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 a medial arch. When assessing the 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, 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.
Here are some fun treatment ideas to promote development of the arch muscles as well as 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.
Intrinsic Plantar Muscle Activation
Vibration or Tactile Input
Use vibrating node or tactile ball along arch of foot to activate muscles of foot.
Scarf Lifts
With play scarves flat on floor, place one foot on top and use muscles of foot to lift scarf up!
Try standing scarf lift for added balance challenge!
Toe Basketball
Pick up marbles or flat “chips” with toes and drop in small container. This requires both initiation & sustained 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
Standing on foam balance pad, 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. Try to retrieve objects placed on floor while maintaining balance atop half moon roller.
Floor Skate
Using tactile footprints, gently slide forward alternating feet.
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 foam 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
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
Walk across the room weight bearing through hands and feet to complete a puzzle. Add onto the challenge by lining the floor with pillows or bubble wrap!
Penguin Walks
Walk forward with heels on the ground and toes up!
Shoe Suggestions for Children with Flat Feet
The ideal shoe:
- Provides Support
- Offers Stability
- Promotes Lower Extremity Alignment
- Encourages Fluidity and Efficiency
My favorite options include:
For more shoe recommendations, check out What a Difference a Shoe Makes!
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Love all of your exercise ideas. Thank your for this post!
Thank you for your feedback! Hope it is helpful!
Timely, thank you!
work with down syndrome individuals, great ideas will come in very useful, thanks a ton
Excellent effort thanks
Thanks for your blog!! I often send parents to it which makes my home programming super easy and efficient!!
Thank you so much for the feedback! Glad it is helpful to you and the families you work with!
THIS IS AWESOME!!!! THANK YOU THANK YOU SO VERY MUCH!!! I cannot express it enough. Thank you! I just had my child examined for a 2nd opinion and doc said to keep wearing orthodics, but I will definitely try these exercise ideas too.
Thank you Sarah! So glad you are finding the ideas helpful! Wishing you and your family the best!
Thank you so much for this post and for all the perfect explained exercises. My son is 4 years old and has flat feet. The Drs recommended that he wears shoes with good support etc and that he does some of the exercises you described. However, they also recommended that he spends as little time as possible bare foot, even at home. Can you provide your opinion on this? How many hours a day can he spend bare foot walking on hard surfaces and will this negatively impact the development of his feet?
Thanks again for the brilliant post!
Thanks a lot , ,got many useful tips ,my son is now 14years old let’s hope these exercises will be a great help.
My 7 year old is flat footed but the doctor said it will never change which is sad cause my son loves running but it hurts his feet. I’m going to try these but is this therapy more for pain or will it help develop an arch? I am also thankful for the shoe recommendations!
Thank you for reaching out! I would highly recommend working with a Pediatric Physical Therapist in your area who can tailor interventions to his needs to both prevent pain & address his gait pattern. Flat footedness in young children is not a fixed condition, interventions can be helpful to develop intrinsic plantar musculature & promote healthy alignment. Feel free to contact me directly if I can help in any other way at info@dinopt.com.
I love this blog! I work outpatient orthopedics but occasionally have children with gait impairments. I love to use this as a resource to refer parents to in order to help them carry over the exercises at home, as it is especially important with these cases.
Thank you so much! I really appreciate your feedback!
Nice information shared by you! This problem is very common in children and some of them didn’t know that their child has a flat feet problem but through your article, everyone gets to know about flat feet problem and physical treatment for them. Thanks for sharing this.
Thank you!
Great tips! Thank you for sharing
Hi there. These all look like super helpful suggestions and we are excited to get started with the exercises. I am noticing that a lot of the recommended shoes are no longer available. Do you have an updated list?
Feel free to email me at info@dinopt.com with your child’s shoe size & I can share specific shoe recommendations!