All newborns are born with flat feet, a normal aspect of their physical development. During the growth phase, as the child learns to walk, they require a broader support base, hence flat feet offer an advantage during this phase and should not be considered pathological.

Typically, by the age of 8-12 years old, the foot arch develops naturally, assuming its characteristic curved shape as the child grows.

What does the term “flat foot” mean?

Our foot features, on the inner edge, a raised area called the “medial longitudinal arch” or “internal longitudinal arch”. Under normal circumstances, this part does not touch the ground but forms an arch that allows for the correct distribution of body weight on the foot.

Flat foot refers to an anatomical malformation characterized by a noticeable flattening, total or partial, of the medial longitudinal arch. Also known as “Pronation Syndrome,” this condition is associated with hindfoot valgus, or “valgus flat foot.” In this case, the heel, observed from behind while the subject is standing, is turned outward. Sometimes, it may be accompanied by an abducted forefoot, meaning it is turned outward, and by shortening of the Achilles tendon.

What are the symptoms?

Typically, the presence of flat feet is not associated with specific symptoms. More commonly, patients may complain of a sense of heaviness or easy fatigue when performing daily activities. However, the alteration of the correct foot-ground contact and consequently, the different distribution of weight on the sole, can lead to foot pain, ankle pain, knee pain, the development of secondary ankle pathologies, overpronation (excessive inward rotation of the foot), and postural problems.

At what age does the foot become “adult”?

In the initial phase of walking, from 10 months of age until 3-4 years, the child typically exhibits a valgus angle of 12-15 degrees, which then stabilizes to 5-7 degrees only after 5-6 years. Until then, cases of children walking with inwardly rotated or toe-in feet may be observed, but these are mostly transient phenomena expected to evolve favorably during growth. Between 8 and 12 years old, the foot gradually begins to resemble that of an adult. From that age onwards, it is possible to determine whether the child will have flat feet even after reaching adulthood.

When is a specialist visit necessary for flat feet in children?

The plantar structure is destined to change during physiological development. It is important for young patients to undergo an initial orthopedic check-up around the age of 6 to ensure that the child correctly supports the feet during walking and to verify that there is no presence of an actual pathology.

How is flat foot in children treated?

If during the initial check-up a diagnosis of Pronation Syndrome associated with valgus flat foot is made, it may be suggested to use shoes, commonly available on the market, that include a standard insole. In more severe cases, customized orthotics, made from foot impressions by a qualified orthopedic technician, may be necessary. However, it’s known that orthotics or rigid footwear can alleviate discomfort but do not alter the development of the foot arch, which can only be surgically intervened upon.

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