If you’ve ever watched your child run across the backyard and noticed their feet look completely flat — no arch, ankles rolling inward — it can be hard not to worry. You might have Googled it at 11pm, ended up on a medical forum, and convinced yourself something is terribly wrong.
Here’s the truth: in most cases, flat feet in children are completely normal. But “most cases” isn’t “all cases,” and knowing the difference can save you a lot of unnecessary anxiety — or help you catch something early that’s worth addressing.
This guide walks you through what the research actually says, what to watch for at home, and when it’s worth booking an assessment with a physiotherapist.
What Are Flat Feet?
Flat feet — clinically known as pes planus — occur when the medial longitudinal arch (the inner curve of your foot) collapses under weight-bearing, so the full sole of the foot makes contact with the ground.
In children, you’ll typically notice:
- Little or no visible arch when they stand
- Feet that roll inward (overpronation)
- Ankles that tilt toward each other
- A soft, flexible-feeling foot
The important thing to know: the arch doesn’t appear until well into childhood, and even then, development varies enormously from child to child.
Are Flat Feet Normal in Kids? What the Research Says
Yes — and quite common.
A study published in Pediatrics (Pfeiffer et al.) examined over 800 children aged 3–6 and found that 54% of 3-year-olds had flat feet, dropping to 24% by age 6 as the arch naturally develops. A large systematic review published in the British Journal of Sports Medicine confirmed what most paediatric physios know well: all typically developing children are born with flat feet, with arch formation beginning around age 3 and often not reaching adult values until somewhere between 7 and 10 years of age.
Why does this happen? A few reasons:
- Babies and toddlers have a fat pad in the arch area that obscures any developing arch
- The ligaments and intrinsic foot muscles are still immature and strengthening over time
- The bones themselves are still forming — there’s a lot going on in a small foot
The Association of Paediatric Chartered Physiotherapists puts it clearly: over 95% of children with flat feet grow out of them and develop a normal arch. The remaining 5% continue to have flatter feet, but only a small number will ever have a problem from it.
So if your toddler or school-aged child has flat feet and no other symptoms, there’s a very good chance this is just part of normal development.
Flexible vs. Rigid Flat Feet: A Crucial Distinction
Not all flat feet are the same, and this distinction really matters.
Flexible flat feet are by far the most common type. The arch disappears when your child stands up, but reappears when they sit down, stand on tiptoe, or you bend their big toe back. This type is generally painless and considered a normal variant — particularly in younger children.
Rigid flat feet are different. The arch remains absent even when your child isn’t bearing weight. The foot may feel stiff, movement may be restricted, and this type is more likely to be associated with an underlying structural issue or condition. Rigid flat feet are far less common, but they should always be assessed by a healthcare professional.
If you’re not sure which type your child has, the tiptoe test is a good starting point: ask them to stand on their toes. If an arch appears, it’s almost certainly flexible. If it doesn’t, that’s worth having checked.
When Should You Actually Be Concerned?
Flat feet alone are rarely the issue. The more important question is whether your child’s feet are affecting how they move, play, and feel day to day.
Consider booking a physiotherapy assessment if your child:
- Complains of pain in the feet, ankles, knees, shins, or hips
- Trips frequently or seems clumsier than other kids their age
- Gets tired easily during walking or sport — asking to be carried more than usual, or sitting out activities
- Is avoiding physical activity that they used to enjoy
- Has noticeably different arches between their left and right foot
- Has stiff or rigid feet (arch doesn’t reappear on tiptoe)
- Is still significantly flat-footed beyond age 7–8 and showing functional difficulties
- Has any delays in gross motor milestones — running, jumping, hopping, or balancing
Pain and fatigue are the biggest flags. If your child regularly has sore feet after walking a moderate distance, or is consistently the last one to the park, that warrants attention — regardless of what their arches look like.
Does Having Flat Feet Actually Cause Problems?
Often, no. Many children with flat feet participate in competitive sport, run around with their friends, and never experience any discomfort whatsoever. Flat feet don’t automatically mean there’s a problem.
