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.
Flatfoot Symptoms and Diagnosis: What Doctors Look For
Flatfoot is diagnosed by examination, not by imaging. The clinician checks whether the arch restores on tiptoes, whether the hindfoot moves, whether the calf is tight with the knee extended, and whether the two feet are symmetric. Imaging is added only when the foot is painful, stiff, asymmetric, or progressive.
Medically reviewed byDr. Mutasem Aldhoon— Pediatric Orthopedic Consultant· Last reviewed: August 2026
The clinical examination
- Standing inspection from behind — heel valgus and the too-many-toes sign.
- Tiptoe test — arch restoration and heel inversion confirm flexibility.
- Jack test — passive great-toe extension raises the arch via the windlass mechanism.
- Silfverskiöld test — dorsiflexion with knee extended vs flexed isolates gastrocnemius tightness.
- Single-heel raise — weakness suggests posterior tibial tendon dysfunction in adults.
- Gait and shoe-wear pattern — medial wear and an out-toed gait support the diagnosis.
When imaging is needed
Weight-bearing X-rays quantify the deformity through Meary's angle, calcaneal pitch and talonavicular coverage — measurements that guide surgical planning. Non-weight-bearing films underestimate deformity and should not be used. CT maps a bony coalition; MRI shows fibrous coalitions, tendon degeneration and bone oedema.
Red flags for urgent referral
- Pain waking the child at night, or fever with foot pain
- Sudden inability to bear weight
- A rapidly progressive or one-sided deformity
- Neurological signs: weakness, numbness, or a change in gait
Frequently asked questions
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.
Discuss your child's foot with a pediatric orthopedic consultant
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.