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Boundless Blog

Custom Orthotics Blog

What is “flat feet” in children and does it require treatment? By: Adrienne Cuch, CO(c), M.Sc, B.A.Kin

Adrienne Cuch, Certified Orthotist, B.A.Kin, M.Sc., CO(c)

We are often asked by parents and therapists about a child’s foot appearance, and whether the child requires an intervention to address their malalignment.  There is some available research in this area, and the expertise of our Orthotists can provide insight on when to be concerned.  First, it’s important to understand what “flat feet” is and what things to look for as parents and therapists.

Flat feet, also called pes planus, is commonly defined as a flattening of the arch during weight bearing.  Pes planus is quite common in young children (up to 44% of three to six year olds) and may or may not be symptomatic.  As the arch is still developing when the child is under the age of six, treatment in this age group is debated in the absence of other symptoms.

 Nale, R. (2016, July).  Pediatric Myth Busters: Common Misconceptions.   Current Pedorthics , July/August, 16-21.  

Nale, R. (2016, July).  Pediatric Myth Busters: Common Misconceptions.  Current Pedorthics, July/August, 16-21.  

What can symptoms look like?  

The most obvious is pain, although this is not the most commonly observed symptom.  The child may be reluctant to participate in activities requiring running, long periods of standing, or endurance activities.  They may have difficulty keeping up with peers, or have balance issues that are not age appropriate.  Late or missed milestones such as standing with support, walking, may also be related to poor alignment at the feet, as this does not place the muscles in an efficient position to stabilize the legs.  These, coupled with a visual malalignment of the ankles may indicate that your child requires treatment.  

How is the treatment plan determined?

Each child will have a complete assessment performed by their orthotist which involves collecting information about family history, medical history, activity level, age of child, symptoms, and other treatments.  A physical exam will reveal joint range of motion, strengths, functional testing, observational gait analysis, and foot and ankle alignment in non-weight bearing and weight bearing.  The heel or calcaneal alignment will determine if it is appropriate for their age.  For example, it is quite normal for a child to stand in some degree of valgus, or tilting inward, and this should diminish with age (they should reach a neutral alignment around age seven).  The assessment will be summarized for the parent and a discussion will allow collective input from everyone about an appropriate treatment plan.  We will commonly use clinical practice guidelines to provide guidance on when to treat children with pes planus. Often if a child with pes planus is asymptomatic and is of a young age, patient education and follow-up is recommended as this tends to resolve without intervention.

What are the treatment options?

Treatment is highly varied and tailored to the specific child and their family.  A number of factors will be considered when developing a treatment plan, and the recommendations may include:

  • Patient/parent/therapist education
  • Footwear
  • Prefabricated foot orthoses or heel cups
  • Custom made foot orthoses
  • Supra-malleolar orthoses (SMO’s) or dynamic movement orthoses (DMC’s)
  • Ankle-Foot Orthoses (AFO’s)

Your therapist may also recommend supplemental treatment options such as stretching or other exercises.  

How long will the child require treatment?

This is very specific to each child and even difficult to determine at any point in time.  Children will require replacement devices due to growth every 12 - 18 months, and these re-assessments will determine if the child still requires intervention.  Some require one set of devices, others will wear them throughout childhood.  Other times we will discontinue treatment for a period of time to see if symptoms return, at which point we will re-evaluate the treatment plan.  In general, you can discuss any concerns or questions you have with your orthotist, who will work with you to determine the best plan for your child.

In summary, treatment of pes planus is highly variable and debated among practitioners, but there are a number of tools available and the expertise of your orthotist to determine if a child requires intervention.  If you are having concerns about your own child or one of your clients, we recommend an assessment with one of our orthotists to determine if intervention is necessary, or if it will resolve on its own.  In general, our recommendations always have the child’s best interests in mind, as we want to help to maximize their quality of life.



D’Amico, J.C. (2001).  Developmental Flatfoot.  An Introduction to Podopediatrics, 2nd Edition.  257-259.  Elsevier Ltd.

Harris, E. J., Vanore, J. V., Thomas, J. L., Kravitz, S. R., Mendelson, S. A., Mendicino, R. W., ... & Gassen, S. C. (2004). Diagnosis and treatment of pediatric flatfoot. The Journal of foot and ankle surgery43(6), 341-373.

Pfeiffer, M., Kotz, R., Ledl, T., Hauser, G., & Sluga, M. (2006). Prevalence of flat foot in preschool-aged children. Pediatrics, 118(2), 634-639.

Rome, K., Ashford, R. L., & Evans, A. (2010). Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev7.