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Flat Feet

When are flat feet normal? 

  • Normal in babies and toddlers, usually resolves by 6 years of age as the longitudinal arch develops.
  • They persist in at least 10% of children, commonly are found with other features of hypermobility and are often familial (check parents feet !!).
  • Management involves explanation, reassurance, and advice regarding appropriate supportive footwear (i.e., supportive heel cup and mid-foot support with fastened laces).
  • Physiotherapists, orthotists and podiatrists may provide exercises and insoles if problems persist.

Photo: Flat feet in a healthy 4 year old - normal arches form when standing on tip-toe - i.e., mobile flat feet. 

 flat feetflat feet normal arches on tip toe

When are flat feet not normal? 

  • Absent arch when child stands on tip-toes (non-mobile flat feet). 
  • Asymmetrical changes (i.e., one foot fixed and flat). 
  • Evidence of pressure on the foot such as blistering / callosities.
  • Swelling or stiffness of joints.
  • Limping or persistent pain.
  • In teenagers with a fixed/painful flat foot, think of Tarsal Coalition (a condition where bones in the foot are joined together). 

  • Inflammatory Arthritis can also cause a painful stiff flat foot. Radiographs can be normal. Referral is required for further investigation. 

The indications for referral are:

  • Joint stiffness or swelling. 
  • Absence of arch on tip-toe.
  • Signs of pressure (e.g., blistering).
  • Persistent pain.
  • Limp or symptoms interfering with function (sport/play).
  • Systemic features. 

Referral is advised to rheumatology or orthopaedics. Conditions to consider are: 

  • Inflammatory Arthritis – joints are stiff, warm or swollen (often the midfoot). 
  • Tarsal Coalition – joints fixed and painful on walking and weight bearing. 

Photo: Stiff Flat Foot due to Inflammatory Arthritis (Juvenile Idiopathic Arthritis).

stiff flat foot due to inflammatory arthritis

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