Hesperian Health Guides

Flat Feet

Most children whose only problem is flat feet really have no problem at all — except that poorly informed doctors or greedy special-shoe salesmen make their parents think so.

Most babies have naturally fat feet, which can look flat.

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normal foot of a child under 2 years old
Do not confuse a FAT foot with a FLAT foot!

In older children and adults there is a lot of natural variation in people’s arches. Even a foot as flat as this, if it causes the child no pain, need not be considered a problem. Often flat feet run in families. If parents or relatives have similar feet but no pain, or if the child can move his feet strongly in all directions, do not worry about it.
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high arch low arch (flat foot)
narrow foot print for a high arch foot print wide foot print for a low arch

Do not worry about flat feet if there is no pain, obvious weakness, or loss of movement.

Children who are late beginning to walk often have weak arches with flat feet, until their feet get stronger.

Even children with very flat feet seldom develop a problem or have more than average pain or discomfort when they do a lot of standing or walking. Usually flat feet are a problem only when paralysis or brain damage is the cause —as in some children with polio, cerebral palsy, or spina bifida. Also, children with Down syndrome some times have flat feet that may lead to pain or discomfort.

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Correcting flat feet

The best treatment to help the child with flat feet and no other problem may be to go barefoot. Walking barefoot on sand or rough ground helps the feet get stronger and form a natural arch. Walking on tiptoe, skipping rope, and picking things up with the toes may also help.
CAUTION! Special exercises, training in ‘foot posture’, shoe adaptations, heel wedges and shoe inserts (heel cups and insoles) are often prescribed to correct flat feet. However, studies show that usually none of these help. Use of insoles to support the arches may even cause weaker arches. Usually insoles should be tried only when pain is a problem, or in some severe flat feet caused by polio, cerebral palsy, or Down syndrome.


An insole is a firm pad that is put inside a shoe or sandal to support the arch.
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Insoles can be made of leather, porous rubber, or a piece of a car tire, shaping it with care so that it will support the foot comfortably.

Some children with flat feet resulting from polio, cerebral palsy, or Down syndrome may be helped by insoles or other foot supports. But other children will not be helped. Each child’s needs should be carefully considered. If after trying an insole for 2 weeks, the child walks with more difficulty, change the insole or stop using it.

Before making the final insole, put a piece of cardboard, wood or some other material shaped like the insole, under the child’s foot. Try different heights to find what seems to work best. Make sure the heel is in a straight line with the leg.

After making the insole, check the position of the foot. Do this with the child standing on just the insole, and then with the insole inside the shoe. Watch him walk, and ask him how it feels. If everything seems right, check it again in 2 weeks.

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CORRECT – The heel is in a straight line with the leg. TOO LOW – The heel tilts outward. The insole should be thicker. TOO HIGH – The heel tilts inward. The insole is probably too thick.

CAUTION! A person who has a weak ankle and low arch sometimes cannot use an insole, because it lets his ankle turn outward as he walks. He may have learned to walk in a way that keeps his ankle from turning out. For such a person, an insole may make walking more difficult, or may force him to use a brace to keep his foot straight.

If the child’s foot is flat or very floppy due to paralysis, often an insole is not enough. He may need a short plastic brace that supports the foot like this, DVC Ch11 Page 118-7.png
built-in sole
DVC Ch11 Page 118-9.png For instructions on making plastic braces, see Chapter 58.
DVC Ch11 Page 118-8.png or a brace that supports the foot and ankle, like this.

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There is probably only one shoe or sandal alteration that does any good. A small metal plate on the inner edge of the heel stops uneven wear—and may help prevent foot pain.

This page was updated:21 Nov 2019