FFF – Flexible Flat Feet

Nev Davies
Reading Children’s Orthopeadic Unit

Information for Families – Flexible Flat Feet

fff clinical photo

What are flexible flat feet?

Most feet have an arch on the inside of the foot; however, some children have flexible flat feet, also known as fallen arches or pes planus. All babies and most toddlers appear to have flat feet due to their “baby fat” which hides the developing arch. Flat feet are considered normal at these developmental ages from 1-5 years old. The feet are flexible because the arch reforms when the child goes up on tiptoes. (See picture) It can be common for other members of the family to have flat feet.

What is the cause?

The incidence of flat feet is the same in populations of people who wear shoes and those who do not wear shoes. Stretchy ligaments that connect the bones together cause flexible flat feet.

What problems can occur?

Most children with flexible flat feet do not have any symptoms. Historically, the army would reject soldiers with flat feet. This is wrong, as it is now known that people with flat feet have the same chance of having foot problems as people with arched feet.

What treatment will be required?

No specific treatment is usually needed for the vast majority of children with flexible flat feet. In young children with no symptoms, the use of shoe inserts or insoles (orthotics) is not recommended, as these have been found to have no effect on the development of the arch. Insoles are only used for older children who have pain in their feet, which is an exceedingly small percentage of the children we see with flexible flat feet. It is recommended that the right shoes for your child fit correctly and are comfortable.

What is the natural history of a child with flexible flat feet?

The arch on the inside of the foot may begin to develop at age 4 and should be developed by age 10. If not, your child is likely to have flat feet in adult life, but there is no evidence to say they will have more problems than a person with an arch. There are numerous tops sports stars and professional dancers with asymptomatic (without symptoms) flat feet.

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