Flat Feet in Children: Treatment Strategies

Flat Feet Treatment Strategies for Children

You may have heard the term pes planus, flat feet, poor arch support, or overpronation… You may notice your child’s feet turning out significantly when standing or walking. You may even notice a more significant wear pattern on the inside of the child’s shoe. So what exactly does a flat footed presentation entail?

Flat Feet (aka Pes Planus)

Children who present with flat feet may have been late ambulators, may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”, denoting a lack of true control as compared to more typical gait pattern (as weight shifts from heels to toes).

Children with flat feet will experience overpronation or excessive pronation, which refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leading to poor lower extremity alignment and the potential for future orthopedic concerns.

It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. We anticipate early ambulators to display a flattened arch with forefoot pronation while weight bearing. Over time most children develop the musculature of their intrinsic foot and plantar arch. Intervention is not necessary if this presentation is not otherwise affecting function.

Here are some fun treatment ideas to promote development of the arch muscles to encourage lower extremity alignment, fluidity of gait mechanics and prevent any potential long term musculoskeletal issues that may arise as a result of this presentation.

All exercises should be done barefoot without sock or shoes, to encourage activation of the intrinsic muscles of the foot. We want child to experience both tactile and proprioceptive input through the soles of their feet.

Treatment for Flat Feet Targets:

Arch Activation/Strength
Lower Extremity Strength & Alignment
Efficient and Fluid Motor Patterns
Biomechanics of Gait

Intrinsic Plantar Muscle (Arch) Activation

Vibration or Tactile Input

Use vibrating node or tactile ball along arch of foot with child comfortably seated, to activate muscles of foot. Can do this before other more challenging activities to ensure arch is activated and ready to “work”.

Scarf Lifts

With fun fabric or play scarves, start with material flat on floor. Encourage child to place one foot on top and use muscles of foot to lift scarf up!

Try standing scarf lift for added balance challenge!

Toe Basketball

For increased challenge, have child pick up marbles or flat “chips” with toes and drop in small container, this requires greater control and prolongs muscle activation.

Squat to Stand

Gently bend knees over toes, and return to stand maintaining alignment with lines of tape placed atop balance pad.

Single Leg Balance

With the standing on foam balance pad or firm cushion, practice balancing on each leg for 10 second intervals to challenge arch activation.

Half Kneel Ball Toss

Pass ball back & forth while maintaining half kneel on balance pad.

Lower Extremity Strength and Alignment

Dyna-Disc Balance

Maintain balance on dyna disc during game of catch.

Try single leg balance on dyna disc for added challenge for muscles of lower extremity!

Half Moon Balance

Stand to squat on half moon foam roller – also great for arch activation. Ask child to retrieve objects placed on floor while maintaining balance atop half moon roller.

Floor Skate

Using tactile footprints, gently slide forward alternating feet, being mindful of alignment as you skate along!

Scooter Adventure

Seated on floor scooter, can pedal feet forwards and back using heels to dig in as we challenge arch activation and lower body engagement.

Bridge Pose

Start in supine with both feet atop dyna disc. Lift bottom for sustained hold or lift & lower for more dynamic activation.

Crab Kicks

Hold bridge position and perform alternating leg kicks with dyna disc under feet.

Motor Planning

Platform Jump Downs

Jump down from small platform promoting full foot contact for take off and landing. Can use tactile spots for added arch activation.

Platform Jump Ups

Jump up onto platform with attention to alignment. Can increase height of platform as child gains mastery.

Biomechanics of Gait

Ball Marching

With child seated on therapy ball and balance pad under feet, encourage alternating marching movement. This assists with lower body disassociation, while promoting lower body and trunk engagement.

Cone Kicks

Encourage kicking ball off elevated cone, alternating sides for bilateral activation.

Bear Walks

Have child walk across the room weight bearing through hands and feet to complete a puzzle. You can increase the challenge and provide sensory input by lining the floor with pillows or bubble wrap!

Penguin Walks