Flat feet (pes planus)

Most children under the age of three have flat feet and rolling ankles. The arch on the inside of the foot does not begin to develop until after this age. The arches may be visible when a child is sitting, when the big toe is bent backwards or if the child stands on tiptoe. Full development of an arch is usually between the ages of 5-7 years old. In most children flat feet do not cause any problems.

Action: Key assessment points

• Ask the child to stand on tip toes. If the arch lifts, the foot is flexible

Action: Referral not indicated

• Child is asymptomatic
• Flat feet are fully flexible

Reassure the parent/guardian and give APCP advice Parent Leaflet - Flat Feet in Young Children | Association of Paediatric Chartered Physiotherapists (csp.org.uk), and if indicated APCP advice leaflet titled Parent Leaflet - Choosing Footwear for Children (Updated 2016) | Association of Paediatric Chartered Physiotherapists (csp.org.uk)

Action: Refer to Paediatric Physiotherapy

• There is pain in the lower limbs
• There is associated muscle tightness and/or weakness
• Referrals for children under the age of 3 with flat feet will not be accepted
• Referrals for pain free flat feet will not be accepted

Action: Refer to Paediatric Orthopaedics

• Rigid/stiff flat feet (arch of the foot doesn't correct on tip toes in over 5's)
• Structural asymmetric flat feet (especially with heel valgus)
• Painful flat feet that have not improved with orthotics and physio

Action: Refer to Podiatry/Orthotics

• Flat feet are causing pain, rubbing or uneven shoe wear