Information
Paediatric Flexible Flat Foot
Flexible flat feet are normal variants caused by increased flexibility of the joints and ligaments of the foot. This is present in 90% of 1 year olds and up to 20% of adults. The arch of the foot usually takes up until 10 years of age to completely develop.
Diagnosis can be aided by observing a difference in arch height from weight bearing to non-weight bearing, heel inversion on tip toe standing and arch formation on hallux dorsiflexion.
Initial self management of this condition is encouraged please see resources below. If self management fails please follow the criteria below
Who to refer:
Consider referring children with flat feet for specialist assessment, using clinical judgement to determine the urgency, if any of the following are present:
- Flexible and painful flat feet, or previously painless flat feet that become symptomatic.
- Absent medial longitudinal arch when the child is on tiptoes or when big toes are extended.
- Rigid flat feet (especially in adolescents — possible tarsal coalition).
- Asymmetrical flat feet.
- Tripping or frequent falls.
- Limp.
- Functional limitation.
- Fatigue of the foot muscles, signs of pressure such as calluses or blistering to the foot, or recurrent ankle sprains.
- Marked hypermobility.
- Morning stiffness, restriction of joint movement, joint swelling (of any joint, not just the foot/ankle), or abnormal joint examination.
- Regression or delayed motor milestones.
- Other features indicative of an underlying diagnosis, for example neurological (cerebral palsy), muscular (muscular dystrophy), syndromic (trisomy 21) or connective tissue (Marfan’s and Ehlers-Danlos syndromes).
Who not to refer:
Asymptomatic flat feet
Patients who are undergoing management for this condition with another service.
General advice
Footwear advice leaflet
Activity modification to manage symptoms.
For Patients
NHS Lothian Podiatry Patient Information Leaflet: Children’s Footwear (nhslothian.scot)
Royal College of Podiatry Flatfoot Patient Information https://rcpod.org.uk/common-foot-problems/flat-foot-management
For Health Professionals
Paediatric Musculoskeletal Matters https://www.pmmonline.org/doctor/joint-pain-by-site/foot-ankle-pain
