A flat footed walking pattern is quite commonly seen in young children. The two major concerns associated with a flat footed walking pattern are:

• flat footed appearance
• tripping over

Children, as they grow, tend to have flat feet. Between birth to six years of age, the feet go through an extremely rapid period of growth. By age six, the feet should have nearly reached the foot posture of that of an adult, namely not flat footed. There are many reasons why children develop a flat footed walking pattern:

• Inward rotation of the feet and legs during pregnancy
• Tight and/or flexible muscles and ligaments around the lower limb joints
• Neuromuscular disorder such as cerebral palsy and hypotonia

Treatment is based on what is expected at their age. For example a 5 year old should not have the flat appearance of a 2 year old. Flat feet in children is always treated conservatively. This is achieved by:

• three monthly recorded reviews of the gait pattern to monitor the need for intervention
• balancing the muscle strength and length of lower limb muscles
• correct shoe selection
• inbuilt shoe inserts
• foot splinting
• customised prescription orthoses

Customised prescription orthotic devices are generally reserved for extreme cases under the age of 5. By 4 ½ to 5 years there should be near to total resolution of the flat footed walking pattern. This is when orthotic devices may be appropriate.