Flexible flatfoot in children

In brief

Flexible flatfoot is very common in young children: the arch disappears when standing and reappears on tiptoe. In most cases it is a normal developmental variant that causes no pain and needs no treatment.

Typical age

Young children

Also known as

Flexible planovalgus foot · Pes planus · Flat feet

What is it?

Flatfoot in children is a reduced or absent arch on the inner side of the foot. It is common in the first years of life and, in many children, is part of normal development.

There are two main types:

• Flexible flatfoot: the arch appears on tiptoe or when the foot is not bearing weight. It is usually harmless and causes no discomfort.
• Rigid flatfoot: the arch stays flat in every position. It may be associated with structural problems and needs a specialist assessment.

Signs parents may notice

• Shoes wear out of shape.
• Feet with no visible arch.

When to see a specialist

Although many children have no symptoms, it is worth seeing a specialist if any of these signs appear:

• Pain in the feet, ankles, heels, knees or legs.
• Tiredness when walking or playing sport.
• Frequent tripping or walking problems.
• Limited foot movement.
• Difficulty wearing certain shoes.
• Avoiding physical activities the child used to do normally.

How is it diagnosed?

The specialist assessment considers the child’s age, symptoms and how the foot works, not just how it looks. The examination may include gait analysis, foot alignment, joint movement and muscle strength. When indicated, X-rays or other imaging tests are added.

Treatment

Treatment depends on age, the type of flatfoot and whether there are symptoms.

• Observation and follow-up: for many children with flexible, pain-free flat feet.
• Conservative treatment: individual measures to relieve discomfort and improve function, including orthotic insoles when indicated.
• Surgical treatment: reserved for selected cases where symptoms persist or a structural problem justifies it.

Surgery may involve different reconstructive techniques adapted to each child.

Conservative treatment

For children without symptoms, comfortable footwear and observation are enough; for those with symptoms, individual measures are considered, along with intrinsic foot muscle exercises and stretching when the calf muscles are tight. The decision to treat should be based on the symptoms, the examination and the pattern of deformity.

Surgical treatment

Flexible planovalgus foot is a condition in which the arch drops when the foot bears weight and the heel tilts outwards. When it causes pain, tiredness or functional limitation and does not improve with conservative measures, surgery may be considered.

There are two main arthroereisis techniques, both aimed at correcting the position of the hindfoot and improving foot alignment:

• Calcaneo-stop (extra-articular arthroereisis): a screw is placed in the calcaneus to limit excessive outward movement of the hindfoot and encourage better alignment, without placing an implant inside the sinus tarsi.
• Subtalar implant (intra-articular arthroereisis, endorthesis): an implant is placed in the sinus tarsi, a space between the talus and the calcaneus. It limits excessive pronation and helps correct heel valgus.

Both techniques aim to improve foot biomechanics, but they differ in the type of implant, where it is placed and possible complications. The choice depends on age, symptoms, the degree of deformity and the individual assessment of each patient.

The decision to operate should be made after a specialist assessment, always giving priority to conservative measures when they are appropriate.

Outlook and recovery

Recovery time after flexible flatfoot surgery with calcaneo-stop or a subtalar implant depends on the technique, the child’s progress and the surgeon’s instructions.

• First 2 weeks: relative rest, keeping the foot raised and wound care. Weight-bearing and the need for crutches or immobilisation depend on the technique and the surgeon’s protocol.
• Return to school: usually possible between 2 and 4 weeks, as long as the child can get around safely, the discomfort is under control and the foot is protected. Sometimes it takes longer.
• Light physical activity: usually resumed gradually from 4–6 weeks, depending on progress and medical approval.
• Sport and PE: impact sports such as running, jumping or football are usually resumed at around 8 to 12 weeks, although some children need more time.

Recovery is gradual and must be tailored to each child. Before returning to sport, the child should walk without pain or a limp, have good movement and have the specialist’s approval.

Every child recovers at their own pace. Following the medical team’s instructions and respecting recovery times helps ensure a safe return to school and sport.

This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.