What is the medical name for flatfoot?
Pes planus. When the heel also tilts outward — the usual pattern — it is called pes planovalgus.
Flatfoot: Frequently Asked Questions
Direct, physician-reviewed answers to the questions parents and patients ask most about flat feet — from arch development in toddlers to recovery after reconstructive surgery.
Medically reviewed byDr. Mutasem Aldhoon— Pediatric Orthopedic Consultant· Last reviewed: August 2026
General
Is flatfoot hereditary?
Foot shape and ligament laxity run in families, and tarsal coalition shows clear autosomal dominant inheritance. A family history of flat feet is common and, on its own, not a reason for treatment.
Can flat feet cause knee, hip, or back pain?
Severe hindfoot valgus changes lower-limb alignment and can contribute to anterior knee pain in some patients. In most people with mild, flexible flat feet, unrelated causes of knee and back pain are far more likely.
How long is recovery after flatfoot reconstruction?
After calcaneal lengthening with soft-tissue balancing, children are typically non-weight-bearing for about six weeks, walk in a boot for a further four to six weeks, and return to sport at around six months.
Is flatfoot surgery safe in a growing child?
Modern reconstruction is deliberately joint-sparing and growth-aware: osteotomies avoid physes and fusions are avoided wherever possible, so the foot keeps growing and keeps its subtalar motion.
Does flatfoot disqualify someone from military or sports service?
Asymptomatic flexible flatfoot does not impair performance and most services accept it. Symptomatic, rigid, or surgically untreated painful deformity is assessed case by case.
Flatfoot
Is flatfoot a disability?
No. Flexible flatfoot is a normal anatomical variant present in roughly one in five adults, and it does not limit walking, running, or sport. Only painful, stiff, or progressive deformity limits function, and that form is treatable.
Do insoles cure flat feet?
No. Randomised evidence shows orthoses do not build an arch or change the natural history of flexible flatfoot. They can reduce pain and shoe-wear problems in symptomatic feet, which is a valid but different goal.
At what age should the arch appear?
The medial arch typically develops between ages 3 and 10. A flat foot in a toddler is expected. Persistent flatness after age 10, especially with pain or stiffness, warrants assessment.
When does flatfoot need surgery?
Surgery is indicated for pain that persists despite a genuine trial of stretching, footwear and activity modification, for rigid deformity such as a symptomatic tarsal coalition, and for progressive neuromuscular planovalgus. The aim is a balanced, plantigrade foot using joint-sparing osteotomies rather than fusion.
Flexible flatfoot
Will my child grow out of flexible flatfoot?
The arch height improves in most children up to about age 10, but roughly 15–20% of adults keep a flexible flat foot for life with no consequences. Function, not arch height, is what matters.
Should my child wear special shoes?
No. Corrective or 'orthopedic' shoes have never been shown to alter arch development. A comfortable, well-fitting shoe with a firm heel counter is enough.
Rigid flatfoot
How do I know if my child's flat foot is rigid?
Ask the child to stand on tiptoes. If the heel does not swing inward and no arch appears, and the foot is painful or stiff, treat it as rigid until proven otherwise and seek assessment.
Is rigid flatfoot always painful?
Not always. Some coalitions are found incidentally and stay silent. Pain typically begins in adolescence as the bar ossifies and stresses the surrounding joints.
Tarsal coalition
Can a tarsal coalition come back after surgery?
Regrowth is uncommon when the resection is complete and the gap is filled with interposition tissue. Persistent pain after surgery more often reflects uncorrected hindfoot valgus or established arthritis than true recurrence.
Is tarsal coalition inherited?
Often yes. It arises from failed segmentation in the embryo and shows autosomal dominant inheritance with variable penetrance, so it is worth examining siblings who complain of foot pain.
Calcaneonavicular coalition
What is the anteater nose sign?
It is the appearance on a lateral foot X-ray of an elongated anterior process of the calcaneus reaching toward the navicular, resembling an anteater's snout. It is a reliable indirect sign of a calcaneonavicular coalition.
Is surgery always needed?
No. Many children settle with immobilisation and orthoses and never need an operation. Surgery is offered when pain returns after non-operative treatment and limits normal activity.
Talocalcaneal coalition
Why is a talocalcaneal coalition harder to treat?
Because it crosses the subtalar joint itself. Removing it means working inside a weight-bearing joint, and if a large share of the joint surface is involved, resection leaves the joint unstable, so realignment or fusion is preferred.
What is talar beaking?
A bony spur on the top front of the talus caused by abnormal stress from the restricted subtalar joint. It indicates a long-standing coalition but does not by itself rule out resection.
Coalition surgery & recovery
How long is recovery after tarsal coalition surgery?
For an isolated resection: two to four weeks in a boot, normal walking by six to eight weeks, and sport at around three months. If a calcaneal lengthening or other osteotomy is added, protected weight-bearing lasts about six weeks and full return takes four to six months.
Can a tarsal coalition grow back after surgery?
