Flat feet in children — when to see a physiotherapist

Flat feet in a preschool child are usually physiological: a study of Austrian preschoolers found them in 54% of three-year-olds and 24% of six-year-olds. It is worth seeing a physiotherapist when the arch of the foot does not appear when standing on tiptoe, the flat foot affects only one side, the child complains of pain, tires quickly when walking or often trips.

Below we explain how to tell a developmentally flat foot from a foot deformity, when to see a doctor first, which foot exercises to do with your child at home and how to choose footwear.

Contents

Are flat feet in a young child a deformity?

Usually not. In babies and preschoolers the foot looks flat because the arch is filled by a fat pad, and the ligaments and muscles are still lax. The arch develops gradually with walking, usually until the age of 6–7. If it appears when the child stands on tiptoe, we speak of flexible flat feet, which rarely need treatment.

A parent can check this in a simple way: ask your child to stand on tiptoe and see whether an arch appears on the inner side of the foot and the heel straightens. If no arch is visible even on tiptoe, the foot is stiff and needs a specialist’s assessment. Foot problems often go hand in hand with other postural problems in children, so it is worth looking at the whole posture.

Which signs of flat feet are worth watching for?

Watch whether your child complains of pain in the feet, calves or knees after a walk, tires quickly, asks to be carried, often trips or walks clumsily. Look out for heels that turn inwards, uneven wear of the shoes, a difference between the right and left foot, and no arch when standing on tiptoe.

A single sign does not automatically mean a deformity, but several at once are a good reason for a consultation. It helps to take a photo of your child’s feet from behind while they stand barefoot and compare it after a few months.

Which foot exercises can you do with your child at home?

Short exercises in the form of play, done barefoot for a few minutes every day, work best. They strengthen the foot muscles and teach correct heel alignment: picking up objects with the toes, walking on tiptoe, the “caterpillar” and rolling a ball with the foot. The exercises should not hurt, and if the foot is stiff or painful, consult a physiotherapist about them first.

1. Treasure collecting. The child sits on a chair with feet flat on the floor. Using their toes, they pick up a tissue or small toys and put them into a bowl: 5–10 objects with each foot.
2. Walking on tiptoe. Barefoot, standing tall, a few steps back and forth across the room: 3–5 lengths.
3. Caterpillar. Sitting down, the child moves the foot forward by bending and straightening the toes, without lifting the heel: 3–5 times with each foot.
4. Ball rolling. Sitting down, the child rolls a small ball with the foot from the toes to the heel: about 1 minute with each foot.

If the pain gets worse or spreads, stop the exercise and consult a physiotherapist.

What shoes to choose for a child with flat feet?

Good children’s shoes have a flexible sole that bends where the toes bend, a firm heel counter that holds the heel and a wide toe box in which the toes fit freely. The shoe should fit in length, with a little room for the foot to grow. At home and on safe surfaces, it is worth letting your child walk barefoot.

Avoid hand-me-down shoes from older siblings, as the insole has already been shaped by another foot. Check the size every few months by measuring the foot while standing. Do not buy orthopaedic insoles on your own.

What does a physiotherapist’s examination of a child’s feet look like?

The physiotherapist asks about motor development and complaints, looks at the child’s feet, knees and posture when standing and moving, and checks the arch on tiptoe and the alignment of the heels. The distribution of pressure under the feet is shown by a podoscope examination, which costs 100 PLN. After the examination, the parent receives recommendations and exercises to do at home.

A child of any age comes with a parent or legal guardian, who is present during the visit. The rules are set out in the clinic’s Child Protection Standards. It is worth bringing the shoes your child wears most often.

Foot examination on a podoscopeassessment of the arch and foot pressure distribution, recommendations for the parent100 PLN

Prices valid from 08.2026. The physiotherapist sets the number of visits individually after the examination.

Summary

A flat foot in a preschooler is usually a stage of development, and the arch develops until about the age of 6–7. It is worth seeing a physiotherapist when the arch does not appear on tiptoe, the changes are one-sided or the child tires quickly; with pain, limping or a stiff foot, see an orthopaedic doctor first.

Frequently asked questions

Does a child with flat feet need orthopaedic insoles?

With flexible flat feet and no pain, insoles are usually not needed, as research does not confirm that they speed up the development of the arch. They are recommended rather for painful complaints or other indications assessed by an orthopaedic doctor. The doctor decides on insoles after an examination, and a physiotherapist can help choose supporting exercises.

Does walking barefoot help with flat feet?

Walking barefoot on a safe, varied surface, such as grass, sand or a rug, stimulates the foot muscles and sensation, so it is worth allowing it. At home, a bare floor or socks with a non-slip sole work best. On hard, uneven and dangerous surfaces, the child should wear well-fitting shoes.

Do flat feet in a child affect the knees and spine?

The feet are the foundation of posture, so their alignment can affect how the knees and pelvis work, for example with heels that turn inwards. However, flexible flat feet without symptoms are rarely the cause of spinal problems. During the examination, the physiotherapist assesses the child’s whole posture, not just the feet.

Do I need a referral for a visit with my child?

A referral is usually not required for a private visit at the “W zdrowym ciele” clinic. The clinic has no contract with the NFZ (the Polish public health fund), so visits are paid. The child comes with a parent or legal guardian. If the child has already seen an orthopaedic doctor, it is worth bringing the doctor’s recommendations and test results, as they help plan the exercises.

Sources

• Pfeiffer M., Kotz R., Ledl T., Hauser G., Sluga M., Prevalence of flat foot in preschool-aged children, Pediatrics, 2006;118(2):634–639.
• Carr J.B., Yang S., Lather L.A., Pediatric pes planus: a state-of-the-art review, Pediatrics, 2016;137(3):e20151230.
• Evans A.M., Rome K., A Cochrane review of the evidence for non-surgical interventions for flexible pediatric pes planus, European Journal of Physical and Rehabilitation Medicine, 2011;47(1):69–89.