The flat foot is one of the most common presentations to health professionals. It is also one of the most controversial treatment. There has been a lot of research into this common childhood condition, helped with the development of the paediatric flat foot proforma (p-FFP) [1]. This tool assisted clinicians with the development of a traffic light system of when we should treat, monitor or leave alone.

The flexible flat foot has the potential to be over treated despite being a relatively common presentation in young children. More often than not, while these children may have a slightly flatter foot, they will rarely complain of any pain and can be highly active kids. So the question remains, if we do treat, what exactly are we treating?

And this is where the importance of looking at a child holistically comes into play. We need to be aware of the number of different causes for the development of a flat foot or that the presenting foot may be a symptom of another condition.

It’s imperative that we have the knowledge of when it as appropriate to implement treatment and to discuss priorities with families.

We need to know if there are any other impacts of this flat foot on this child’s life? Are they in pain, are they not keeping up with other children of the same age or do they become tired when walking to the park to play? If the answer is yes, then we need to be doing something. Our assessment techniques become really important in these cases and looking at the child as a whole, not just the foot in front of us.

A flat foot deformity may be related to a collagen disorder such as ligament laxity or Ehler’s Danlos syndrome; a genetic cause such as Down’s Syndrome or Marfan’s syndrome; a muscular cause such as muscular dystrophy or a neurological cause such as hypotonia or cerebral palsy. Is the flat foot rigid or is there a clinical suspicion of a vertical or oblique talus, tarsal collation, peroneal spasm, an iatrogenic cause or related to trauma? In these cases, referring on for a more specialized assessment and management is appropriate and necessary.

While these conditions may be the cause of a flat foot in a child, there may or may not be symptoms associated with this, therefore sometimes our role is minimal or more of a referral based role. As clinicians, we may monitor these children or intervene depending on the presentation.

So in considering all of the above information, what is our role with these children? Do we monitor them, provide footwear advice, prescribe orthotics or exercises or do we refer on? If we decide not to treat, will the family seek another opinion and end up in an orthotic? Highly likely but really, that shouldn’t be our concern. However as long as we feel confident with our assessment skills and we are using the most up to date evidence to back up our clinical decision making, this is more than justified.


  1. Evans, A. M., Nicholson, H, and Zakarias, N, The paediatric flat foot proforma (p-FFP): improved and abridged following a reproducibility study. Journal of Foot and Ankle Research, 2009. 2 (25)