Flexible Flatfoot
The arch appears when the child stands on tiptoes or sits. It is usually painless, very common, and most children need observation and supportive footwear rather than surgery.
Pediatric Orthopedic Foot & Deformity Care
Comprehensive Care & Advanced Solutions for Pediatric Flatfoot.
Expert diagnosis and state-of-the-art surgical management for complex foot deformities.
- Flexible & Rigid
- Both flatfoot types assessed
- Joint-Sparing
- Reconstructive techniques
- Pediatric-First
- Growth-aware treatment plans
Understanding Flatfoot
Most children with flat feet are healthy and pain-free — the arch simply develops later. A smaller group has a stiff, painful, or progressive deformity that benefits from expert assessment. Knowing which is which is the first, most reassuring step for any parent.
Rigid Flatfoot
The arch never appears and the hindfoot does not move freely. Stiffness, pain, and rapid shoe wear suggest an underlying structural cause that should be imaged and evaluated.
Tarsal Coalition
An abnormal bridge of bone, cartilage, or fibrous tissue between tarsal bones. It commonly presents in older children as a painful, stiff flatfoot with recurrent ankle sprains.
Explore every flatfoot topic
In-depth, physician-reviewed guides covering each form of flatfoot, how it is diagnosed, and every treatment option from stretching to reconstruction.
Flatfoot
Flatfoot, or pes planus, is a foot shape in which the medial longitudinal arch is low or absent when standing, so more of the sole contacts the ground and the heel tilts outward. Most flat feet are flexible, painless and need no treatment. Flatfoot needs medical assessment when it is painful, stiff, one-sided, worsening, or appears suddenly in an adult.
Read guideFlexible flatfoot
Flexible flatfoot is a flat foot whose arch returns as soon as body weight comes off it — on tiptoes, when sitting, or when the big toe is lifted. It is the commonest form of flatfoot, is usually painless, and in the absence of symptoms requires reassurance and observation rather than insoles, braces, or surgery.
Read guideRigid flatfoot
Rigid flatfoot is a flat foot in which the arch does not reappear on tiptoes and the hindfoot cannot be moved passively. Unlike flexible flatfoot it always has an identifiable structural cause — most often a tarsal coalition, and less commonly congenital vertical talus, inflammatory arthritis, or post-traumatic deformity — and it always warrants imaging and specialist assessment.
Read guideTarsal coalition
A tarsal coalition is an abnormal bridge of bone, cartilage, or fibrous tissue joining two tarsal bones, most often the calcaneus to the navicular or the talus. It affects around 1% of the population, becomes painful in early adolescence as the bridge ossifies, and typically presents as a stiff flat foot with recurrent ankle sprains.
Read guideAdult flatfoot
Adult acquired flatfoot is a progressive collapse of the arch in a previously normal foot, usually caused by degeneration of the posterior tibial tendon. It starts as pain and swelling behind the inner ankle, progresses to a visibly flattening foot with an outward-tilting heel, and is one of the few flatfoot presentations where early treatment genuinely changes the outcome.
Read guideSymptoms & diagnosis
Flatfoot is diagnosed by examination, not by imaging. The clinician checks whether the arch restores on tiptoes, whether the hindfoot moves, whether the calf is tight with the knee extended, and whether the two feet are symmetric. Imaging is added only when the foot is painful, stiff, asymmetric, or progressive.
Read guideTreatment
Non-surgical treatment of flatfoot aims at symptoms, not at arch shape. The three interventions with real value are a daily gastrocnemius stretching programme, footwear with a firm heel counter, and an orthosis used for pain relief in a symptomatic foot. A painless flexible flat foot needs none of them.
Read guideFlatfoot in children
Flat feet are normal in young children. A fat pad fills the arch in infancy, ligaments are naturally lax, and the medial longitudinal arch typically develops between ages 3 and 10. A painless, flexible flat foot at any age in childhood needs reassurance only; pain, stiffness, or asymmetry needs assessment.
Read guide
Advanced Surgical Management
When symptoms persist despite conservative care, surgery is planned around the individual foot: what is deformed, what is tight, and what must keep growing. These are the core joint-sparing procedures used in modern pediatric flatfoot reconstruction.
01
Calcaneal Lengthening
Correcting structural deformities.
A joint-sparing osteotomy of the lateral column of the calcaneus that lengthens the outer border of the foot, swings the hindfoot out of valgus, and restores the medial longitudinal arch without fusing growing joints.
02
Gastrocnemius-Achilles Complex Lengthening
Relieving contractures to restore normal biomechanics.
Selective gastrocnemius recession or graded Achilles lengthening releases the equinus force that collapses the arch, allowing the corrected foot to load evenly from heel strike to toe-off.
03
Cotton Osteotomy
Medial column procedures for severe cases.
An opening-wedge osteotomy of the medial cuneiform that plantarflexes the medial column, eliminating residual forefoot supination after hindfoot correction and delivering a plantigrade, balanced foot.
04
Internal Bracing
Advanced stabilization for complex neurological cases.
High-strength suture-tape augmentation reinforces the spring ligament and medial soft-tissue restraints, protecting the reconstruction in low-tone or neuromuscular feet where recurrence risk is highest.
05
Excision of Tarsal Coalition
Surgical resection to restore joint mobility.
Precise resection of a calcaneonavicular or talocalcaneal bar with interposition to prevent regrowth, freeing subtalar motion and relieving the pain and stiffness of rigid flatfoot.
Dr. Mutasem Aldhoon
Pediatric Orthopedic Consultant
- Queen Rania Children's Hospital — King Hussein Medical City
- Amman, Jordan
Dr. Mutasem Aldhoon is a leading Pediatric Orthopedic Consultant specializing in complex lower extremity deformities. With extensive experience in advanced joint-sparing and reconstructive techniques, he is the trusted authority for severe pediatric flatfoot and neurological foot reconstructions.