Flat Feet: Does My Child Have Them?

IA barefoot toddler plays by stepping on dried macaroni that has spilled on the floor.
Image of a barefoot toddler stepping in dried macaroni that has spilled on the floor.

In my years as a pediatric physical therapist, one of the questions I get asked most often is, “Does my child have flat feet?” Here’s a quick guide to normal foot development, and how to tell if your child’s feet could use a little extra arch support. 

Normal Foot Development

Baby feet are very flexible and have a fat pad covering the area that will eventually develop into an arch. As they begin to stand and put weight through their feet, babies build strength in their foot muscles and joints. When they start walking around 1 year of age, children normally appear flat-footed. The medial arch of the foot begins to lift away from the ground around 2 years of age and continues to develop until about age 6. So, in a technical sense, flat feet are “normal” for young children. However, sometimes children have excessively flat (or pronated) feet. Overly pronated feet can cause foot, knee, or hip pain over time if left untreated.

Signs of Excessively Flat Feet 

  • No visible arch after 3 years of age. Between the ages of 2-3, you should be able to start seeing some “space” between the floor and the inside of your child’s foot. If the middle of their foot stays in contact with the ground, this can indicate excessively flat feet. 
An example of a flat foot
Signs of excessively flat feet: No visible arch over 3 years of age. This child has the entire inner edge of their foot in contact with the floor.
  • Heel tilts inward. If you look at feet from the back, the middle of the heel (use the Achilles tendon as a reference point) should be nearly vertical. Imagine a clock face, where the leg is 12 o’clock. The heel should be pointing to 6 o’clock (or fairly close to it). If you see most of their weight on the inside of their foot, or the pinky toe lifting off the ground, this is a pretty good sign they are “rolling in” with their feet. 
Signs of excessively flat feet: Heels tilting inward. This child’s left heel is angled so that it is pointing to 7 o’clock compared to the angle of the leg. The right heel is in a more vertical position, pointing to 6 o’clock.
  • Toes angle away from the rest of the foot. Our toes should extend straight out, in line with the borders of our feet. When kids have too much pressure on the inside of their feet, they often compensate by trying to grip the floor with their toes. This can cause their toes to angle away from the border of the foot, and eventually lead to bunions. 
Signs of excessively flat feet: Toes angle away from the rest of the foot. This child is curling their toes, trying to grip the floor. Their big toe is also angled out compared to the rest of the foot, which is compensation for having too much weight on the inner foot. This can lead to bunion development if not corrected.

What Should I Do? 

If you suspect that your child has excessively flat feet for their age, talk to your pediatrician. You should take your child to see a pediatric physical therapist or a pediatric podiatrist, who can recommend appropriate arch supports. It is important to not only support the foot with shoe inserts but also strengthen the foot muscles responsible for arch development. Untreated flat feet can lead to delays in gross motor skills and possibly pain, but with the right tools, you can set your child up for success and prevent potential problems down the road. 

A toddler demonstrating the use of custom shoe inserts
A view from the back of the same child wearing custom shoe inserts. The flat foot posture is corrected, with heels both pointing to 6 o’clock now in reference to vertical.
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Brittany Aquart
Brittany is a pediatric physical therapist and owner of Lemon City Therapy. She has worked as a physical therapist in a variety of settings, from the NICU to outpatient clinics to in-home therapy. She and her high school sweetheart-turned-husband, Andrew, are both Miami natives and proud UM alumni. They currently live in Little Haiti with their two young boys. Brittany loves all things culture, art, music, and food-related, and is always down for a good cup of coffee. Pre-pandemic days, there was nothing she loved more than going to a new restaurant with good friends, but backyard hangs are a satisfying trade-off. At home, you can catch her experimenting with gluten-free recipes in the kitchen, or taking a walk to the park down the street with her boys. Connect with Brittany @lemoncitytherapy on Instagram and Facebook.