles.

However, not every child with flat feet needs special shoes, arch supports or orthotics.

Any recommendation should be based on the child's symptoms, foot function and individual needs rather than the appearance of the arch alone.

Where orthotics are appropriate, we can work alongside podiatrists, orthotists or other members of the child's healthcare team.

What does physiotherapy look like at Positive Steps?

There is no single physiotherapy programme for flat feet.

A child who has painless flexible flat feet and no difficulty with movement may not need physiotherapy at all.

For a child experiencing pain, weakness, stiffness or difficulty participating in activities, our sessions are tailored around what matters to them.

This might mean helping a child:

• Walk comfortably

• Run and jump with confidence

• Keep up with friends

• Take part in PE

• Return to sport

• Improve balance

• Build strength

• Understand their symptoms

• Feel more confident using their feet and lower limbs

For younger children, exercises can be incorporated into play-based activities. For older children and teenagers, rehabilitation can be more sport-specific and focused on their individual goals.

Working with the wider team

Some children with flat feet benefit from support from more than one professional.

Depending on their needs, this may include:

• Parents and carers

• GPs

• Physiotherapists

• Podiatrists

• Orthotists

• Orthopaedic specialists

• Other healthcare professionals

At Positive Steps, we are happy to work alongside the wider team where this is appropriate.

What are the goals of physiotherapy for flat feet?

The goals will depend on the individual child but may include:

• Reducing pain and discomfort

• Improving foot and ankle strength

• Improving flexibility and movement

• Developing balance and coordination

• Improving walking and running confidence

• Supporting participation in PE, sport and play

• Managing contributing factors such as calf tightness or weakness

• Helping families understand when treatment is and is not needed

• Supporting children to remain active and confident

How can Positive Steps help?

Having flat feet does not necessarily mean that your child needs treatment.

For many children, flexible flat feet are simply part of normal development and do not prevent them from walking, running, playing or taking part in sport.

Where flat feet are associated with pain, stiffness, weakness or difficulty participating in everyday activities, physiotherapy can help us understand why the child is struggling and what can be done to support them.

At Positive Steps, we focus on the whole child rather than simply the shape of their feet, creating personalised rehabilitation around their symptoms, activities and goals.

Always finding what can be done.

If your child is experiencing foot or ankle pain or you have concerns about how their flat feet are affecting their movement, get in touch with the Positive Steps team to arrange an assessment.

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Find out more

For further information about flat feet in children, speak to your GP, physiotherapist, podiatrist or other healthcare professional.

Useful sources include:

• NHS – information about children's foot development and musculoskeletal conditions

• Association of Paediatric Chartered Physiotherapists (APCP)

• British Orthopaedic Association – information about children's orthopaedic conditions