Pediatric Flatfoot

In this video, Dr. Baravarian discusses treatment option available for pediatric flatfoot.


While flat feet in children are a fairly common problem that can usually be treated non-surgically, it's important to have them evaluated by a foot and ankle specialist to avoid future complications.


The physicians at University Foot and Ankle have decades of experience treating children and their unique foot and ankle needs. They pride themselves in offering the best care possible in a compassionate and caring manner.


Symptoms of Pediatric Flatfoot

Some children with flat feet experience pain or discomfort during exercise, and may start to withdraw from sports and other physical activities. In some cases, the collapsed arch can cause the knee and leg to rotate inward, which can cause foot, back, and knee problems. It’s important to have their condition evaluated by a foot and ankle specialist to avoid any further pain or future problems.


Many children with mild pediatric flatfoot may not experience symptoms. However, moderate and severe cases tend to cause:

  • Visible collapse of both arches when weight bearing. If you are walking behind your child, you might notice their ankles rolling in and heels rolling out.
  • Mid-foot pain, especially in the joints of the arch
  • Stiffness in the foot
  • Toes may be pointed in, or “pigeon-toed”
  • Pain while walking, running, or playing
  • Increased tripping or clumsiness
  • Muscle fatigue in the legs, especially after long periods of standing or physical activity
  • Calf, knee, or lower back pain
  • Lack or loss of interest in sports or physical exercise



Diagnosing Pediatric Flatfoot

If you notice these symptoms in your child, or your child complains of chronic foot or leg pain, please make an appointment to have him or her evaluated by a foot and ankle specialists. The specialists at UFAI use the latest testing and diagnostic technology to pinpoint the source of the issue, including on-site MRI, X-ray, ultrasound, and weight-bearing 3D CT imaging. Once a diagnosis is made, we can help you identify the best course of action for the health of your growing child.



Types of Pediatric Flatfoot

Flexible Flatfoot

The foot has an arch when sitting or on tip-toes, but the arch collapses when standing. A common cause of pediatric flexible flatfeet is a tight Achilles tendon. The growing bones in children cause surrounding tendons and soft tissues to stretch, which can result in an Achilles tendon that is shortened and tight. The foot compensates for the tight tendon and the heel lifts off the ground earlier when walking and running.


Fixed or rigid flatfoot (also known as tarsal coalition)

The foot is in a permanent flat foot position; there is no arch in the foot with or without weight. This can happen when two bones in the rear of the foot fuse together, rendering the joint immobile. Fixed flatfeet can be the cause of injury or infection, however most often it is a condition you are born with. The most common forms of rigid flatfeet are taloalcaneal coalition and calcaneonavicular coalition.


Another cause of flatfeet is accessory navicular. This happens when there is an extra piece of bone or cartilage just above the arch on the inside of the foot. Accessory navicular can affect the mechanics of the posterior tibal tendon (the tendon that supports the arch), resulting in flatfeet. Read more about accessory navicular here. Insert link here



Pediatric Flatfoot Treatment

If your child is experiencing chronic pain, or having a hard time running due to flatfloot, then your foot and ankle specialist may recommend treatment. There are a few different treatment options, depending on the severity of the condition.


Non-invasive treatment options

Children’s feet can grow quickly and mature at a pace all their own. For mild cases of pediatric flatfoot, it may be best to treat the condition with conservative measures. The goal of treatment is to stabilize the heel position so that the joints aren’t irritated.

  • Stretching exercises. Your child’s foot and ankle specialist can demonstrate some stretching exercises that your child can perform regularly at home.
  • Insoles or custom orthotics. This is a conservative, non-invasive form of treatment that provides support for the arch about brings the heel into alignment while your child is walking or playing. The orthotic support can relieve pain, strain, and muscle fatigue and improve the mechanics of your child’s gait to avoid further problems. An over-the-counter device such as a UCBL insert can assist in stabilizing the heel position.
  • Braces. In some severe cases, an orthotic may not provide enough support. If the child is not a good candidate for surgery, your foot and ankle specialist may provide him or her with a special brace to accommodate the foot and ankle.


Surgical Flatfoot Reconstruction

The goal of pediatric flatfoot reconstruction is to realign the foot and create in each foot a strong, stable tripod. One or a combination of these procedures may be performed:

  • An implant is inserted between the bones of the foot to prop up and support the arch, functioning as an internal orthotic.
  • The tight Achilles tendon is lengthened, relieving pain and relaxing the tension that causes arch collapse.
  • In cases of severe arch collapse, the heel bone is lengthened to correct the heel’s support of the leg.
  • The arch is surgically repositioned to establish a more stable tripod on the ground.


In the case of tarsal coalition, the flat foot position is corrected by removing the bone bridge between the two bones and realigning the bones of the foot.


Read more about flatfoot reconstruction in the Podiatry Today article: "When Pediatric Flatfoot Requires Surgery," written by UFAI's Dr. Baravarian.

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