Does my child need orthotics for flat feet?

Why flat feet in young children are usually normal

Every baby is born with flat feet. The medial arch forms gradually as a fat pad under the sole reabsorbs and the foot's ligaments and small muscles mature, typically over the first decade of life, with a visible arch usually established by around age 8 to 10 PMC: Pediatric Flexible Flatfoot. Estimates of how common flat feet are vary widely by age: it's present in over a third of children aged 2-6, dropping off substantially by the early school years as arches mature PMC: Pediatric Flexible Flatfoot. Cleveland Clinic notes that many children develop a visible arch by around age 10, and having flat feet as a toddler or young child is developmentally typical rather than a problem Cleveland Clinic: Flat Feet.

This is why both the American Academy of Family Physicians and the American Academy of Pediatrics describe painless, flexible flat feet as a normal physiological variant that should be monitored rather than treated AAFP: Cochrane review summary. A 2023 Cochrane review looking at 16 trials and over 1,000 children found that custom and prefabricated foot orthoses did not produce meaningful improvements in pain, function, or quality of life for children with flexible flat feet, and the certainty of that evidence was low to very low AAFP: Cochrane review summary. In practical terms: for a happy, active child with no complaints, an orthotic is unlikely to speed up arch development or change the long-term outcome.

The red flags that do warrant an assessment

Evidence-based reassurance doesn't mean flat feet are never worth a closer look. It's reasonable to book an assessment with an orthotist, podiatrist, or your GP/paediatrician if you notice any of the following:

Pain or fatigue — foot, arch, ankle, or calf pain during or after activity, or a child who tires or asks to be carried much sooner than peers PMC: Pediatric Flexible Flatfoot.

A rigid foot — no arch appears even on tiptoe or when the foot is unweighted (as opposed to a flexible flatfoot, where the arch reappears off-weight).

Asymmetry — one foot noticeably flatter or more rolled-in than the other.

Abnormal gait — persistent in-toeing, out-toeing, toe-walking, or a limp that seems linked to how the foot is loading.

Uneven or rapid shoe wear — clinical literature notes that flexible flat feet can cause rapid, uneven wear on the inner heel and sole of school shoes, which is a useful clue for parents as well as clinicians PMC: Pediatric Flexible Flatfoot.

Stiffness, swelling, or a foot shape that looks unusual, or flat feet that persist with symptoms well past the age when arches normally settle.

None of these findings automatically means your child needs a custom device — but they do mean a proper biomechanical assessment is worthwhile rather than assuming it will simply resolve. Chronic Disease List conditions such as juvenile idiopathic arthritis are a specific exception where orthoses have shown a modest, evidence-backed functional benefit AAFP: Cochrane review summary.

School shoes: the first and simplest intervention

Before any discussion of custom devices, footwear does most of the day-to-day work. For South African families this usually means the school shoe: a firm, structurally supportive shoe — rather than a soft slip-on, sandal, or flip-flop without arch support — is generally the more useful everyday choice for a developing foot CHOP: Flat Feet in Children. If your child is hard on shoes, showing uneven wear patterns, or outgrowing school shoes every term, that's worth mentioning at an assessment — it's often more informative than it seems.

Where a child does need extra support, this can range from an off-the-shelf orthotic insert to a custom orthotic moulded to their foot shape, depending on what the assessment finds. The right starting point is rarely the most expensive one.

Medical aid and cost: what to expect in South Africa

Because asymptomatic flat feet aren't a Chronic Disease List condition, and the Council for Medical Schemes' Prescribed Minimum Benefits framework doesn't set out specific cover for orthotic devices Council for Medical Schemes: PMB, whether your scheme contributes toward a child's orthotics depends entirely on your specific plan, its day-to-day or savings benefits, and sometimes pre-authorisation from a treating doctor. PMBs are assessed on diagnosis rather than the device itself, so a device linked to a listed PMB condition (for example, a genuine structural or neuromuscular diagnosis) is handled very differently to an insert for an otherwise well child. Because cover varies so much between schemes and plan options, the practical approach is to ask your scheme directly what your plan covers before committing, and to request a written, itemised quotation from your orthotist so you can check it against your benefits and, where relevant, submit it for authorisation.

When to see an orthotist

If your child's flat feet are painless, flexible, and not slowing them down, the evidence supports watching and waiting rather than fitting an orthotic. If you're noticing pain, fatigue, an unusual gait, asymmetry between feet, or shoes wearing out oddly, or you'd simply like a professional opinion, a proper assessment is a sensible next step — paediatric assessment is one of our practice's areas of focus, and we offer home and hospital visits across Centurion and the wider Pretoria area for families for whom a clinic visit isn't practical. Explore our conditions we support or book an assessment to talk through what's normal for your child's stage of development and what, if anything, might help.

This article is general information for South African parents and is not a substitute for individual clinical assessment of your child by a qualified practitioner.