Rarely, and almost only when the resection was incomplete or the gap was not filled with interposition tissue. Pain that persists after surgery is far more often due to uncorrected hindfoot valgus or existing arthritis than to true regrowth.
Is tarsal coalition a disability?
Most people with a tarsal coalition live and work normally, and many never have symptoms at all. An untreated painful coalition can limit standing, walking on uneven ground and sport, but successful resection or reconstruction usually returns the person to unrestricted activity.
Is tarsal coalition genetic?
Frequently. It results from failed separation of the tarsal bones in the embryo and shows autosomal dominant inheritance with variable penetrance, so siblings with foot pain are worth examining.
Adult flatfoot
How is adult flatfoot different from childhood flatfoot?
Childhood flexible flatfoot is a developmental shape that is usually stable and painless. Adult acquired flatfoot is a new, progressive deformity in a foot that used to have an arch, and it is a tendon disease first and a bone deformity second.
Can I still exercise?
Yes, with modification. Swimming, cycling and controlled strengthening are encouraged; prolonged standing, running on hard surfaces and unsupported footwear aggravate the tendon.
Symptoms & diagnosis
Do I need an X-ray for flat feet?
Not if the foot is flexible and painless. X-rays are indicated for pain, stiffness, asymmetry, or a deformity that is getting worse, and they must be taken standing.
Which specialist treats flatfoot?
A pediatric orthopedic surgeon for children and adolescents, and a foot and ankle orthopedic surgeon for adults. Complex, rigid, neuromuscular, or revision cases should go to a subspecialist who reconstructs these feet regularly.
Treatment
Can flat feet be fixed?
A painless flexible flat foot does not need fixing, and no insole, exercise or shoe permanently raises the arch. A painful flat foot can almost always be fixed in the sense that matters — pain relieved and function restored — with calf stretching, supportive footwear and an orthosis, and with joint-sparing surgery such as calcaneal lengthening in the minority who do not respond.
What exercises help flat feet?
Calf stretching with the knee straight is the priority. Heel raises, short-foot exercises and single-leg balance work strengthen the supporting muscles and reduce pain, though they do not permanently change arch height.
Are custom orthotics worth the cost?
For most symptomatic flexible flat feet, a good prefabricated device performs as well. Custom devices are justified for marked deformity, neuromuscular feet, or when an off-the-shelf device cannot be fitted comfortably.
Flatfoot in children
My 4-year-old has flat feet — should I worry?
No. At four, an absent standing arch is expected. If the arch appears when they stand on tiptoes and they have no pain, no treatment is required.
Do children need arch-support shoes?
No. Studies of corrective footwear in children show no effect on arch development. Flexible, well-fitting shoes and barefoot play are better for developing foot strength.
What causes flat feet in kids?
In the large majority it is not a disease at all: a plantar fat pad and naturally lax ligaments make the arch look absent until it develops between ages 3 and 10, and the tendency runs in families. Less commonly the cause is a tight calf muscle, a tarsal coalition joining two bones of the hindfoot, generalised ligament laxity such as in Ehlers-Danlos or Down syndrome, or a neuromuscular condition such as cerebral palsy.
Can flat feet in children be corrected?
A painless flexible flat foot does not need correcting — it is a normal variant and it usually improves on its own as the arch develops. No insole, brace, exercise or shoe has been shown to change the final arch shape. When the foot is painful, stiff, or getting worse, correction is possible: calf stretching and an orthosis for symptoms first, and joint-sparing reconstruction such as calcaneal lengthening when pain persists.
Do orthotics correct flat feet in children?
No. Controlled trials of insoles and corrective shoes in children with flexible flat feet show no lasting effect on arch height. Orthoses are still useful for one purpose: reducing pain and fatigue in a child who has symptoms. If an insole is not relieving symptoms after about three months, it can be stopped.
How can I check my child's arch at home?
Three simple checks: the tiptoe test (an arch that appears when the child stands on tiptoes means the foot is flexible), the wet footprint test (a footprint with no inward curve on the inner side means a low arch), and the too-many-toes view (looking from behind, seeing more than two toes outside the ankle suggests significant heel valgus). Flexible plus painless is reassuring; stiff or painful needs review.
Can Crocs or flat shoes cause flat feet?
No. Footwear does not create a flat foot — arch shape is determined by bone, ligament and muscle, not by shoes. Soft backless shoes can make the foot work harder and cause aching if worn all day, so a shoe with a firm heel counter is a better everyday choice, but it is a comfort issue, not a cause of deformity.
How do I prevent flat feet in my child?
There is no way to prevent the foot shape a child inherits, and no need to. What does help long-term foot health is barefoot play on varied surfaces, well-fitting flexible shoes, daily activity, a healthy weight, and calf stretching if the heel cords are tight.
Dr. Mutasem Aldhoon
Dr. Mutasem Aldhoon is a leading Pediatric Orthopedic Consultant specializing in complex lower extremity deformities. With extensive experience in advanced joint-sparing and reconstructive techniques, he is the trusted authority for severe pediatric flatfoot and neurological foot reconstructions.