Pediatric Flatfoot

Pediatric flatfoot usually presents during early teenage years, as pain along the inside of the ankle or arch, especially during increased activities or sports. The cause of pain is the lack of bony structure throughout the arch, placing more strain on the tendons and ligaments that try to support the arch. This may also lead to pain in the knee or hip, as well as decreased desire to participate in activities.

The most focal point of pain is usually along the Posterior Tibial Tendon, especially where it inserts on the navicular bone, on the inside arch. In contrast to Adult Acquired Flatfoot, the Posterior Tibial Tendon is rarely damaged or torn in children.

Flat feet only need to be treated if there is pain or other symptoms. The foot structure will continue to form into the early teenage years, so a young child with a flatfoot deformity may "grow out of it." However 2% to 4% of children will have symptoms that require treatment to prevent worse issues later in life. If your child is complaining of pain, and you believe they have flat feet, it is best to get an evaluation.


Like most deformities, the treatment of flat feet requires a comprehensive evaluation. There are multiple joints, tendons, and ligaments that need to be examined to help confirm the correct diagnosis. Also, evaluation of the child's gait, or walking pattern, can help uncover potential deformities of the lower leg, knees, or hips. There are also other conditions, such as tarsal coalitions, congenital deformities, and global ligament laxity that can cause or exacerbate a flatfoot deformity.


There are very few options available when treating the pediatric flatfoot. For most children, it is best to start with non-surgical treatment. This includes the use of custom orthotics, ice, anti-inflammatory medication, and possible activity limitations. It is important to note that over-the-counter shoe inserts are usually not powerful enough to help treat symptoms of a flatfoot. Although there is no scientific proof that the foot will actually "grow into proper position" around the orthotic, there is plenty of evidence to show that orthotics help to reduce pain, especially in children with higher activity levels.

Surgery is indicated if conservative treatment options fail. We tend to see an increased need for surgery in children with higher levels of activity, but there is a chance surgery may be necessary for any child with a painful flatfoot. It is well accepted that surgery should not be performed in children younger than 10 years of age, as there is still a chance for the pain to subside naturally, but rare exceptions do exist. Surgery should be delayed as long as symptoms can be controlled, and ideally would be best to wait until the child becomes skeletally mature, ages 13-18. However, this is not always possible, as pain can be significant, and surgery is needed prior to maturity. 

Much like the Adult Flatfoot, surgery for Pediatric Flatfoot involves multiple procedures performed in a same-day surgery setting. With children, it is often best to spend at least one night in the hospital, to ensure the child's pain is adequately managed. The recovery period for these surgeries can be lengthy, but the success rates are very high.

If your child is suffering from a painful flatfoot, Call us at 512-593-2949 or CLICK HERE to Schedule an Appointment.