Conditions

Flatfoot

What is flatfoot?

Photo of a child's feet and ankle taken from behind. Photo by Vincent S. Mosca, MD.
In children with flatfoot, the arch along the inside of their foot disappears when they stand up.

Flatfoot is a common foot shape that doctors sometimes call pronated foot. When a person with flatfoot stands up, the arch in the middle of the foot disappears. The foot seems to lie flat on the ground.

Almost all babies are born with flatfoot. Studies estimate that 8 to 9 in every 10 babies born in North America have flatfoot. Studies in other countries have found similar numbers. Children often outgrow flatfoot naturally.  

Types of flatfoot

There are 3 types of flatfoot. Knowing which kind your child has helps you and your child’s doctor decide if your child needs treatment and, if so, which kind.

  • Flexible flatfoot: Almost all children with flatfoot have flexible, or hypermobile, flatfoot. This means the bones in their feet move easily in relation to each other. When the child stands, the weight of their body presses on their feet, making their arches flatten out. When they sit, taking weight off their feet and letting their feet dangle, the arches appear. This condition is not painful, causes no disability and does not need any treatment. It always affects both feet. 
  • Flexible flatfoot with a short : This happens very rarely in young children. It affects both feet and may cause pain and disability, like trouble walking, running or playing sports. 
  • Rigid flatfoot: This is the least common type. Rigid flatfoot most often shows up in people who have a problem with the bones in their feet (tarsal coalition). Some of the bones don’t move as easily as is typical. Whether the child stands or sits, their foot does not appear to have an arch. About 1 in 4 people with rigid flatfoot has pain and disability. About half of the time, rigid flatfoot affects both feet. 

Why choose Seattle Children’s for flatfoot treatment?

The experts in our Foot and Ankle Deformities Program, which is part of Orthopedics and Sports Medicine, treat flatfoot. 

  • The foot experts you need are here
    • Our Foot and Ankle Deformities team includes experienced pediatric , , and nurses who know how to evaluate and treat all types of foot and ankle conditions.
    • If your child needs treatment, we can successfully treat flatfoot in most children with nonsurgical methods, like arch supports or Achilles tendon stretches. We have onsite orthotists and the largest team of physical therapists in the Pacific Northwest who specialize in the care of babies, children, teens and young adults. 
    • In the rare cases when surgery is needed, doctors at Seattle Children’s developed the most common operation now used nationally to correct severe, painful flatfoot with short Achilles tendon in adolescents. We have pediatric orthopedic surgeons with expanded fellowship training in foot and ankle conditions. 
  • Treatment designed for growing bodies
    • Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. At Seattle Children’s, your child’s team has special training in the physical, emotional and social needs of young people. 
    • We understand your child’s body doesn’t stop at their foot and ankle. We see them as a whole person. For example, in our Foot and Ankle Deformities Program, we look at not only your child’s feet and ankles but also their legs, spine, strength, movement and other features that might play a role in their condition, such as nerve problems.
    • We have the largest group of board-certified pediatric radiologists in the Northwest. For imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images.
  • Support for your whole family
    • Having a child with a foot or ankle condition can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family.
    • Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help. 
  • Research to improve care
    • Seattle Children’s is active in the Pediatric Foot Research Group, an international group of researchers studying foot and ankle differences in children.  
    • Our growing research program is discovering better ways to diagnose and care for children with this condition. For example, we are studying a device a child can wear on their foot that senses how they walk. The goal is to better understand their gait and plan the most effective treatment. Our research program is funded in part by the Lynn Taylor Staheli Endowed Chair in Pediatric Orthopedics.
    • Outcomes research helps us know which treatments work best. For example, we use tools to ask children about their function after surgery for limb differences. Asking children about their experience is essential to improving their lives.
    • We take part in several registries (databases that collect information about patients who volunteer) so we can work with doctors around the country and the world to better understand orthopedic conditions, such as foot, leg, hand and arm differences.
    • Learn more about current orthopedics research at Seattle Children’s. 

What are the symptoms of flatfoot?

When a child has flexible flatfoot – the kind that needs no treatment – we can see an arch in the foot when the child stands on tiptoe or lets the foot hang down.

When children have rigid flatfoot, which may cause pain and disability, we usually cannot see an arch even when they stand on tiptoe.

Some children with flatfoot have pain on the inside or outside of the foot, usually when walking or playing sports.

How is flatfoot diagnosed? 

We examine your child’s foot and ankle. We look at your child’s feet as they stand up. We may ask your child to stand on tiptoe or dangle their foot in the air as they sit on an exam table.

We also check to make sure the joints in your child’s feet and ankles all move well. If your child’s ankle does not move much, it could mean that the Achilles tendon is shortened or tight. That may be a sign that your child has flexible flatfoot with short Achilles tendon.

If your child’s feet hurt and they have the type of flatfoot that usually is not painful, we may take X-rays to get more details about what is possibly causing the pain.

How is flatfoot treated?

First, we always evaluate your child to find out what type of flatfoot they may have. Your child needs treatment only if flatfoot causes pain or disability. 

If your child has normal flexible flatfoot that doesn’t hurt, we recommend no treatment. Your child should wear regular shoes and be treated the same as if their feet had arches. 

Non-surgical treatments for flatfoot

  • If your child has flatfeet that hurt, we recommend trying arch supports. These can be simple and inexpensive over-the-counter cushioned arch supports or running shoes with built-in arch support.
  • To treat flexible flatfoot with a short Achilles tendon, we may try to stretch the Achilles tendon. It is more difficult to stretch this tendon if your child has flatfoot than if they have a typical arch. We need to rotate the foot inward to raise the arch while the Achilles tendon is being stretched. Our physical therapy team can stretch your child’s foot and teach you how to do it at home.  
  • For flexible flatfoot with a tight Achilles tendon, we suggest you avoid using hard or rigid arch supports. They are often made of hard plastic and can cause more pain. 

Surgery for flatfoot

  • In rare cases, nonsurgical treatment doesn’t help with flatfoot and children need surgery to relieve their pain.
  • In almost all cases that require surgery, the child is at least 8 years old and their Achilles tendon is short. The surgeon makes the Achilles tendon longer and corrects the flatfoot. 
  • The surgeon lengthens the heel bone (calcaneus) using a . They insert the graft on the outer edge of the middle of the foot. This procedure is called calcaneal-lengthening osteotomy

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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