That said, in some children — particularly where foot strength and control are reduced — flat feet can contribute to:
- Poor balance and coordination (the foot’s arch plays a role in stability)
- Reduced endurance during physical activity
- Altered movement patterns that create extra load through the knees and hips over time
- Pain in the knees or lower limbs, not just the feet
A 2024 cross-sectional study published in the Journal of Orthopaedic Surgery and Research found that children with flexible flat feet had significantly higher pain scores compared to children with typical arches, suggesting that for a meaningful proportion of kids, the condition isn’t entirely without consequence. It’s not about catastrophising — it’s about paying attention to how your child actually feels and functions.
Will My Child Grow Out of It?
Probably — but not definitely, and that’s okay.
The evidence shows flat feet naturally resolve for most children as the muscles and ligaments of the foot mature. But some children will continue to have low arches into adulthood, and many of those people live completely pain-free lives. Not every child needs to “fix” their flat feet.
The question that matters most isn’t “does my child have flat feet?” — it’s “are these feet getting in the way of my child living their life?”
If the answer is no: reassurance and monitoring is usually all that’s needed. If the answer is yes: there’s plenty that can be done, and treatment is typically straightforward.
What Does a Physio Assessment Actually Involve?
A physiotherapy assessment for flat feet goes beyond just looking at your child’s arch. At Ohana Physiotherapy, we take a whole-body approach because the foot doesn’t work in isolation — it affects and is affected by the hips, knees, and core.
A typical assessment covers:
- Foot posture and structure — flexible vs. rigid, degree of pronation
- Muscle strength — particularly intrinsic foot muscles and the lower limb
- Balance and proprioception
- Walking and running analysis — looking at how weight is distributed through the foot and how the rest of the body compensates
- Functional skills — hopping, jumping, single-leg balance, age-appropriate tasks
This gives us a complete picture: not just what your child’s feet look like, but how they’re actually working.
Treatment Options: What Actually Helps
If your child does need support, the good news is that treatment is almost always conservative, non-invasive, and — for kids — usually pretty fun.
1. Targeted Strengthening Exercises
This is typically the cornerstone of treatment. The intrinsic muscles of the foot are small but powerful when trained well, and research supports exercise as an effective intervention for improving arch strength and function.
For kids, this might look like:
- Towel scrunches — picking up a small towel or marbles with their toes
- Short foot exercises — activating the arch muscles without curling the toes
- Heel raises — standing on tiptoe and slowly lowering back down
- Single-leg balance challenges — on firm and soft surfaces
- Functional play-based activities — walking on sand, grass, and uneven surfaces to naturally activate the foot
A study published in PMC examining physiotherapy and orthoses interventions found measurable improvements in plantar arch index and subtalar flexibility following a short foot exercise program, making them one of the most evidence-backed tools in the physiotherapy toolkit for flat feet.
2. Footwear Guidance
Shoes matter more than most parents realise. For children with flat feet who are experiencing symptoms, we generally recommend footwear with:
- A firm heel counter (the back of the shoe shouldn’t collapse when you squeeze it)
- Flexible forefoot so the foot can bend naturally during walking
- Proper fit — not too large, which causes the foot to work harder to stabilise
Overly stiff shoes aren’t ideal either. The goal is support without restriction.
3. Barefoot Time
This one surprises some parents. Research supports barefoot walking on varied surfaces — grass, sand, pebbles — as beneficial for foot strength development. Bare feet on natural surfaces provide proprioceptive feedback that shoes can’t replicate, and that stimulation helps build the intrinsic muscles of the foot.
This doesn’t mean abandoning shoes entirely. For longer walks and sport, appropriate footwear is still important. It’s about finding balance — structured support when needed, barefoot freedom when safe.
4. Orthotics — When Are They Actually Needed?
Orthotics come up in almost every conversation about flat feet, and there’s often confusion about whether kids actually need them.
