The dilemma of your child’s feet. Flat or Lazy ?

The dilemma of your child’s feet. Flat or Lazy ?

Flat feet, or pes planus, are defined by the collapse of the arches of the feet and fall of the heel inwards making the feet look flat on the ground. Are flat feet in children normal, or abnormal? Very normal, more specifically up until the age of 4 years.

WHY? Babies are born with flat feet. The ligaments and tiny muscles of the feet only start to develop once the feet are loaded in standing, therefore, when a child begins to get up and walk! The speed of this development varies from child to child and because of this there’s an important fat pad at the surface of these little feet protecting them by distributing the weight more evenly across to avoid overloading of the joints but also makes the arches less visible.

This fat pad disappears by 3-4 years, with the increase of neuro-muscular control and strengthening of the skeletal system. However there may still remain some rotational deformities at the knees and hips which may cause incorrect diagnosis of flat feet or just unnecessary concerns to parents.

There are too many of these unnecessary doctor visits and orthotic prescriptions to children with ‘flat feet’ today. If there is no underlying pathology, disease or injury and you are a concerned parent, simply ask your child to perform a toe stance — does an arch appear in this position? Or does it still appear very flat? If an arch appears upon a toe stance, then it’s most likely a flexible flat foot that either needs more time to develop or at times (below age 4 and a bit older) or it is a lazy foot needing more attention. Flexible flat foot usually affects both feet symmetrically, and doesn’t cause any disability or pain.

If the foot remains flat during the toe stance then it may be a rigid flat foot, which is usually caused by a complication, for example of the tarsal bones, or have another reason for its delay in developing correctly. This is the least common type of flat foot, but is definitely an indication for visiting your family doctor especially if other symptoms such as pain, or changed walking pattern is present.


The most important aspect for treating flat feet is to first distinguish between if they are rigid, or flexible and then if they present with symptoms (symptomatic) or asymptomatic.

The majority of flexible flat feet cases are asymptomatic. They require only monitoring for a period of time, alongside few specific flat feet exercises to speed up the development. Changes in mobility and growth last until 8 years of age approximately, therefore if there is persistence of flat feet past this age, another treatment approach may be necessary, such as orthotics. Keep in mind though, that flat feet may also be genetically determined.

Symptomatic flat feet on the other hand cause pain or some kind of disability. Frequently, a child may not complain of pain but show other signs such as a change in the way they walk to avoid the pain. In all cases, a rigid type flat foot requires medical attention to seek out the best intervention and most importantly, the cause of the foot disorder. In some cases it may be treated by the use of special orthopedic shoes, physiotherapy and activity modification and in more severe cases, orthotics and surgical intervention may be indicated.


The first step in conservatively managing flat feet is education of the patient and parents. If you have any questions or concerns, please do not hesitate to contact or visit us for advice or a consultation.



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