Developmental Flatfoot in Children

By Dr. Carlo A. Messina

Developmental flatfoot is one of the most common conditions affecting the musculoskeletal system of children and teenagers. There is a tendency for the child’s flatfoot to be ignored or treated with benign neglect. The facts are that it is NOT normal, the majority of children do NOT outgrow it, and there IS cause for some concern.

Flatfeet are a genetic problem. Ligaments in the arch which connect the bones together are loose, allowing the arch to collapse. Congenital bone abnormalities as well as trauma to the tendons and ligaments in the inner arch can cause flattening of the arch and foot. A common cause of developmental flatfoot is tightness in the calf muscles, which aggravates the severe foot deformity.

Symptoms include young children constantly preferring to be carried by a parent or be put in a stroller due to fatigue in their legs. Another symptom is leg pain, especially at night, and premature fatigue with activity, especially in young children or teenagers. Inner leg, ankle and foot pain with activity is common. Other symptoms occasionally associated with flatfeet are inner knee pain and lower back pain.

Signs of developmental flatfoot include lowering or complete collapse of the arch. The front part of the foot is turned out relative to the back part of the foot and the arch bulges towards the inside of the ankle. Knock-knees are common, which exasperates the deformity. The feet, ankles, and legs just do not appear right upon examination or when the patient is standing. The child can be overweight and lacks athletic ability. General inactivity or avoidance of activity in children is common. Abnormal shoe wear as well as a child or teenager that does not run correctly occurs due to the deformity.

Treatment begins with a complete physical examination of the lower extremity and spine to find the underlying cause. This includes examining the child’s gait (walking pattern). Physical therapy may be prescribed to strengthen weak muscles and loosen tight muscles and to help improve overall coordination. Occasional immobilization of the extremity to loosen up tight muscles with a walking cast is necessary to decrease the deforming force of the calf muscle on the flatfoot. Custom molded shoe insoles (orthotics) to help permanently support the foot and put it in its proper position may be recommended. In most cases, this will overnight correct the fatigue and leg pain that the child experiences. It will also help to allow better performance in activities of daily living or sports. In some cases when conservative treatment fails, surgery can be done to help with the problem. 

The appropriate treatment plan can be a life-changing experience for the child. Prognosis is excellent, especially with timely management of the problem.

  • Carlo A. Messina, DPM, is a Board Certified Reconstructive Foot and Ankle Surgeon, Diplomate American Board of Foot and Ankle Surgery. He is a Foot and Ankle Surgeon with the Foot, Ankle and Leg Specialists of South Florida and specializes in treating infants, children, teens and adults. His partners are Dr. Robert Sheinberg, Dr. Al DeSimone, Dr. Fernando Moya, Dr. Alexander Bertot, Dr. David Shenassa, Dr. Michael Cohen and Dr. Franz Jones. The South Florida Institute of Sports Medicine in Weston is located at 1600 Town Center Blvd., Suite C, (954) 389-5900 and in Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901. The practice website is