Flat feet in children: when do they need orthotics?

​One of the most common questions parents ask is: "My child has flat feet. Is this normal? Do they need orthotics?" The answer is nuanced — not all flat feet require treatment, but some do. Understanding the difference can help you make an informed decision about whether your child would benefit from orthotic support.
 
Are flat feet normal in children?
Yes. In fact, most infants and young children have flat feet. This is completely normal. Here's why: a newborn's arch is not yet developed — the foot is mostly fatty tissue and cartilage that will gradually strengthen and shape over time. A flat-footed gait and inward-turning feet are expected in toddlers up to about age 3–4.
By age 6–8, most children develop a visible arch when standing on tiptoe or during certain movements. However, some children naturally have very flat feet throughout childhood and into adulthood, and this may not cause any problems at all.
 
When are flat feet a concern?
Flat feet become a clinical concern when they are associated with one or more of the following:

• Pain or fatigue — the child complains of sore feet, especially after activity or school days
• Difficulty with activities — the child struggles to run, jump, or keep up with peers; avoids sports or physical play
• Inward-turning ankles — the foot rolls inward excessively when walking or standing (overpronation)
• Tight heel cords — the child cannot pull their toes toward their shin or has difficulty walking barefoot
• Toe-walking — persistent toe-walking past age 3, especially if combined with flat feet
• Visible arch collapse — the arch flattens completely when bearing weight, with no contour even on tiptoe

 
If your child has flat feet but none of these features, they likely do not need orthotics. However, if they have pain, difficulty with activity, or progressive deformity, an assessment with a specialist orthotist is warranted.
 
How do orthotics help flat feet?
Custom foot orthotics (insoles) do several things:

• Provide arch support — lift the medial arch to reduce stress on the foot's soft tissues
• Control overpronation — prevent excessive inward rolling of the ankle, which can contribute to foot pain and leg strain
• Improve alignment — encourage the foot and ankle to function in a more neutral position during walking and activity
• Reduce fatigue — by supporting the arch, orthotics reduce the effort required to stabilize the foot, allowing children to be more active without discomfort

 
Orthotics work best when fitted to the individual child's foot shape, gait pattern, and activity level. Off-the-shelf insoles rarely provide adequate correction for true flat feet requiring intervention.
 
What does an orthotic assessment involve?
At Gibson Orthotics, we conduct a comprehensive foot assessment that includes:

• Gait analysis — watching your child walk and run to observe foot alignment and movement patterns
• Non-weight-bearing examination — assessing flexibility and passive range of movement
• Weight-bearing assessment — evaluating arch height and stability when the child is standing and bearing weight
• Functional testing — checking for pain points, assessing strength, and identifying activities that cause discomfort
• 3D foot scanning — capturing a precise digital model of your child's foot shape to design custom orthotics

 
After assessment, we discuss findings with you and recommend whether orthotics are indicated. If they are, we design a pair of custom insoles fitted to your child's footwear and activity level. Most children tolerate orthotics very well once they become accustomed to them (typically 1–2 weeks).
 
How long will my child need orthotics?
​This depends on the underlying cause. Some children wear orthotics for a few years while their arch develops; others benefit from ongoing use throughout childhood and into adulthood. At each follow-up appointment, we reassess whether orthotics are still needed and make any necessary adjustments for growth.
 
When to seek an assessment
Your child has flat feet AND any of the following:

• Complains of foot pain or sore feet
• Tires easily during physical activity or avoids sports
• Walks with feet turning inward significantly
• Persists in toe-walking past age 3
• Shows visible deformity or asymmetry between the two feet

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Author Kirsten Gibson, Ndip Med Orth Pros, B-Tech Med Orth Pros

Founder, Clinical Director and Senior Orthotist Prosthetist at Gibson Orthotics. 
Chair of The South African Orthotic Prosthetic Association.

Kirsten Gibson is a Clinical Orthotist Prosthetist (CPO), founder and director of Gibson Orthotics in Kyalami, Johannesburg. She holds Level 2 certification in the Rigo Concept for scoliosis bracing, is an authorised Orthomerica STARband provider, and is Chair of the South African Orthotic & Prosthetic Association (SAOPA) and Executive Board Member of ISPO. She has a clinical focus in paediatric orthotics, neuromuscular conditions, scoliosis management, and lymphoedema compression therapy.

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