The short answer: not always. As outlined in a widely cited clinical review of paediatric flexible flatfoot published in PMC, asymptomatic flexible flat feet generally don’t need orthotics. However, custom or semi-custom orthotic devices can be genuinely helpful when:
- Your child has significant pain that isn’t resolving with exercise alone
- There are notable alignment issues contributing to load through the knees or hips
- Function is meaningfully impacted despite other interventions
Orthotics are a tool, not a cure — and they work best as part of a broader plan that includes strengthening and movement. The goal is always to support your child’s development, not to create long-term dependence on a passive solution.
Common Myths Worth Clearing Up
“Flat feet always need orthotics.” Not true. The majority of children with flat feet need nothing more than monitoring, or at most a targeted exercise program.
“If you don’t fix it now, it’ll definitely cause problems later.” The research doesn’t support this as a blanket statement. Untreated, painful flat feet with functional limitations may lead to ongoing issues. Asymptomatic flat feet in a child who runs, jumps, and plays without discomfort? Probably not.
“Flat feet mean my child can’t do sport.” Plenty of elite athletes have flat feet. Foot structure alone doesn’t determine athletic capacity. What matters is how the foot functions and whether it’s causing symptoms.
What You Can Do at Home Right Now
You don’t need to wait for an appointment to start supporting your child’s feet. Some simple everyday habits make a real difference:
- Encourage active play — running, jumping, climbing. Physical activity directly promotes healthy arch development
- Let them go barefoot on safe natural surfaces like grass, sand, or carpet
- Check their shoes — squeeze the heel counter to make sure it’s firm, and make sure the shoes actually fit properly
- Watch for fatigue and pain — especially after walks, sport, or a day at school
- Avoid very flat, unsupportive shoes for children already showing symptoms (thin thongs or cheap canvas shoes for all-day wear isn’t ideal)
When to Book an Assessment at Ohana Physiotherapy
Trust your instincts as a parent. If something seems off — whether that’s pain, fatigue, clumsiness, or just a nagging sense that your child’s feet aren’t quite right — an assessment will give you clarity either way.
Sometimes the outcome is simply reassurance: this is normal, here’s what to expect, come back if things change. That in itself has real value.
Other times, we identify something worth addressing early, and put a simple plan in place. The earlier we catch genuine functional issues, the simpler the solution tends to be.
At Ohana Physiotherapy, we assess the whole child — not just the foot. We’ll tell you honestly whether we’re concerned, what we’d recommend, and what you can do at home to support your child’s development. No unnecessary interventions, no alarming parents unnecessarily.
If your child has flat feet and you’re unsure whether it’s worth looking into, the answer is usually: it doesn’t hurt to check.
Ohana Physiotherapy | Paediatric Physiotherapy Assessment | Gold Coast
References
- Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. (2006). Prevalence of flat foot in preschool-aged children. Pediatrics, 118(2), 634–9. https://pubmed.ncbi.nlm.nih.gov/16882817/
- Evans AM, Karimi L. (2015). The paediatric flat foot and general anthropometry in 140 Australian school children aged 7–10 years. Journal of Foot and Ankle Research. Systematic review: https://pubmed.ncbi.nlm.nih.gov/28814975/
- Asghar A et al. (2025). Prevalence and functional impact of flexible flatfoot in school-aged children: a cross-sectional clinical and postural assessment. Journal of Orthopaedic Surgery and Research. https://link.springer.com/article/10.1186/s13018-025-06207-y
- Chetana S et al. (2022). Monitoring the role of physical activity in children with flat feet by assessing subtalar flexibility and plantar arch index. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC8947427/
- Halabchi F, Mazaheri R, Mirshahi M, Abbasian L. (2013). Pediatric flexible flatfoot: clinical aspects and algorithmic approach. Iranian Journal of Pediatrics, 23(3), 247–60. https://pmc.ncbi.nlm.nih.gov/articles/PMC3684468/
- Association of Paediatric Chartered Physiotherapists. Flat Feet in Children. https://apcp.csp.org.uk/content/flat-feet-children