Pediatric Injuries

Our Specialties

Pes Plano Valgus (Flexible Flatfoot in Children)


Nearly one-fourth of all bones in the human body are in the feet. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections, the forefoot, midfoot and hindfoot. The midfoot contains a pyramid-like group of bones, strengthened by tendons, muscles and ligaments to form three curves, or arches (medial, lateral and fundamental longitudinal), at the bottom of the foot.

Most infants are born with very little arch in the feet. As a child grows and walks, the soft tissues along the bottom of the feet tighten, which gradually shapes the arches of the feet.


When a child with flexible flatfoot stands, the arch of the foot disappears. The arch reappears when the child is sitting or standing on tiptoes. Although called "flexible flatfoot," this condition always affects both feet. A flexible flatfoot is considered to be a variation of a normal foot, with muscles and joints that function normally. Children with flexible flatfoot often do not begin to develop an arch until the age of 5 years or older, and some never develop an arch.

Nonsurgical Treatment

Treatment for flexible flatfoot is only required if the child is experiencing discomfort from the condition.

  • Stretching exercises—If your child has activity-related pain or tiredness in the foot, ankle or leg, your doctor may recommend stretching exercises for the heel cord.
  • Shoe inserts—If discomfort continues, your doctor may recommend shoe inserts. Molded arch supports in soft, firm or hard may be used to relieve your child's foot pain and fatigue while also extending the life of your child's shoes, which may otherwise wear unevenly.
  • Additional treatment—If your child has flexible flatfoot with tight heel cords, physical therapy or casting may be prescribed.


Occasionally, if an adolescent is experiencing persistent pain, surgical treatment may be necessary. In a small number of children, flexible flatfeet become rigid instead of correcting with growth. These cases may need further medical evaluation.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.